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Situation analysis in Kyrgyzstan

Situation analysis in Kyrgyzstan . Making Opioids Available in Eastern Europe and Central Asia March 5-6, 2013 Vienna . Opioid analgesics are currently registered in the country. WHO List Codeine - Morphine inject form 10 mg + Morphine oral

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Situation analysis in Kyrgyzstan

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  1. Situation analysis in Kyrgyzstan Making Opioids Available in Eastern Europe and Central Asia March 5-6, 2013 Vienna

  2. Opioid analgesics are currently registered in the country WHO List Codeine - Morphine inject form 10 mg + Morphine oral immediate and sustained release - IAHPC List Codeine - Fentanyl- Methadone + Morphine (immediate release) + Morphine (sustained release) - Oxycodone- Tramadol+

  3. List of medicines for cancer patients under State Guarantee Program on preferential terms Code and of Medicine form Cost of reimbursement for 1 piece (in som) Code and Brand name of Medicines Medicine’s form Dosage mg, etc. number

  4. The system of drug control

  5. Department of Medicines Supply and Medical Equipment of the Ministry of HealthRegistration Pharmacy Warehouse Storage State Agency for Drug Control Get approval and include to the Register List Pharmaceutical Distribution Company Pharmacy Hospital (Oncology Center) Customs Customs Clearance Health Insurance Fund Copayment Medical Practitioner Prescription Patient • Barriers • Special prescription form • Four stamps and two signs • Pharmacy dispense limit time (9:00 am – 4:30 pm) • Limit on q-ty (20 vials of morphine) • Limit time – prescription form works 10 days

  6. 2 hospices for HIV/AIDS patients Opioids are always available in specialized hospitals (oncology centers) National Oncology Center PC Department (25 beds) Morphine is allowed to prescribe to patients with cancer on 4th stage only In other cases, doctors prescribe Tramadol and Promedol • Inter oblast Oncology Center PC Department Pharmacy Length of Rx is 10 days 1. Morphine in 10 mg injection form 2. Promedolum in 20 mg injection form 3. Tramadolum Family Medicine Center Maximum amount of: Morphine for on prescription form - 20 vials Tramadol- 10 vials Family Medicine Center Diploma of a physician or feldsher. Family Medicine Center

  7. Opioid accessibility

  8. The cost of medications and health insurance coverage Health Insurance Fund covers cost of medicines by two ways: • Additional Package – for all insured people according to the list of medicines • State Guaranty Program (SGP) – for 5 types of monitored diseases, including cancer on 4th stage only The cost of one vial of Morphine – 25,73 KGS (0.53 USD) one vial of Promedol – 42,73 KGS (0.91 USD) Reimbursement by Health Insurance Fund – 97% Limits of SGP for cancer patients: • Ketoprophen – 36000 mg or 360 vials • Promedol – 4800 mg or 240 vials • Morphine – 3000 mg or 300 vials

  9. Coverage by State Guarantee program of preference patients (9 months of 2012, number of preference patients , % of coverages)

  10. The volume of sold medicines(during 9 months 2012)

  11. Opioid prescription’s forms

  12. Prescribed opioids registration book Patient chart and list of opioids injection chart

  13. 1. References for pharmacy registration book for taking opioids 2. Sample of reference form

  14. The registration book of used opioid’s ampoules

  15. 1. Registration book of certificates damaging empty ampoules of opioids 2. Sample of certificate

  16. 6. What is the projected need for morphine in the country by dosage form (IR, SR, and injectable) Mortality: Cancer - 3400 AIDS - 100 TB – 600 Need in Palliative Care – 4100 Need in morphine – 24,9 kg

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