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 immediate and sustained release- IAHPC List Codeine- Fentanyl - Methadone+ Morphine (immediate release)+ Morphine (sustained release)- Oxycodone - Tramadol +

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

Ministry of Health Statistics on controlled drug usage annually Than chief nurse reports to regional Health Department Doctor reports to Chief Nurse the list of prescriptions with patient’s name KG State Agency for Drug Control Annually EstimateFor 2013 – April 2012 International Narcotic Control Board Has access to SADC data base The system of drug control

Pharmacy Warehouse Storage Pharmacy Warehouse Storage Pharmacy Medical Practitioner Prescription Medical Practitioner Prescription Patient Health Insurance Fund Copayment Health Insurance Fund Copayment Pharmaceutical Distribution Company Department of Medicines Supply and Medical Equipment of the Ministry of Health Registration State Agency for Drug Control Get approval and include to the Register List Customs Customs Clearance Hospital (Oncology Center) 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

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

Opioid accessibility

Health Insurance Fund covers cost of medicines by two ways: 1.Additional Package – for all insured people according to the list of medicines 2.State Guaranty Program (SGP) – for 5 types of monitored diseases, including cancer on 4 th 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: 1.Ketoprophen – mg or 360 vials 2.Promedol – 4800 mg or 240 vials 3.Morphine – 3000 mg or 300 vials The cost of medications and health insurance coverage

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

The volume of sold medicines (during 9 months 2012)

Opioid prescription’s forms

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

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

The registration book of used opioid’s ampoules

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

6. What is the projected need for morphine in the country by dosage form (IR, SR, and injectable)