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
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 Estimate
For 2013 – April 2012
International Narcotic Control Board
Has access to SADC data base

5. Patient Barriers Special prescription form Four stamps and two signs
Pharmacy Warehouse
Storage
Pharmacy
Medical Practitioner
Prescription
Patient
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)
3. The process of testing and registration, importation, warehousing, distribution, storage, prescribing, dispensing, monitoring of prescription usage, etc.
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
National Oncology Center PC Department (25 beds)
Opioids are always available in specialized hospitals (oncology centers)
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
4. What are the restrictions on prescribing, i.e. route of administration, dose, length of prescription?
PC Department in National cancer center serves arround 500 patients per year, 42.2% of of them die in the first year of the disease (one-year mortality rate)
Family Medicine Center
Maximum amount of:
Morphine for on prescription form - 20 vials
Tramadol 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 – 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
5. Who can write opioid prescriptions, i.e. an oncologist?

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

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

14. The registration book of used opioid’s ampoules
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 AIDS TB – 600 Need in Palliative Care – 4100 Need in morphine – 24,9 kg