Identifying barriers and contradictions in laws affecting pain management in Georgia

Pati Dzotsenidze, Ioseb Abesadze, Martha A. Maurer, Nino Chikhladze, Dimitri Kordzaia, Maka Jorbenadze, Aaron M. Gilson

Abstract


Background: Though the negative impact of chronic pain on incurable patients is well known, hardly anything has changed regarding pain management in Georgia.  Efforts to improve availability and accessibility of opioid analgesics (OAs), critical for severe pain relief, started a decade ago through refinement of the legislation, followed by importation of oral morphine formulations and the introduction of modern guidelines in chronic pain management.  Despite these activities and significant progress, the desirable results were not achieved.  The morphine consumption rates, the most objective indicator for adequate pain control, remain critically low.

Aim: To highlight the impediments and discrepancies in Georgian legislation influencing pain management.

Methods: We analyzed the legislation regulating the medical use of OAs to identify barriers to OA availability and accessibility.  This analysis was guided by and compared to internationally recognized indicators, and then reviewed to identify contradictions within the Georgian legislation and regulations.

Results: We identified numerous examples of potential barriers to OAs availability in the Georgian legislation.  We also found several inconsistencies among current legislation and regulation governing OA use for medical purposes. 

Conclusion: The activities undertaken by the government between 2007-12 to improve OA availability and accessibility for pain treatment were not fully accomplished which resulted in unclear legislation containing contradictory standards.  It is unclear to whom, when and how OAs can be prescribed and an urgent response is required to make adequate pain management available for incurable patients suffering from unbearable pain.


Keywords


Pain; barrier; legislation; contradiction; incurable patient; opioid analgesic; Georgia

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References


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DOI: http://dx.doi.org/10.29088/TCM-GMJ.2018-2.19

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