Education Policy and Its Impact on Pain Management in Terminally Ill Patients in Republic of Georgia

Abstract Introduction Pain management in terminally ill patients often requires opioid prescription. While national regulations in Georgia permit opioid use for incurable patients, opioids are not consistently prescribed to relieve pain and suffering. This study reviews the influence of physicians' knowledge, attitudes, and misconceptions on opioid prescribing practices, beyond the impact of restrictive regulations and systemic barriers. Methods: Data were drawn from the author's study "Evaluating Barriers to Chronic Pain Management and Their Impact on the Quality of Health Service", which assessed the knowledge and attitudes of physicians responsible for prescribing opioids in Georgia. Findings were analyzed within the historical and socio-cultural context of a post-Soviet country. Results: Up to 40% of primary health care physicians responsible for prescribing opioids to outpatients were hesitant to do so, and only 43% initiated treatment independently. Although 93% claimed to assess pain regularly, just 55% used standardized pain scales, and fewer than half (48%) consistently applied the WHO Analgesic Ladder. Only one-third prescribed morphine on an around-the-clock basis, and just 7% prescribed morphine for breakthrough pain. Overall, only 9-10% of physicians demonstrated "good knowledge and prescribing practice." Misconceptions were widespread: 44% believed morphine frequently causes dependence syndrome, and 46% equated physical dependence with addiction. Conclusion: Significant gaps in medical knowledge, misconceptions, and inconsistent prescribing practices hinder effective pain management for terminally ill patients in Georgia. These findings underscore the urgent need for targeted educational interventions, reforms in medical curricula, continuous training for practicing physicians, and implementation of evidence-based guidelines to ensure safe and adequate opioid prescribing.