Georgia
A post-Soviet country that rewrote police-linked narcotics rules for palliative care, the most direct precedent in the register for changing licensing and dispensing rules.
9 domains reviewed · 8 high-confidence · 2 dated estimates · 9 material gaps
WHO region: Europe. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 9 of 9
- Hospice: 3 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 13
- Sources behind this dossier
- 7
- Newest source 2026Thin evidence
Lessons from Georgia
- Changing the rules was not enough. After Georgia let any physician prescribe, doctors who used the new rules were investigated by legal authorities several times more often, and many stopped prescribing. Reform must reach police and drug inspectors with guidance that protects lawful prescribing.153
- Police-station dispensing survived years of legal liberalisation. The operational orders that carry such rules need repeal, not only the statute above them.152,154
- A dedicated state programme with fixed reimbursement rates eroded as those rates were never updated, and home care collapsed. A palliative tariff should be indexed.154
- A country can fund large-scale methadone treatment while still blocking pain relief, so restrictive rules such as police-station dispensing need separate review.154,641
Palliative care
Is morphine available in Georgia?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
- 60 to 66 S-DDD per million inhabitants per daySOURCE-CHECKED
Morphine consumption, Georgia, 2022154
Last checked 2026-09-24.
Reported from INCB for 2020 to 2022, the very low band. An atlas total of 1,176 includes non-analgesic opioids.
Cite this figure:
Morphine is the only opioid used for pain, with oral forms available since 2012 but mainly in cities. Consumption sits in INCB's very low band, and opioids are free for cancer patients.154,152
How much morphine is produced domestically, and what is the trend over the past decade?
Help answer it:Search PubMedHow does Georgia regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
A 2000 joint order of the health and interior ministries limited outpatient opioids to terminal patients and routed dispensing through pharmacies inside police stations. Laws amended in 2007 made palliative care an essential service; later changes moved prescribing from a commission to a single physician and extended a prescription from three to seven days. Patients still collected opioids at police stations in 2017.154,152
Has police-station dispensing been abolished, and by which instrument?
Help answer it:Search PubMedWho can prescribe morphine in Georgia?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
- 38 percentSOURCE-CHECKED · 2018 DATA
Surveyed primary care physicians who avoid prescribing opioids, Georgia, 2018153
Last checked 2026-09-24.
Cite this figure:
Any physician may now prescribe for terminal patients, including rural primary care doctors. In practice many avoid it: few know the liberalised rules, and those who follow them are investigated by legal authorities several times more often. Only about half of primary care doctors in palliative programmes hold prescribing authorisation.153,154
What training is required for authorisation, and has enforcement practice changed?
Help answer it:Search PubMedHow does palliative care reach patients in Georgia?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
- 16.70 percentMODELED ESTIMATE · 2024
Estimated palliative care need met through the formal health system, Georgia, 2024154
Last checked 2026-09-24.
Cite this figure:
Care runs through inpatient facilities, a handful of outpatient units and primary care home visits. Most beds are in Tbilisi, most regions have no outpatient service, and home care fell for lack of funding.154
Who pays for palliative care in Georgia?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
A dedicated state programme funds palliative care from the annual budget, covering opioids in full and part of inpatient and outpatient costs, at reimbursement rates set in 2004 and never updated. It funds only a doctor and a nurse per service and covers only terminal-stage patients.154
How are palliative care clinicians trained in Georgia?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
Palliative care is a recognised subspecialty and taught in a minority of medical schools, with a four-month subspecialty course at Tbilisi State University since 2014.154,152
How does Georgia prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
Georgia allows outpatient opioids only for terminally ill patients, with a maximum 7-day supply dispensed from pharmacies at police stations. In a survey, 38% of primary care physicians avoided prescribing opioids, and those following liberalized rules were investigated three to five times more. Meanwhile a fully government-funded methadone program has enrolled 30747 patients since 2008, and harm reduction vending machines have distributed kits including naloxone.154,153,641,642
Have the terminal-illness requirement and police-station dispensing been removed, and is naloxone available beyond pilot projects?
Help answer it:Search PubMedHow do children get palliative care in Georgia?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
Georgia has six state-funded pediatric palliative care units and one non-state-funded children's hospice, Firefly World, which opened in 2017.154,152
How many children do these services reach each year, and which oral opioid formulations are available for children?
Help answer it:Search PubMedHospice care in Georgia
How the hospice model works here, who can use it, who pays and who it reaches. Covered 3 of 4.
What does hospice care look like in Georgia?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
Georgian sources use 'palliative care' for adult services, delivered since 2006 through a state program of inpatient, outpatient and home care. 'Hospice' names a service for children: a children's hospice opened in 2017, and a 2026 review lists one non-state-funded children's hospice, Firefly World.154,152
Are any adult services formally registered as hospices, and does the term differ from 'palliative care' in Georgian regulation?
Help answer it:Search PubMedWho can get hospice care in Georgia?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
Entry rules for the children's hospice were not found. The adult state palliative program limits home care to a life expectancy of 3-6 months or less (PMID 42500467), but sources do not call it hospice; does the children's hospice use prognosis rules?
Help answer it:Search PubMedWho pays for hospice care in Georgia?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
The children's hospice Firefly World is not state funded. The state palliative program fully covers opioids and reimburses 80%-90% of inpatient palliative care costs, using reimbursement rates set in 2004.154
What share of Firefly World's budget comes from donors, international grants or families?
Help answer it:Search PubMedHow many people reach hospice in Georgia?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
Children can use six state-funded pediatric palliative care units and one children's hospice. Palliative care overall reached 16.7% of estimated need in 2024, and services are concentrated in Tbilisi.154
How many children and adults use hospice-type care each year outside Tbilisi?
Help answer it:Search PubMedWhat fills the gap in Georgia
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Charity, religious giving and mutual aid
Among 181 patients in active cancer treatment, 71.3% paid out of pocket and 44.2% took loans for care, most often to cover diagnostic procedures. 74.5% reported a moderate or heavy economic burden on the household.466
Subnational evidence
Sources cited here
- 154Bulia T, Beruchashvili T, Abesadze I, Gamkrelidze A, Dzotsenidze P, Dalal K.
Benchmarking Georgia's palliative care system, using WHO's new actionable indicators: alignment with the European Association for Palliative Care (EAPC) 2025 atlas. Frontiers in Health Services 2026;6:1837167. DOI 10.3389/frhs.2026.1837167. Assessment for 2021 to 2024: share of need met, inpatient facilities and beds concentrated in Tbilisi, few outpatient units, falling home care, INCB morphine consumption in the very low band, half of primary care doctors in palliative programmes authorised to prescribe morphine, a 2000 joint health and interior ministry order behind police-station dispensing, later amendments widening prescribing to any physician, and a state programme with reimbursement rates unchanged since 2004. Full text read.
- 152Kiknadze N, Dzotsenidze P.
Palliative care development in Georgia. Journal of Pain and Symptom Management 2018;55(2S):S25-S29. DOI 10.1016/j.jpainsymman.2017.03.021. Abstract read. Legislation amended; palliative care a subspecialty in several disciplines; all physicians may prescribe and a prescription now lasts seven days instead of three; patients must still collect opioids from pharmacies in police stations; opioids free for cancer patients.
- 153Dzotsenidze P, Lekashvili T, Chikhladze N, Jorbenadze M, Abesadze I, Kordzaia D.
Impact of ambiguous and restrictive regulations on opioid-prescribing practice in Georgia. Journal of Pain and Symptom Management 2018;56(1):63-71. DOI 10.1016/j.jpainsymman.2018.03.018. Abstract read. Survey of primary care physicians: many avoid prescribing opioids, few know or follow the liberalised legislation, and those who apply it are investigated by legal authorities three to five times more than those who do not.
- 641Giorgobiani L, Todadze K, Ruadze E.
Seventeen years of experience: a retrospective cohort analysis of methadone maintenance treatment program patterns in Georgia. Harm Reduct J 2026;23(1):16. National routine data on 30747 patients (2008 to 2024); authors are from the agency that runs the program, so partly a self-evaluation. Abstract read.
- 642Walker JG, Kirtadze I, Tabatadze M, et al.
Costs of syringe vending machines in Tbilisi, Georgia. Harm Reduct J 2023;20(1):103. Costing of a 2019 to 2020 vending-machine project that distributed harm reduction kits including naloxone; co-authored by the implementing NGO. Abstract read.
- 643Bulia T, Abesadze I, Tananashvili D, et al.
Palliative care among cancer patients in Georgia: System-level gaps identified through health-related quality of life discrepancies. J Public Health Res 2026;15(3):22799036261470318. Multicenter cross-sectional study in nine palliative care clinics with 298 patients, 298 family members and 80 staff (2024 to 2025). Abstract read.
- 466Kakhniashvili T, Kiladze I, Okribelashvili N
The Cancer Burden on Patients and Their Families in a Resource-Restricted Country: A Cross-Sectional Survey Study From Georgia. Cancer Control 2025;32:10732748251359407. Survey of 181 patients in active cancer treatment across 7 tertiary hospitals on out-of-pocket costs and household debt. Abstract read.