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COLUMN ONE : Soviets' Pain Gets Physical : The pharmaceutical industry is in disarray. Drugstores--and patients--go begging for even the most basic medicines.


MOSCOW — Larissa Fedorova walked up to a counter at Moscow Drugstore No. 139 and handed two prescriptions to the pharmacist, who just shook her head, " Nyet. "

"These prescriptions are for my mother who is very ill with cancer, and she needs one of these pain relievers," Fedorova said, her voice taking on an edge of anger and frustration. "I've been searching for a month. I can't count the number of pharmacies I've visited, and I've spent hours on the telephone calling other pharmacies. . . . My 80-year-old mother is in terrible pain."

Fedorova's complaint echoes across the Soviet Union as the country's economic crisis leaves the nation's pharmaceutical industry in disarray. Soviet patients are suffering more, healing more slowly and dying because they can't get the medicines they need.

Medicines for some serious illnesses--heart problems, cancer and psychological disorders--have long been in scarce supply; now they often cannot be found at all. Even the most basic drugs--simple pain relievers, laxatives, antiseptics and the like--have disappeared from most drugstores.

Surgeons have declined to operate because they run out of solutions for post-operative intravenous feeding. Diabetics go into shock because they cannot get their insulin prescriptions filled.

The old Soviet boast that the socialized medical system here meets at least the basic needs of all the people has been abandoned, even by top officials.

"As early as next February, the country may run out of drugs altogether, since the pharmaceutical industry is crumbling even more rapidly than the rest of the economy," Igor N. Denisov, the Soviet health minister, said recently.

Only 30% of the demand for drugs will be met next year, Denisov said, unless there are drastic changes in the production of pharmaceuticals. Already this year, supply is likely to meet only 75% of demand, compared to 80% to 90% in recent years.

Analgesics, hormonal drugs, cardiovascular medicines, decongestants, allergy medicines and antibiotics are now critically scarce, according to doctors.

An informal survey of six Moscow drugstores on the availability of 10 most-frequently used medicines--ranging from analgin, the favorite pain reliever here, to a popular digestive--turns up six medicines that can't be found in any of the stores. Three medicines--an anti-hypertension drug, nitroglycerin and a sulfa-based antibacterial--were found in half the stores, and one common antibiotic with ampicillin was found in two stores.

Even traditional Russian folk medicines such as the mustard plaster, which is used by almost everyone here to ward off coughs and colds, are increasingly unavailable.

The drug shortage is a virtual case study on the disintegration of the Soviet economy and why it is failing to meet the basic needs of consumers.

The old system under which the state planned, produced and distributed medicines--and virtually everything else--is collapsing through its own inefficiency and the economic reforms of President Mikhail S. Gorbachev. But the market forces of supply and demand that reformers hope will bring an economic revival have not yet begun to work.

Most of the equipment in pharmaceutical plants here has been allowed to wear out. Inadequate investment has left managers unable to repair old machinery, let alone modernize.

Now the disintegration has been magnified by an unintended effect of Gorbachev's glasnost : Grass-roots groups, which once would not have been tolerated, are protesting pollution--including the air and water contamination of chemical plants that supply the pharmaceutical industry.

In many cases, the chemical plants were located near urban centers, close to employees and the government units that owned and operated them. Amid protests from nearby residents, a number of chemical factories have been closed, unable to pay the cost of relocation or the purchase of pollution control equipment.

"Four or five Soviet chemical factories have been closed down in reaction to the demands of local people," said Vyacheslav M. Voronin, deputy chief of the Union of Pharmacies, the official organization that controls the purchase and distribution of drugs to the Soviet Union's pharmacies. "Since they were the main suppliers of raw materials for the pharmaceutical industry, closing them affected supplies and, probably, will keep affecting them in the future."

A factory in Yerevan, Armenia, that was the main producer of synthetic resins and a factory in Kirovograd, Ukraine, that was the sole producer of hydrochloric acid for pharmaceutical use are among those that have been closed. Environmentalist groups have prevented or postponed the opening of 37 other chemical factories, Voronin said.

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