They represent holistic pain therapy. In contrast, you used to prescribe many opiates yourself …
Dr. Johannes Lutz: For a long time I thought that pain therapy was primarily a question of the dose. Perhaps it is one way that everyone, and also a doctor, has to go: to understand that pain therapy is not just about medication.
How do your patients experience this rethink?
The wish to "heal me" is probably as old as mankind. But we don't get any further with the pain. We have just made a film in our clinic that accompanied four senior citizens during their stay. They all came with the rollator, two of them initially withdrawn from opiates. But then they learned what influence they have – ice rubbing, balance training, breathing training, etc. – and at some point they literally sauntered through the hallways. Getting rid of helplessness is pain relieving.
Does this work at any age?
Sometimes I have the feeling that it works even better for our older patients. The younger ones often have completely different conflicting goals. Many want to hear from me that they are no longer able to work because they have applied for a pension.
From 2000 to 2018, opiate prescriptions doubled. Are we facing a development like that in the United States, where the abuse of painkillers has led to a drug crisis?
I do not think so. About 30 years ago it was noticed that especially tumor patients do not get the pain therapy they need. And opiates often help them relatively well. The resident doctors have been criticized for undersupply and have changed their behavior. However, many opiates are now prescribed, and the majority of people who have no tumor at all. But we do not have the prerequisites for such a catastrophic development as in the USA – and as it seems to be repeating itself in China.
Because we have opiates under the Narcotics Act?
That is one reason. They must be prescribed on registered prescriptions, there is a follow up. But also because there is a ban on advertising for opiates. We can only advertise in specialist journals. Incidentally, I find that too much myself. In the USA, however, the drug Oxycontin was advertised everywhere. However, the recipe block is also quite loose here. I notice that rethinking is now taking place in the specialist societies. But opiates are also due to the zeitgeist: They offer seemingly quick solutions to serious, long-standing problems.
Do more and more of your patients first have to have an opiate withdrawal?
The selection that we have at our clinic is certainly not representative. Many come here because they know that we are withdrawing. A lot of people want to get rid of the means, but don't dare to break out of the rail on which medicine has placed her so far.
So there is a lack of support?
Clear. The established colleagues are afraid. You see a patient in the office for five minutes. It is much easier to make 40 milligrams per day 60 than to go the wrong way. Withdrawal can be violent and should be done in hospital.
When do you think opiates make sense outside of cancer medicine?
They are essential for operations or in intensive care medicine. But when these acute phases are over, you have to say goodbye to them again. And someone has to take care of that. That failed completely in the United States. People got the funds and were left to their own devices. We need a close reinstatement. The question must always be asked: have we achieved our goal? And that does not mean that the pain is less, but above all: Can someone work again and participate in everyday life.
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