Pubdate: Wed, 19 Nov 2003
Source: Sun Herald (MS)
Copyright: 2003, The Sun Herald
Contact:  http://www.sunherald.com
Details: http://www.mapinc.org/media/432
Author:  Doris Bloodsworth, The Orlando Sentinel
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)

OPIOIDS LIKE OXYCONTIN CHANGE HOW PATIENTS FEEL PAIN, PLEASURE

ORLANDO, Fla. (KRT) -- If you want to learn about pain and addiction, study 
Tom Albright's brain. Albright is a cancer survivor who was hooked on the 
painkiller OxyContin.

When he was born in Kissimmee, Fla., in 1951, his brain already was wired 
to deal with the many experiences he would face - law school, learning to 
fly a plane, starting a family and battling cancer and drug addiction. It 
also was wired for pain and pleasure - very powerful motivators.

It's only natural that we move away from hurtful experiences toward ones we 
enjoy. Pain can force battle-hardened soldiers to cry like babies. Pleasure 
keeps the maternity wards full and the ice-cream case empty.

By 1983, when Albright finished law school at the University of Florida, 
his brain had matured. As a young adult, he had many pleasurable 
experiences - marriage and fatherhood - that caused his brain to release 
natural drugs, called endorphins.

"My life was pretty much a normal and happy progression," he said.

Then in the prime of midlife, Albright's brain learned about chronic pain.

For 16 years Albright had managed Volusia Timber Corp. In January 2001 a 
doctor diagnosed the Ormond Beach, Fla., executive with a vicious form of 
leukemia. That started Albright's education about pain, tolerance and 
addiction.

No one knows exactly what causes addiction, and not everyone agrees on what 
it means.

But researchers have found clues in recent years pointing to a number of 
factors that include genetics, emotions and powerful drugs that mimic the 
body's natural painkillers. There is general agreement that addiction is a 
brain disease characterized by craving and loss of control.

Opioids, such as OxyContin, change the body's pain receptors over time. 
That tends to cause "tolerance," meaning the body requires more drugs to 
maintain the same relief, and "dependence," referring to withdrawal 
symptoms that kick in when medication is stopped or rapidly reduced.

Many people taking OxyContin say they became accidental addicts, just like 
Albright.

For many months, Albright's main focus was undergoing lifesaving chemotherapy.

"I did my best to project my usual in-charge confidence," he recalled. "But 
in reality, I was scared to death."

Albright's spleen, swollen from the cancer, sent pain messages in the same 
way a burned finger would when he was a child. The messages were picked up 
by receptors all over his body. Many receptors are concentrated in the 
brain, spine, stomach and intestines.

While Albright underwent treatment, his doctor prescribed OxyContin. The 
opioid carried a double whammy: The pills reduced his pain and increased 
his sense of well-being - he hurt less and felt happier.

As opioids passed through Albright's system, they were attracted to his 
receptors. It was a perfect fit. Like a key locking a door, the opioids 
blocked pain messages. Opioids have side effects, like most drugs. Because 
there are many receptors in the intestinal area, opioid patients are likely 
to get constipated; some get nauseated.

Albright said that, while his doctor treated him for the cancer, the 
OxyContin allowed him to function.

"For 11 months, OxyContin kept me quite comfortable," Albright said.

Then doctors decided Albright's only chance to live was a bone-marrow 
transplant. But before he could be considered, he had to get off OxyContin.

"No problem. I'll just quit," he thought.

That was when Albright's brain became an expert on addiction. He stopped 
taking the medication on a Friday night. By Saturday afternoon, he was in 
full-blown withdrawal.

"I was walking with shaky knees, feeling like I was going to throw up; my 
skin was crawling and my bones were aching," Albright recalled. "I should 
have seen the deterioration of my lifestyle, but it was only then that I 
realized I was addicted."

The father of two daughters didn't realize that his receptors, which had 
been so effective in transmitting pain and pleasure, were physically 
changed by the powerful narcotic that had blocked his cancer pain.

Pain messages that once stopped at his spine - a central junction or 
connection - now zoomed unabated to Albright's brain like incoming 
missiles. Norepinephrine, a chemical transmitter in the central nervous 
system, was released in the brain, causing goose bumps, rapid heartbeat and 
muscle cramps.

Constipation was replaced by diarrhea; euphoria, by anxiety.

Problems associated with opioid withdrawal are usually at the heart of most 
media stories about OxyContin.

"We've often said that if opiates weren't used for pain management, this 
(addiction) would be a moot point," said Susan Dempsey, a pain-management 
specialist at Orlando Regional Medical Center.

Dempsey said opioids often cause the most problems but also often offer the 
best pain relief.

Pain-management specialists such as Dempsey say the real problem often is 
that many doctors and nurses have little experience in managing pain or 
treating addiction.

Patients who die while taking OxyContin or its active ingredient, 
oxycodone, basically stop breathing and suffocate, said Dr. David Egilman, 
a Massachusetts internist who has treated pain patients.

"It is through depression of the respiratory-control mechanism in the 
central nervous system," he said. "The brain stops telling the lungs to 
breathe. The lungs do not expand without 'orders' from the brain, and you 
stop breathing and suffocate."

Albright couldn't tolerate the painful withdrawal symptoms that came when 
he and his doctor tried weaning him from painkillers. He called Purdue 
Pharma, the company that makes OxyContin, and asked for help in getting off 
the drug. A company official sent Albright a schedule, he said, that would 
take 44 weeks to be drug-free by reducing his doses in baby steps.

"I didn't have 44 weeks," Albright said. "And I don't know how someone 
could be trusted with the deep cravings that the drug induces.

"I would shake uncontrollably and felt as if I would crawl out of my skin," 
Albright, 52, said. "I was at the end of my rope."

At one point, he walked to the edge of a pond and put a 9 mm handgun in his 
mouth.

"I could taste the gunmetal," Albright said. Thoughts of his wife and 
daughter kept him from taking his life.

Desperate, Albright turned to the Internet and discovered a process called 
rapid detox. At a Tarpon Springs, Fla., hospital, medications fed 
intravenously pried the OxyContin off Albright's receptors while other 
drugs kept any residual opioids from reattaching.

Two days later, Albright was home, free of his addiction. Within weeks, he 
went to Texas, where he received a successful bone-marrow transplant.

Today, Albright enjoys work, family and flying his Cessna Seneca. He has 
these words of advice about powerful painkillers and addiction:

"Keep in the back of your mind that you're going to mortgage the lifestyle 
and existence that you have in exchange for that pain relief," Albright 
said. "You'll end up with a bad monkey on your back at the end of that 
path. And that monkey turns into a gorilla."

[SIDEBAR]

PAIN AND ADDICTION

Acute pain: Pain from an injury that begins suddenly; can occur after a 
sprain or surgery.

Chronic pain: Unrelenting pain that does not subside within several months.

Tolerance: Increased dosage of medication needed to produce the same level 
of comfort.

Dependence: A state in which withdrawal symptoms occur after drug use is 
stopped or quickly decreased.

Addiction: A disease influenced by genetic, psychological and environmental 
factors characterized by compulsive use or craving.

SOURCE: Sentinel research
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MAP posted-by: Jackl