CANCER PATIENTS SWEAR BY OXY

Minority risk addiction, pain specialist says

Thanks to OxyContin, Margaret can cope with the pain of gall bladder cancer.
Ban the drug or restrict its use, and legitimate sufferers such as Margaret
say they'll be the true victims.

Following gall bladder surgery in November 2003, Margaret, who did not want
her last name used, said laboratory tests revealed she had cancer.

"I'd had only one gall bladder attack, so this can happen to anyone, so
unexpectedly. I was taking Tylenol 2 for a long time, then went on one mg of
quick acting OxyContin four to five times a day. Eventually I needed more
cancer treatments and that's when ... the pain management doctor in Windsor
came on board."

Margaret was prescribed 80 mg of long-acting OxyContin twice daily, at 9
a.m. and 9 p.m.

"I'm very comfortable with that and I'm able to sleep, which is very
important to healing the body," Margaret said. "If I take more than I need
for the actual pain it makes me wishy-washy, kind of spacey and bombed out.
I don't feel like myself. Then I take less. It's wonderful as far as I'm
concerned."

Supporters say OxyContin, which contains the opiate oxycodone, is a miracle
pain reliever whose benefits far outweigh the problems it can cause.

As pressures mount on governments and health authorities in North America to
rein in the use of oxycodone-containing drugs, pain specialists caution a
balanced approach to controlling its abuse.

"There is also a worry about diversion of the drug from a legitimate use to
illegal abuse, but it's an important medication in the treatment of chronic
pain," said London pain-management specialist Dr. David Boyd.

"For those who take it, 19 out of 20 will have no problem and one in 20 can
usually manage with less. But in a dependent situation a co-management
approach is needed, treating the pain and the addiction."

Boyd said use of narcotics such as oxycodone has been a long-standing issue
for doctors.

"For me what's happening now is a news story on an old concern. One problem
physicians have had in treating pain is balancing the needs of the patient
with concerns about addiction," Boyd said.

Dr. Charmaine Jones, a palliative care specialist at the Hospice of Windsor,
said while drugs containing oxycodone are not her first choice, they work
well.

"I find it very useful and as far as I know my patients have very little
problem with it. Of course all my patients have an identifiable cause for
their pain and have no fears about it," said Jones. "It's a good drug and
it's a shame if a drug gets misused or diverted, and results in any negative
effects for people who really rely on it for pain management."

Jones said scientists are looking at human receptor sites - mu, delta and
kappa - that might hold the key as to why some people develop addictions and
others don't.

"Perhaps in the next 10 years patients will be given a particular
prescription drug depending on the set of receptors an individual has," said
Jones. "My understanding is that they (scientists) believe each person has
different receptors in their normal state, than they do in a state of pain."

John Stewart, general manager of drug maker Purdue Pharma in Canada, said
the company is working with governments and health officials to help deal
with the abuse problem.

"What's often missing in stories about drug abuse is the incredible good
they do for thousands of people in Canada and the U.S. who use them
appropriately," said Stewart.

Jones said controlling pain is often trial and error, but future pain
management will have much more science behind it. She said dilaudid peaks in
four to six hours, while 30 per cent of OxyContin is released in the first
hour, and the balance slowly released over the next 11 hours.

"It's believed that oxycodone reacts on kappa receptors, which might have
something to do with a tendency for it to be misused," said Jones.

"About six per cent of the population has addictive potential. A functional
MRI can tell which part of the brain is being activated when an addict is on
a high. It's the same high for gambling, smoking or drugs."

A study in the spring 2004 issue of The Journal of the Canadian Pain
Society, reported that patients with chronic non-cancer pain can be treated
safely with opioids.

"Opioids can also be prescribed even to some patients with a history of
chemical dependency who have a severe pain problem, if care is taken and
close follow-up is maintained," states the report.

Boyd agrees.