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