Migraine Drugs and Dependence: Part 2

I promised Parin that I would address this topic again and explain my point a bit clearer. It all comes down to semantics of the words dependence and addiction. I hope that it is sufficient to say that some medical websites use the words interchangeably, referring to the physiological need for a particular drug. For instance, here is the definition of dependence taken from the e-Medicine Health (a part of WebMD.com) website:

Drug dependence is the body’s physical need, or addiction, to a specific agent. Over the long term, this dependence results in physical harm, behavior problems, and association with people who also abuse drugs. Stopping the use of the drug can result in a specific withdrawal syndrome.

The Mayo Clinic also uses these words interchangeably. I think that for consistency, dependence should refer to physiological need and addiction should add the characteristics of psychological need and drug seeking behaviors.

To answer Parin’s question, no I would not consider someone taking insulin or thyroid medicine addicted or dependent because neither are drugs, but rather replacements for a hormone that is missing.

Getting back to the article. The author’s headline is down-right WRONG on 2 points. First, neither of these drugs (Fiorinal and Percocet) are Migraine drugs. The FDA has not approved their use in the treatment of acute Migraine, although some physicians prescribe them as Migraine rescue drugs.

As I stated in the original post, these medications carry with them a double whammy. Not only can unwary Migraineurs develop medication overuse headaches (MOH), but they also run the risk of becoming dependent on the butalbital in Fiorinal or the oxycodone in Percocet.

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Migraine and Drug Dependence

 

This post is in response to Arabella’s post regarding the difference between medication overuse headache (MOH) and addiction. We are both responding to redOrbit’s article Migraine Meds Can Become Addictive  (BTW, the original AP article is better. Thanks, Parin). What followed was not on addiction, but on medication overuse headaches (MOH) or rebound headaches. These headaches occur when the culprit medication wears off and a severe headache occurs.

RedOrbit’s headline conjures images of Migraineurs sneaking out at night in dark alleys looking for their next fix. This is unfortunate because there is some truth to it. Anyone who takes a medication runs a risk in becoming addicted or dependent. This is NOT the same as abusing the drug. That is a whole other ball of wax.

In the medical community addiction or drug dependence means

is a state in which the body relies on a substance for normal functioning and develops physical dependence, as in drug addiction. When the drug or substance on which someone is dependent is suddenly removed, it will cause withdrawal, a characteristic set of signs and symptoms

It doesn’t mean that the person is liable to engage in dangerous behaviors to get another “fix”. That is drug abuse. Indeed, for most patients on pain medication, the fix is not necessarily just euphoria, but pain relief. And that certainly brings a sense of well-being.

There are many pain relievers that have the potential to cause drug dependence. Two of these are mentioned in the redOrbit article: Fiorial and Percocet. Fiorinal is a combination of three drugs: butalbital, aspirin, and caffeine. Butalbital is a sedative barbiturate that slows down the central nervous system. Patients can become dependent on butalbital and may find themselves taking Fiorinal more frequently just to function.

There is a double whammy in Fiorinal in that the butalbital can cause dependence; the aspirin and the caffeine can cause medication overuse headaches. So the woman highlighted in the article may have had both drug dependence and MOHs.

The same is true for Percocet. It is a similar drug prescribed for pain. It contains oxycodone and acetominephin. Oxycodone is an opoid narcotic pain reliever, similar to morphine. Acetominephin (Tylenol®) is a milder analgesic and enhances the pain relieving properties of oxycodone. Like butalbital, oxycodone can cause drug dependence, especially if taken more frequently than prescribed. The acetominephin can be the culprit in medication overuse headaches.

So it appears that drugs that combine a barbiturate or an opioid analgesic with aspirin, caffeine, or acetominephin carries the risk of both drug dependence (addiction) and medication overuse headaches. It does NOT necessarily lead to drug abuse.

Have an AWAP day,

Debbie

Photo courtesy of http://content.answers.com/main/content/wp/en/d/d7/VariousPills.JPG

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