Hydrocodone is one of the most commonly prescribed pain medications in the US. Although it is very effective for treating pain, it is also highly addictive, and widespread abuse of opioid prescriptions leads to thousands of overdoses per year. Read on to learn more about hydrocodone, the signs of abuse, and how to keep yourself safe.
Note: By writing this post, we are not recommending this drug. Some of our readers who were already taking the drug requested that we commission a post on it, and we are simply providing information that is available in the scientific literature. Please discuss your medications with your doctor.
What Is Hydrocodone?
Hydrocodone is an opioid invented in 1920 by 2 German scientists, originally developed to treat severe pain and coughs.
Hydrocodone has adapted from codeine — another highly addictive opioid — in the hopes of creating a less-addictive alternative. Today, it is mostly sold in combination products that include additional substances (such as acetaminophen, aspirin, ibuprofen, or antihistamines) in order to further reduce the likelihood of abuse and addiction [R].
Common brand names of drugs that contain hydrocodone include Vicodin, Lorcet, and Lortab [R].
However, a study on the abuse potential of hydrocodone-based combination drugs found that these medications still have the significant potential to create addiction. Therefore, one must take care when using any medication that contains hydrocodone [R].
Due to its high addiction potential, hydrocodone is classified as a schedule II narcotic by the FDA, and therefore requires a prescription for use [R].
Hydrocodone is the most frequently-prescribed opioid pain relief medication in the US, with over 121 million prescriptions in 2008 alone. Unfortunately, this leads to large amounts of the drug being illegally re-sold on the street, resulting in the highest abuse rates of any opioid [R].
According to the American Society of Addiction Medicine (ASAM), over 2 million Americans are estimated to have opioid dependence.
Hydrocodone was involved in over 100,000 emergency room visits in the US in 2011. This number is on the rise, making opioid abuse a major health problem [R].
Hydrocodone Mechanisms opioid receptors
Hydrocodone is a central nervous system depressant that works mainly by binding to opioid receptors.
Opioid receptors are found in the brain, spinal cord, and gastrointestinal tract. They transmit pain signals to the brain and are also involved in coughing and breathing. The effects of opioids on the nervous system involve several different types of opioid receptors [R]:
- Delta receptors (in the limbic regions)
- Mu receptors (involved in pain signaling)
- Kappa receptors (throughout cortex)
- Sigma receptors
The peak effects of a single hydrocodone dose usually occur 60 to 90 minutes after ingestion. People who abuse hydrocodone often crush and snort the pills to speed up the effects, although this greatly increases the risks of negative effects [R].
The effects of hydrocodone typically last around 4 hours, with some “extended release” pills that can last for up to 12 hours. However, these estimates are based on the average person and vary between individuals [R].
Medical Uses of Hydrocodone
1) Pain Management
The effectiveness of hydrocodone in reducing and managing pain has been established by a large number of scientific studies.
Twenty patients with cancer experienced pain relief when given oral doses of hydrocodone every 4 hours. This study also showed similar pain relief effectiveness between hydrocodone and morphine, with older patients requiring smaller doses to achieve similar effects [R].
A study in patients with chronic pain found that daily use of hydrocodone significantly improved pain intensity and quality of life [R].
A comparative study indicated that hydrocodone reduced pain in chronic pain patients as effectively as oxycodone [R].
Hydrocodone was able to maintain pain management in chronic pain patients that had formerly taken a mix of hydrocodone and acetaminophen [R].
In a study on pain management, hydrocodone improved pain, sleep patterns, and ability to perform daily activities in a group of 728 patients with moderate to severe chronic pain [R].
Hydrocodone reduced pain in 19 out of 26 patients in a study on individuals with chronic pain who had recently stopped using morphine [R].
A study (DB-RCT) in patients dealing with severe chronic lower back pain found that hydrocodone significantly reduced pain [R].
2) Suppressing Coughing
Hydrocodone reduced coughing frequency by an average of 70% in a study on patients with advanced stages of cancer [R].
Recreational Effects of Hydrocodone
Hydrocodone is frequently abused for its “positive” (pleasurable) effects, which often lead many users to become addicted. These effects include [R]:
- Anxiety relief
- A sense of euphoria
However, this effect can easily lead to addiction, because the euphoria felt from the initial use is temporary and becomes weaker over subsequent uses. The individual gradually develops a tolerance to the chemical, and continually chases a “high” that the medicine will never again provide for them [R].
Hydrocodone Side Effects
Whether it is used for medical purpose or abused recreationally, hydrocodone has many potential negative effects, including [R]:
- Mood changes
- Dry mouth
- Blurred vision
- Elevated blood sugar levels (hyperglycemia)
- Shallow breathing (respiratory depression)
- Slowed heart rate (bradycardia)
- Impaired cognition
- Impaired consciousness
- Seizures (during overdose)
With hydrocodone being the main ingredient in the most commonly prescribed medications in the US, a large population of abusers suffering from opioid addiction is inevitable [R].
Addiction causes compulsive drug use, drug craving and obsession, and uncontrollable drug-seeking behavior. The addiction becomes more severe the longer the drug is used, and also makes the withdrawal process more unpleasant and difficult.
The most common symptoms of opioid withdrawal include [R]:
- Irregular heart rate
- A headache
- Suicidal thoughts
- Using hydrocodone for medical purposes only
- Checking in with your doctor frequently
- Paying attention to the details of your prescription (dose frequency, amount, etc.)
- Avoiding hydrocodone if you have a history of addiction to alcohol or other drugs
Users of hydrocodone often develop tolerance to the drug, which causes the same dose to have smaller and less noticeable effects the longer it is used. This results in the individual having to increase their dosage over time to maintain the same level of effects.
Using opioids can also lead to “cross-tolerance,” where tolerance to one opioid results intolerance to other types as well. This makes it more difficult to achieve the original effectiveness of pain relief, even when switching to other opioid medications [R].
Due to its addictive nature, addiction and withdrawal can occur regardless of whether it is being used legally or illegally. For this reason, even individuals who take the drug purely for medical purposes can experience withdrawal after ending use and therefore have to be closely managed by a doctor when stopping treatment [R].
Medical professionals prescribing hydrocodone, therefore, prescribe a dosage frequency that slowly decreases toward the end of the treatment in order to avoid a sudden “cold turkey” scenario [R].
Common symptoms of hydrocodone withdrawal include [R]:
- Mood swings
- Impaired attention/ability to focus
- Inability to feel pleasure (anhedonia)
- Agitation and restlessness
- Night Sweats
- Suicidal thoughts
- Drug craving
- Muscle aches
- Sleep difficulties
- Chills/sudden changes in body temperature
- Elevated blood pressure
- Irregular heart rate
Withdrawal can begin as soon as 6 to 12 hours after the last dose is taken, and withdrawal symptoms reach their peak at around 72 hours from the last dose. The withdrawal process can last anywhere from 1 week to several months, depending on how long the user was taking the drug, as well as the size of the doses they were taking [R].
The detox procedure typically lasts a week and is best done under direct medical supervision at a detox clinic to avoid severe medical side effects.
Detoxing frequently involves using other medications to manage the symptoms of withdrawal, such as naltrexone, buprenorphine, and methadone [R].
Buprenorphine is a partial opioid agonist, meaning it also has the possibility for addiction; this drug should be taken with caution [R].
Thousands of people die every year from opioid overdoses, which are most often caused by recreational abuse. People who abuse prescription opioids often crush the drug up in order to snort it. This causes the drug to be absorbed much more quickly, making the dose more potent, while also greatly increases the risk of overdose [R].
However, overdose is always a possibility, even when taking pills that were prescribed legally in a normal manner. This is why it’s always extremely important to follow your prescription instructions carefully.
Common signs of overdose include [R]:
- Extremely small pupils
- Low blood pressure
- Slow, shallow, or interrupted breathing (respiratory depression)
- Cold, clammy skin
- Pale skin (especially in the face)
- Bluish lips and nails
- Unconsciousness or unresponsiveness
If you think someone is overdosing, it is important to call 911 immediately. Meanwhile, make sure the individual is kept awake and in an upright position while waiting for help to arrive. Above all, the most important thing is to prevent the person from losing consciousness.
A common method of treating overdoses is giving the patient naloxone. Although it is not clear whether naloxone simply competes for the same receptors, or whether it actively removes opioids from occupied receptors, the drug nonetheless quickly reverses the effects of opioids when given to overdosing patients [R, R].
Hydrocodone can interact negatively with many other drugs, making them highly dangerous when mixed.
Hydrocodone can interact with:
- Sedatives: Taking hydrocodone together with sedatives (such as alcohol, Valium, or lorazepam) can prolong and strengthen the effects of the sedatives, and can also increase the negative effects of the opioid. This results in a much greater risk of overdosing [R].
- Tryptophan: Tryptophan can increase serotonin production in the brain, which can cause serotonin syndrome [R].
- St. John’s Wort: Taking this herbal medication with any opiate will reduce the effectiveness of the opioid. This can lead individuals to increase their dosage of the drug, which significantly increases the chances of overdosing [R].
Hydrocodone can also interact with pre-existing medical conditions, including:
- Asthma/respiratory issues: Compared to regular asthma patients, those with opiate addictions have a higher frequency of sudden death [R].
- Serotonin syndrome: Having too much serotonin in the brain can lead to symptoms such as agitation, confusion, and muscle breakdown. Serotonin syndrome can be caused by mixing opiates like hydrocodone with other substances that affect serotonin levels (such as tryptophan or SSRI antidepressant medications) [R, R].
Hydrocodone and Alcohol
Alcohol and hydrocodone are both nervous system depressants that increase each other’s effects when taken together. This makes combining them extremely dangerous, and this combination should always be avoided [R, R].
Because of their similar effects on the brain, a history of alcoholism or alcohol abuse is a strong risk factor for hydrocodone abuse and addiction. For this reason, people who have had problems with alcohol use should probably avoid opioids altogether [R].
Does Hydrocodone Harm the Liver?
There is no solid evidence that hydrocodone causes damage to the liver when it is taken alone. However, many popular forms of hydrocodone (such as Vicodin) include other compounds such as acetaminophen, and there is some evidence that these additives may contribute to liver damage [R].
Hydrocodone and Fertility/Pregnancy
Women who use opiates while pregnant are at risk of making their unborn baby addicted, which can cause their children to go into drug withdrawal after birth (a condition called neonatal withdrawal).
If taking opiates is absolutely necessary to manage pain during pregnancy, opiate doses should be kept as low as possible, and should only be used under ongoing medical supervision [R].
Hydrocodone can also be passed on to a child through breast milk. It was observed that babies received about 3% of the dose taken by the mother through breast milk. For this reason, nursing mothers should limit their dose to 30mg/day or less [R].
A typical dose of hydrocodone is one 10 mg dose per day, combined with 100 mg of acetaminophen [R].
However, hydrocodone dosage varies from person to person, and patients should follow the advice of the prescribing physician.
Hydrocodone Drug Testing
Hydrocodone is a very popular drug, and many people who have taken it have reported varying degrees of effectiveness. While nearly all users report that it is effective at reducing or alleviating their pain, many people have reported unpleasant side effects, such as nausea, headaches, tiredness, or difficulty thinking clearly:
- “I was prescribed [Vicodin] after wisdom tooth removal surgery. It makes me nauseous so I also take Zofran, which fixes that. It also makes me extremely tired but it takes most of the pain away. Not all of it, but it definitely helps me function a little better.”
- “I have been given Vicodin for severe migraines, back pain, wisdom tooth removal and kidney infection with kidney stones. It never fails to make me feel nauseous, give me headaches, and make it incredibly difficult to function at times BUT it did take away my pain.”
Although hydrocodone abuse is widespread, one benefit of this situation is that people have become more highly aware of the potential for addiction, even when taken strictly as prescribed for legitimate medical purposes. For these reasons, many users express concerns about becoming dependent on or addicted to their medications, and only take pills when they absolutely need to (which is a good idea):
- “I’ve been taking Vicodin or something like it for years. First for a migraine headache and occasional back pain. Total of maybe 30 pills a year. My most pressing need was bouts with cellulitis. If I were to describe the pain, think of placing your leg in a bucket of scalding water up to the knee. I took it round the clock for a few weeks. I now take it for chronic knee and hip pain. The dosage is 5 mg 3 times a day as needed. I rarely ever take 3 doses. Most days maybe 1 or 2 and if the pain is manageable, I don’t use it at all. I’m averaging 60 pills every 4 months. The talk of addiction precludes me from taking it when I (or even my wife) feel I should. I’ve never felt high or drugged. The only side effect I see is less pain.”