Key takeaways:

  • Hydrocodone activates opioid receptors at sites in the peri-aqueductal and peri-ventricular gray matter of the brain, the ventromedial medulla, and the spinal cord to produce analgesia
  • As with other forms of opioid painkillers, abusing hydrocodone can lead to a dependence on the drug forming quickly. This dependence is formed when the brain builds up a tolerance to the drug's effects, meaning the user will require larger doses to feel the effects
  • Vicodin is the most widely recognized brand name for prescription painkillers with a hydrocodone base. These drugs will be combined with a non-opioid pain reliever known as acetaminophen and include the brands Norco and Lortab

Hydrocodone is a semi-synthetic opioid painkiller often used to treat moderate to severe pain. Doctors will prescribe hydrocodone, often under the brand name Vicodin, to people who have recently had surgery or those who have had painful accidents.

Understanding hydrocodone

Hydrocodone is a semi-synthetic opioid painkiller often used to treat moderate to severe pain. Doctors will prescribe hydrocodone, often under the brand name Vicodin, to people who have recently had surgery or those who have had painful accidents. These prescriptions are usually on a short-term basis as hydrocodone can be highly addictive.

Both prescription painkillers and illicit opioids work by binding to the mu-opioid receptors in the brain that are responsible for indicating pain. Hydrocodone activates opioid receptors at sites in the peri-aqueductal and peri-ventricular gray matter of the brain, the ventromedial medulla, and the spinal cord to produce analgesia. It elicits euphoric, respiratory depressant, and physiologic dependence properties of mu receptors within the central nervous system.

When hydrocodone bonds to these receptors the pain signals in the brain are weakened or blocked entirely. These Mu receptors are also responsible for the positive reinforcement that users feel when they take the drug, which can lead to abuse.

Hydrocodone brand names

  • Anexsia
  • Ceta Plus
  • Co-Gesic
  • Dolorex Forte
  • Hycet
  • Lorcet
  • Lortab
  • Maxidone
  • Norco
  • Stagesic
  • Vicodin HP
  • Zohydro
  • Zydone
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Short and long-term effects of hydrocodone abuse

Taking hydrocodone without a prescription, taking more than the recommended dose, or taking in any form other than the recommended method of ingesting (such as snorting or injecting) is considered abuse.

As with other forms of opioid painkillers, abusing hydrocodone can lead to a dependence on the drug forming quickly. This dependence is formed when the brain builds up a tolerance to the drug's effects, meaning the user will require larger doses to feel the effects. Some will take higher doses or begin snorting or injecting hydrocodone (by crushing the pills into a fine powder) and many start to rely on regular hits to feel normal. After repeated abuse, the brain’s frontal cortex becomes impaired, meaning the user will struggle with decision-making and mood regulation.

Effects of hydrocodone abuse

  • Confusion
  • Constipation

  • Diarrhea

  • Dry mouth

  • Euphoria

  • Itchy skin

  • Lightheadedness

  • Nausea

  • Nodding in and out of consciousness

  • Pinpoint pupils

  • Reduced breathing rate

  • Seizures

  • Sleepiness

  • Slowed heartbeat

  • Slurred speech

  • Vomiting

  • Warm, flushed skin

Continuous abuse of hydrocodone over a long period can have lasting effects on brain functionality, as well as mood and thought patterns and physical health.

Effects of long-term hydrocodone abuse

  • Insomnia
  • Depression

  • Anxiety

  • Mood swings

  • Liver disease
  • Kidney disease

Mental health disorders such as depression and anxiety can be treated through therapy and a combination of medication, such as antidepressants, if necessary. The damage caused to the liver and kidneys is less simple to treat and can often result in permanent damage.

There is also the risk of hydrocodone overdose if someone abuses the drug in large quantities or by combining it with other drugs. When someone overdoses on hydrocodone their heart and breathing rate slow rapidly, which can lead to breathing stopping entirely, causing hypoxia (the brain being starved of oxygen).

Diagnosing Hydrocodone Addiction

Like most forms of addiction, a person with opioid use disorder will be diagnosed by a licensed professional using these 11 criteria, outlined by the DSM-5: [1]

  1. Hazardous use: You have used the substance in ways that are dangerous to yourself and/or others, i.e., overdosed, driven while under the influence, or blacked out.

  2. Social or interpersonal problems related to use: Substance use has caused relationship problems or conflicts with others.

  3. Neglected major roles to use: You have failed to meet your responsibilities at work, school, or home because of substance use.

  4. Withdrawal: When you stop using the substance, you experience withdrawal symptoms.

  5. Tolerance: You have built up a tolerance to the substance so that you have to use more to get the same effect.

  6. Used larger amounts/longer: You have started to use larger amounts or use the substance for longer amounts of time.

  7. Repeated attempts to control use or quit: You've tried to cut back or quit entirely, but haven't been successful.

  8. Much time spent using: You spend a lot of your time using the substance.

  9. Physical or psychological problems related to use: Your substance use has led to physical health problems, such as liver damage or lung cancer, or psychological issues, such as depression or anxiety.

  10. Activities given up to use: You have skipped activities or stopped doing activities you once enjoyed in order to use the substance.

  11. Craving: You have experienced an intense craving for the substance.

These criteria are measured by the negative impact the substance has on a person's life; including physical, psychological, and behavioral measures, and are classified as mild, moderate, and severe. The criteria are measured against the previous 12 months of substance use and a score of 2-3 is considered mild, 3-5 moderate, and 6 or more severe. Even severe hydrocodone addictions can be treated and overcome. [1]

Types of Hydrocodone

Vicodin is the most widely recognized brand name for prescription painkillers with a hydrocodone base. These drugs will be combined with a non-opioid pain reliever known as acetaminophen and include the brands Norco and Lortab. Hydrocodone painkillers without acetaminophen are sold under the brand name Zohydro.

Vicodin

Dose: 5mg, 7.5mg, or 10mg combined with 300mg acetaminophen

Appearance: white tablets with dosage amount debossed on one side and “VICODIN” (may also have ES or HP) on the other.

Each Vicodin tablet has 300 mg of acetaminophen and comes in three different dosage levels of hydrocodone-5 mg, 7.5 mg, and 10 mg. It is generally prescribed for one tablet taken every 4 to 6 hours, though addicts may take much higher doses.

Norco

Dose: 7mg, 10mg combined with 325 mg acetaminophen)

Appearance: white tablets with orange specks with “WATSON” debossed on one side and 913 on the other, light orange tablets with “NORCO® 729” on one side and bisected on the other, and yellow tablets with “NORCO 539” debossed on one side and bisected on the other.

Lortab

Dose: 5mg, 7.5mg, 10mg combined with 325mg acetaminophen)

Appearance: tablets in multiple colors depending on strength (white with pink, green, or blue specks, or wholly pink) with “ucb” debossed on one side and a number (901, 902, 903, 910) on the other.

Zohydro

Dose: 10mg, 15mg, 20mg, 30mg, 40mg, 50mg

Appearance: white, light green, dark blue, or dark brown capsules with “Z3## [dosage] mg” in black ink.

Zohydro was approved by the FDA in 2013 as a pure hydrocodone painkiller, despite a medical science board voting against its approval. Zohydro is far more addictive than Lortab, Vicodin, and Norco as the potency is not offset by the addition of acetaminophen. Zohydro prescriptions are often only written for cases of severe or chronic pain.

Hydrocodone withdrawal

Like all forms of opioid withdrawal, hydrocodone withdrawal can be extremely uncomfortable. Hydrocodone is an extended-release painkiller, meaning the drug stays in the system longer and withdrawal symptoms are delayed (if abused in pill form. Snorting or injecting hydrocodone removes the time-release properties and will cause withdrawal to set in faster).

Withdrawal from hydrocodone usually sets in within 6-12 hours of the last dose, with the most severe and painful symptoms peaking at the 72-hour mark. Acute withdrawal symptoms can last for up to two weeks, depending on the severity of the addiction and abuse. Post-acute withdrawal symptoms (PAWS) can last for up to 24 months and include a range of psychological ailments such as anxiety, depression, and insomnia.

Hydrocodone acute withdrawal symptoms

  • Anxiety and agitation
  • Diarrhea

  • Dilated pupils

  • Fever
  • Insomnia

  • General depression

  • Joint and muscle pain

  • Nausea and vomiting

  • Runny nose

  • Sweating

  • Watering eyes

Hydrocodone detox

As hydrocodone withdrawal can be so uncomfortable and painful, attempting to stop abusing on one's own can often lead to relapse. That is why it is always advised to attend a medically supervised detox in an inpatient or outpatient rehab center to boost the chances of a successful recovery. Since hydrocodone detox can be so difficult, in most cases, medical supervision is necessary so the person can not only recover but also minimize the risk of relapse.

Medically assisted treatment (MAT) for opioid addiction often involves a course of medications to help reduce severe withdrawal symptoms during detox and as part of long-term recovery programs.

Drugs often used as part of hydrocodone addiction treatment:

Clonidine

Patients who take Clonidine report having a more tolerable withdrawal process, and therefore have improved chances of making it through withdrawal and advancing in the process of long-term recovery. Clonidine is a medication used to lower blood pressure so medical monitoring is advised. It works in the brain to change some of the nerve impulses in drug withdrawal.

Suboxone

A combination of buprenorphine and naloxone, Suboxone provides relief from hydrocodone withdrawal symptoms without the “high” of hydrocodone. It is often used during detox to alleviate the discomfort of withdrawal and reduce cravings. Suboxone works by tightly binding to the same receptors in the brain as other opiates.

Naltrexone

A common drug used for detox and maintenance, Naltrexone is essentially the chemical opposite of opiates. The medicine blocks receptors in the brain that bind to hydrocodone, dulling the drug’s euphoric effects. This helps reduce cravings and prolongs long-term recovery. It is also used for alcoholism. It blocks the feelings of pain relief or well-being.

Treatment for hydrocodone addiction

Suffering from hydrocodone addiction can be incredibly harmful to physical and mental health as well as having an adverse effect on a person's personal life. On top of this, the harsh withdrawal symptoms can make it feel like stopping is not an option.

This of course is not true. Stopping hydrocodone abuse on your own is difficult and not advised if you have a severe addiction or dependence. It is always recommended to seek professional help from a rehab center, especially to help manage withdrawal symptoms which can be painful and damaging to health.

If you or someone you know is suffering from hydrocodone addiction, then contact a treatment center today to start the journey to recovery.