What is Hydrocodone?
Hydrocodone is a semi-synthetic opioid drug used as both a narcotic analgesic for pain relief and as a liquid antitussive or cough suppressant, and is typically taken orally. Hydrocodone, also known as dihydrocodeinone, is synthesized from codeine, which is an opioid alkaloid found in the opium poppy. The drug is generally considered to be 6 times the strength of codeine and about half the strength of oxycodone, despite offering nearly the same pain relief as morphine.
As a Schedule II drug of the Controlled Substances Act (CSA), hydrocodone is only legally available through a doctor’s prescription, and is typically prescribed under trade names including Vicodin, Norco, Fentora, Lorcet, Zohydro ER, Lortab, and others. Hydrocodone is also found in prescription cough medicines, and in combination paracetamol/acetaminophen, aspirin, and with ibuprofen, which are used for mild to severe pain relief. Hydrocodone is a fast acting drug, with an onset period of 10-30 minutes, and a duration of 4-6 hours. However, because hydrocodone is available in extended-release capsules such as Zohydro ER, the drug can remain effective for 12 hours. Hydrocodone is one of the most commonly prescribed painkillers in the United States, despite its high risk of causing physical and psychological dependence, even with regular prescribed use. In fact, more U.S. prescriptions have been written for hydrocodone and acetaminophen combinations like Vicodin than for any other drug. In 2012, that included over 135 million prescriptions, despite thyroid hormone (levothyroxine sodium) being the only other drug to surpass 100 million prescriptions.
History of Hydrocodone
Hydrocodone was first synthesized in 1920 by German chemists Carl Mannich and Helene Löwenheim while they were studying the process that would later be known as the Mannich Reaction. Hydrocodone was one of the first pure opioid alkaloid’s, and was at the forefront of their adoption in the pharmaceutical world. Mannich and Löwenheim were then working in the University of Frankfurt and chose to sell their codeine reduction to the German pharmaceutical company Knoll, who refined the formula, and sold it in the German market in 1924 as Dicodid.
By the 1930s in the United States, the U.S. Bureau of Social Hygiene was in the middle of a long and fruitless search for a non-addictive substitute to opium and morphine. Following research in the 1920s, the BSH funded a study by the National Research Council to research the harmful effects of opium and morphine addiction in the United States, and if possible, to find a replacement for the painkillers. In 1930, the NRC appointed Dr. Nathan Eddy, a University of Michigan pharmacologist to the task of testing potential substitutes for effectiveness as an analgesic, and after 5 years, he concluded his study. Dr. Eddy reported that hydrocodone showed the most promise for replacing morphine as an analgesic, but due to it’s euphoria inducing effects, it was likely to create the same dependency and addiction problems as morphine. He followed this study up with a 1956 report, where he directly compared the risk of addiction to opium alkaloids such as hydrocodone and morphine as statistically the same. Despite his warnings, Hydrocodone was approved by the FDA in 1943 under the brand name Hycodan, and eventually replaced morphine and opium in popularity.
Hydrocodone is prescribed primarily for it’s pain killing and cough suppressing properties, and is used legitimately by many Americans for this purpose. The drug works by binding and activating opioid receptors in the central nervous system, which releases endorphins throughout the body. Endorphins naturally act as a painkiller by inhibiting the transmission of pain signals along the nervous system. They also produce a feeling of euphoria, which is responsible for most hydrocodone abuse and addiction. In the short term, hydrocodone produces:
- Drowsiness or lethargy
- Light to moderate euphoria
- Reduced stress due to increased dopamine in the brain
- Reduced pain
If the patient is not already in pain, the euphoric effects can be much stronger.
Side Effects of Hydrocodone
Hydrocodone also has a number of side of effects. These include nausea, vomiting, drowsiness, lightheadedness, mood swings, rash, itching, and pupil contraction. In very large doses, hydrocodone may cause respiratory issues such as slowed or irregular breathing. This is caused by the same endorphin reaction that causes euphoria, because hydrocodone reacts primarily with the MOR receptor, an opioid receptor in the brain that also controls breathing. For this reason, a hydrocodone overdose can be fatal.
Most users eventually build up a tolerance to hydrocodone, which can lead to dependency and addiction. Tolerance is the process of becoming adjusted to a drug. Patients who are adjusted need more of the drug to produce the same effect. Studies show that the body can begin to tolerate hydrocodone anywhere from a few doses in to over a period of months. Patients may unintentionally develop a hydrocodone dependency, simply by taking enough of the drug to stop their pain. The drug is easy to abuse because many take slightly more of it to achieve the same effect, which continues to increase as their tolerance rises. For this reason, patients should stick to the recommended dose at all times.
Hydrocodone creates a physical and psychological dependence, even for users who take it on a doctor’s prescription. The endorphins released by Hydrocodone are psychologically addictive. The brain can become convinced that it needs the drug to function, creating significant cravings, which many people will not notice right away. Persons with a dependence might make excuses to themselves for taking more of the drug, or find themselves taking it without thinking. Hydrocodone also creates physical dependence, so that a heavily dependent person may actually be unable to function without it. Endorphins are naturally produced by the brain during physical and social activities, and are often used as part of a rewards system in the brain. Hydrocodone floods the brain with these endorphins, which changes the reward system, so that the person becomes entirely dependent on the drug to provide those levels. Over time, as tolerance increases, the person needs more and more of the drug to get the same level of high, or the same level of reduced pain. Dependency is not hydrocodone abuse but it often leads to it. Someone who does any of the following may be hydrocodone dependent. A person who is dependent on hydrocodone will experience withdrawal symptoms when these cease taking it. A person who is hydrocodone dependent may:
- Continue to take hydrocodone when they no longer need it
- Take more than the recommended dose regularly
- Go into withdrawal without the drug
Someone who is heavily dependent on hydrocodone must be weaned off of the drug by a physician to prevent withdrawal issues.
In 2010, nearly 12 million Americans used prescription painkillers like Vicodin (hydrocodone) for non-medical purposes. Hydrocodone abuse is the process of using hydrocodone for any purpose other than one specifically prescribed by a practicing physician.
This can include:
- Taking more than the recommended dose
- Taking hydrocodone when not in pain
- Taking hydrocodone for the purpose of getting “high”
- Taking hydrocodone in a way not in line with the physician’s recommendations. For example, chewing an extended-release capsule.
Hydrocodone abuse will not necessarily lead to an addiction or other problem, but it can. Importantly, hydrocodone abuse can also lead to other types of drug abuse, as the users hydrocodone tolerance increases and the patient looks for a high elsewhere.
A hydrocodone addiction is defined as the practice of compulsively seeking hydrocodone, and addicts will often break the law to get more of it. Hydrocodone addiction is physically and emotionally taxing and dangerous, and can be life threatening in the case of an overdose. More importantly, many hydrocodone addicts begin using hydrocodone according to their doctor’s prescription, but increase the dose as their tolerance rises, and eventually become completely dependent and addicted to the drug. While hydrocodone was originally adopted as a replacement for morphine, studies show that there is no significant difference in the abuse liability for morphine and hydrocodone. While codeine produces a more powerful ‘high’, hydrocodone is one of the most abused drugs in the United States thanks to it’s ready availability and the ease of obtaining a prescription for pain relief. Because hydrocodone is prescribed very often in the United States, it is very common on the streets, and relatively easy for addicts to acquire illegally.
Anyone who takes too much of any hydrocodone product can suffer from an overdose. While the exact amounts required for an overdose vary depending on the drug, its potency, its paired drug (most hydrocodone pills are paired with aspirin, paracetamol/acetaminophen, or ibuprofen), and the age and weight of the person who took the pills. Hydrocodone Overdose Symptoms:
- Pinpoint pupils
- Breathing problems
In the case of a large overdose, the patient may have difficulty breathing, their breathing may slow, and they may stop breathing altogether. A hydrocodone overdose should be treated with oxygen in a hospital in the case of breathing difficulties. In severe cases, doctors will administer a drug called Naloxone. This drug counteracts the respiratory effect of Hydrocodone by blocking the MOR opioid receptor in the brain. However, Naloxone can cause severe side effects such as seizure, headaches, vomiting, sweating, nausea, and even changes to the heart rhythm, so most doctors will only administer it when necessary. Naloxone is sometimes available as an over the counter medicine in some states. If you or someone you know has taken a Hydrocodone overdose, call the Poison Control Center at 1-800-222-1222 or call 911.
Anyone who is dependent on drug will experience hydrocodone withdrawal, and this includes persons who are still taking the it in line with their physician’s recommendations. Hydrocodone withdrawal symptoms can set in anywhere from 6-48 hours after taking the final dose, and can range from mild to severe. Persons who have a strong dependency are advised to seek out a detox center or to wean themselves off of the drug with the aid of a physician. Withdrawal symptoms include:
- General malaise
- Irregular Heartbeat
Anyone who has used hydrocodone for some time will experience both physical and psychological withdrawal symptoms, which can present a strong barrier to getting off of the drug. In some cases, hydrocodone withdrawal symptoms can be severe enough to cause physical harm, so any withdrawal should be overseen by a physician. Mental anxiety, depression, and mood swings are also very common, and can be harmful to the person withdrawing. In most cases, withdrawal should be undertaken as part of a hydrocodone treatment program, where doctors can prescribe drugs such as Methadone, Buprenorphine, Naloxone, Clonidine and others to reduce the symptoms of the withdrawal. While the worst withdrawal symptoms will typically be over within 3 days, full withdrawal can take anywhere from one week to over one month.
Hydrocodone Addiction Treatment and Recovery
Hydrocodone addiction is serious and withdrawal symptoms can be difficult and even dangerous. Someone who is physically and mentally dependent on hydrocodone should seek out medical help in order to ensure that they complete the withdrawal process safely. In addition, while physical withdrawal symptoms can be gone in as little as a month, the psychological effects often last much longer. In fact, 40-60% of opiate addicts eventually relapse without help.
Hydrocodone addiction treatment can help addicts to withdraw safely, while breaking the long-term cycle of drug abuse, so that the person can go back to living their life without drugs. Recovery programs include inpatient and outpatient options: Inpatient – Inpatient programs help a patient to recover from hydrocodone abuse inside of a clinic, without the distractions of their daily life, or the temptation to purchase or take more of the drug. Inpatient programs are often the most effective, especially when followed up with a long-term maintenance program. Outpatient – Outpatient recovery programs allow patients to seek daily counseling and assistance while still living at home and going to work. Outpatient recovery programs are less effective, but offer the patient privacy in that they can seek counseling without interrupting their life. Maintenance – Depending on the severity of the hydrocodone addiction, the physician in charge of overseeing the withdrawal process may determine a maintenance period of one to several months or even years. During this period, the patient is given regular therapy and sometimes drugs including Buprenorphine – also known as Suboxone or Subutex – Methadone, and Naltrexone to prevent further cravings or relapse. The Oceanfront Recovery Hydrocodone Addiction Treatment Program can help you or your loved one through the difficult and dangerous process of withdrawal and subsequent recovery from Hydrocodone addiction. Our clinicians focus on bringing the underlying causes of addiction to the surface with a modern and effective recovery program in a closed setting. Contact Oceanfront Recovery today for a confidential assessment, and begin the journey of recovery from Hydrocodone addiction today.