Hydrocodone abuse and addiction has become common because it is the most frequently prescribed opioid pain reliever in the US. According to IQVIA / IMS Health, in 2017, over 83 million prescriptions of hydrocodone were dispensed!
There are hundreds of branded and generic products of the drug on the market, most being combination products. The most common combination is hydrocodone and acetaminophen in products like Vicodin and Lortab.
An important note: in January, 2018, the FDA issued a drug safety communication requiring safety labeling changes for prescription cough and cold medicines containing hydrocodone to limit the use of these products to adults 18 years and older.
What is Hydrocodone?
Hydrocodone is an antitussive or cough suppressant and an opioid analgesic used for the treatment of moderate to moderately severe pain. Hydrocodone has
been shown to be as or more effective than codeine for cough suppression and almost equivalent to morphine for pain relief. It was first approved for prescription in the United States in 1943 but it wasn’t until October 2013 that the FDA approved a single-ingredient, pure hydrocodone product Zohydro ER (extended release).
Generic hydrocodone is widely available, and the drug is marketed under various FDA-approved brand names:
Single-ingredient hydrocodone brand names:
- Zohydro ER
- Hysingla ER
- Vantrela ER
Hydrocodone ER is only prescribed for round-the-clock, severe pain relief and in cases where other opiate analgesics are not effective.
Due to hydrocodone’s contribution to the ongoing opioid crisis in America, this drug is only legal with a doctor's prescription. Hydrocodone is classified as a Schedule II controlled substance in all 50 US states.
Is Hydrocodone an Opiate or Opioid?
Hydrocodone is a semi-synthetic opioid derived from and similar in structure to codeine with powerful opiate pain-relieving effects. As with other opiate analgesics, it works by attaching to the opioid receptors in the brain and changing the brain's perception of pain. Hydrocodone has similar side effects and withdrawal symptoms to other drugs of the opiate class.
The distinction between an opiate and opioid is whether the entity is derived from a natural source (opium poppy flower) versus synthetically developed to mimic and act like the natural substance but have different chemical structures. Hydrocodone is semi-synthetic because it is a hybrid developed by modifying naturally occurring codeine (obtained from the opium poppy) and hence technically would be classified as a semi-synthetic opioid.
Hydrocodone vs Oxycodone – How Are They Different?
A question that comes up often is, what is the difference between these two codones, hydrocodone and oxycodone. Oxycodone is also a semi-synthetic opioid like hydrocodone but it is derived from thebaine versus codeine which are both chemical entities obtained from the opium poppy. Oxycodone is classified as just a narcotic analgesic while hydrocodone is classified as that plus as an antitussive or cough suppressant. Both have formulations for immediate and extended release, but oxycodone has a maximum of 12 hours versus hydrocodone has a 24-hour dosage strength.
That all being said, oxycodone and hydrocodone are similar in their pain-relieving effects, have the same side effects with some varying differences noted, withdrawal symptoms, and abuse potential. As far as side effects, oxycodone is more likely to cause dizziness and drowsiness, as well as fatigue, headaches, and feelings of euphoria while hydrocodone is more likely to cause constipation and stomach pain. Oxycodone has been shown to have a slightly higher abuse potential and more powerful than hydrocodone but generally are regarded as similar. Which drug to take should be based on a doctor’s evaluation and recommendation. Both drugs are classified as Schedule II controlled substances and only available by prescription.
Hydrocodone Side Effects
Hydrocodone side effects include but are not exclusive to:
- Abdominal pain
- Peripheral edema or swelling
- Upper respiratory tract infections
- Muscle spasms
- Urinary tract infections
- Back pain
Hydrocodone addiction has long been documented going back 50 to almost 100 years ago. The first report on hydrocodone’s euphoric and habit-forming effects was published in 1923. The first report of hydrocodone dependence and addiction was published in 1961.
Hydrocodone is a powerful painkiller that is can become very addictive, both physically and psychologically, especially when it is abused and not taken as prescribed. Even those that follow a hydrocodone prescription exactly as prescribed for a given condition can become physically dependent if they take hydrocodone for a longer period.
Misuse among school age children has become of particular concern in the last few years. Thankfully the trend has been going down but still 0.6%, 1.1% and 1.7% respectively of 8th, 10th and 12th graders used Vicodin for non-medical purposes in the last year, as reported in the December, 2018 Monitoring the Future Survey.
When taking this drug regularly and for a period of time, hydrocodone will stop working effectively and opioid withdrawal syndrome can occur. In order to achieve the same effects as before, the individual will have to increase the dosage of hydrocodone they take. This is known as drug tolerance. Hydrocodone addiction occurs when an individual becomes compelled to take hydrocodone whether there is a physical need or not.
Addiction is not the same as dependence. Hydrocodone dependence can occur through abuse of the drug or as a byproduct of taking a regular prescription.
Addiction in its truest form is a chronic, progressive and life-threatening brain disease. It can manifest in many forms and attach to many substances and to behaviors. In an individual that is pre-disposed to developing addiction or has a history of addiction, there is a higher risk of them becoming addicted to hydrocodone.
For an individual to suffer from hydrocodone addiction there needs to be an element of psychological attachment and compulsion. Addiction is characterized by an overwhelming craving and compulsion that surpasses all reason.
Those that suffer from hydrocodone addiction will go to extreme lengths to hide their addiction from others. They will be compelled to seek out and take the drug regardless of the cost to their own well-being and to their loved ones’ peace of mind.
Hydrocodone Withdrawal Symptoms
Hydrocodone withdrawal symptoms include, but are not exclusive to:
- Lacrimation (tearing)
- Rinorrhea (runny nose)
- Myalgia (muscle pain)
- Mydriasis (dilated pupils)
Other signs and symptoms also may develop, including:
- Joint pain
- Abdominal cramps
- Increased blood pressure
- Increased respiratory rate
- Increased heart rate
Hydrocodone withdrawal is very unpleasant and there is a high risk of relapse during detox. Physical withdrawal symptoms last for approximately one week or so but can be prolonged over several weeks/months if you have been taking the drug for a long period of time or in high amounts.
Hydrocodone withdrawal symptoms can be eased by undergoing a medically assisted tapering off regime.
Where Hydrocodone addiction has been identified, a SAMHSA certified opioid treatment program is recommended.
How Long Does Hydrocodone Stay in Your System?
The length of time hydrocodone stays in your system varies from person to person and is dependent on several personal factors. Body fat percentage, metabolism and other medications can all affect the rate that your body dispels this drug.
Hydrocodone has a half-life of approximately four hours. The time the remaining half can be detected in your system falls within the following time frames, to be used as a broad guideline only:
- Urine: 2-4 days
- Saliva: 12 -24 hours
- Blood: 12 to 24 hours
- Sweat: 1 to 4 weeks
- Hair: 4 to 6 months