Close photo of prescription bottle for Hydrocodone tablets and pills on wooden table

Hydrocodone was once the number one prescribed drug in the United States, and today, hydrocodone products are still widely prescribed. The drug ranks as the third most filled prescription drug, with 97 million prescriptions filled in 2015, the Pain News Network reports.

Hydrocodone is an opioid narcotic painkiller, often marketed as a combination drug containing an over-the-counter analgesic like acetaminophen or aspirin. Popular brand-name drug formulations containing hydrocodone include Vicodin, Lortab, Lorcet, and Norco. The United States is one of the only consumers of hydrocodone globally, consuming almost 100 percent of these products around the world in 2013, the National Institute on Drug Abuse (NIDA) reports.

Hydrocodone is intended to treat acute and moderate levels of pain, and it is used as a cough suppressant. The drug interacts with opioid receptors in the brain and along the central nervous system. By binding to these opioid receptor sites, hydrocodone creates a backlog of “happy cells,” or some of the brain’s chemical messengers like dopamine that tell a person when to feel pleasure.

Hydrocodone slows down, or lowers, many of the functions of the central nervous system like breathing rate, heart rate, blood pressure, and body temperature. This has a sedative and relaxing effect. Some of these side effects of hydrocodone may make it desirable as a drug of abuse.

How Hydrocodone Abuse Begins

Prescription bottle of tablets on wooden table

Prescription drug abuse, and particularly the misuse of opioid pain relievers, has reached epidemic proportions in America. NIDA estimates that over 50 million Americans have misused a prescription drug at least once in their lives, with prescription painkillers being the number one type of drug abused. In 2014, the National Survey on Drug Use and Health (NSDUH) found that nearly 4.5 million adults in the United States were currently abusing prescription painkillers, meaning that they had misused one in the month leading up to the survey. In 2011, over 80,000 people sought emergency department (ED) treatment for a negative reaction involving hydrocodone abuse, the Drug Abuse Warning Network (DAWN) publishes.

The NSDUH finds prescription painkiller abuse in nearly all demographics and age categories; however, the largest percentage of people abusing these drugs at the time of the national survey were between the ages of 18 and 25. Hydrocodone products have also traditionally been popular among adolescents, and the 2015 Monitoring the Future (MTF) survey, as published by NIDA, reports that close to 4.5 percent of high school seniors abused Vicodin in the past year. People of all ages seek out the pleasant effects of the drug, as hydrocodone makes a person feel happy, mellow, less inhibited, more social, relaxed, and free from pain.

Hydrocodone combination products were rescheduled by the Drug Enforcement Administration (DEA) in 2014, as published in the Federal Register, in part due to its high abuse and diversion rates as well as the high number of opioid overdose deaths and the increasing amount of individuals battling opioid addiction. The Centers for Disease Control and Prevention (CDC) reports that over 60 percent of all of the 47,055 overdose deaths in the United States in 2014 (the most of any year on record) involved an opioid drug, with hydrocodone (and oxycodone) leading the pack. Hydrocodone combination products were moved from the less restrictive Schedule III to the highest level of controlled substances with an accepted medical use in the United States, Schedule II, as of October of 2014. New guidelines for prescribing hydrocodone were established, limiting prescriptions to 90 days with restrictions on refills.

One of the main reasons for these tighter restrictions is related to how addictive hydrocodone can be. Mayo Clinic warns individuals that hydrocodone products can be habit-forming, leading to both mental and physical dependence with long-term use. Withdrawal symptoms and cravings can become intense and very uncomfortable when the drug wears off, leading individuals to want to take more of the drug more often. Hydrocodone abuse may start out with a legitimate prescription to relieve pain and can quickly devolve into misuse and abuse once dependency has formed.

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Abuse to Addiction

Drug addict or medical abuse concept with man handcuffed to a medicine bottle. Obsession to pharmaceutical substances or narcotics or anxiety pills. Addiction written with tablets on dark background.

Called hydro, norco, and vikes on the street, hydrocodone products are generally found in tablet or capsule form, which may be chewed or swallowed. They may also be crushed and then snorted, smoked, or injected when abused.

Often deemed “safer” than illicit drugs like heroin, hydrocodone abuse spans all demographics in the United States, although it may be often be considered a “white collar” addiction, the DEA postulates. From recreational drug users and to first-time drug initiates, to individuals looking to self-medicate difficult mental or medical issues, hydrocodone abuse is widespread and its users are diverse.

Some individuals may be more prone to abusing a drug like hydrocodone than others. For example, high levels of stress, difficulties at home, family history of addiction, co-occurring mental or medical issues, and a lack of a strong support system may all make someone a target for hydrocodone abuse.

It can be important, therefore, for families and loved ones to be able to spot when someone may be struggling with hydrocodone abuse. Individuals may appear drowsy, uncoordinated, happy, and sociable, and they may slur their speech, fall down, and make questionable decisions when under the influence of hydrocodone. They may also struggle to breath, have pinpoint pupils, be cold to the touch, have a bluish tinge to their skin, have a weak pulse, be confused, and have difficulties remaining conscious, which are signs of a hydrocodone overdose that requires immediate medical attention. Recognizing hydrocodone abuse can literally be lifesaving.

More signs of hydrocodone abuse include:

  • Inventing or exaggerating symptoms to get a prescription for the drug
  • Taking more of a licit prescription than prescribed or for longer than needed
  • Altering the drug and taking it in a manner other than as prescribed
  • Going to more than one doctor to get prescriptions, called “doctor shopping”
  • Mood swings from euphoric “highs” to depressed lows
  • Presence of drug paraphernalia and tools used to crush, cut, snort, smoke, or inject hydrocodone (e.g., rubber tubing, razors, credit cards, straws, syringes, rolled-up papers, etc.)
  • Empty pill bottles and pills in easy-to-reach locations
  • Powdery residue on clothing, face, and furniture
  • Trouble with money
  • Interactions with law enforcement and possible legal troubles
  • Increased secrecy and social withdrawal
  • Changes in social circles
  • Lack of interest in things and activities that used to be a priority in life
  • Drop in grades at school and/or production and attendance at work
  • Weight loss and reduced appetite
  • Irregular sleep patterns
  • Questionable sexual encounters
  • Increased risk-taking behaviors
  • Personality shift
  • Out-of-character actions that may be unpredictable and irrational
  • Outbursts of anger, aggression, hostility, violence, or self-harming behaviors
  • Lack of concern about personal appearance
  • Inability to regularly attend to normal obligations
  • Difficulties with relationships

Hydrocodone abuse can quickly lead to tolerance to the drug with regular use. When someone is tolerant to it, the same levels of hydrocodone will no longer have an effect and individuals will have to take more of it for the desired results. Chronic use also causes drug dependence, which occurs as the changes hydrocodone makes to brain chemistry and circuitry become more fixed. Individuals may now have difficulties feeling pleasure without hydrocodone, and willpower, short-term memory, and the ability to regulate moods normally may be impaired.

Difficult withdrawal symptoms come with dependence. These symptoms include both emotional disturbances and physical flu-like symptoms. Everyone who suffers from drug dependence is not necessarily battling addiction, however. Addiction is defined as a brain disease that impacts a person’s ability to function normally in everyday life, and it is signified by a lack of control over drug use. The American Society of Addiction Medicine (ASAM) reports that nearly 2 million Americans battled prescription opioid addiction in 2014.

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Getting Help for Hydrocodone Addiction

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Hydrocodone is a powerful opioid drug that hijacks normal brain functions and quickly leads to chemical dependency and often addiction. Individuals who are dependent on hydrocodone should never stop taking it “cold turkey,” as withdrawal symptoms can be significant.

If hydrocodone is suddenly stopped, the brain will attempt to rebalance itself causing the central nervous system to become hyperactive. Blood pressure, heart rate, and body temperature all spike. Nausea, vomiting, diarrhea, muscle aches, joint and bone pain, tearing up, runny nose, excessive yawning, chills, abdominal cramps, and dilated pupils are common physical opioid withdrawal symptoms. As levels of mood-regulating neurotransmitters dip without hydrocodone’s influence, depression, anxiety, difficulties sleeping, agitation, restlessness, irritability, and problems with thinking, focusing, and memory functions occur.

Medical detox is considered the optimal method for safely processing toxins like hydrocodone out of the body, as medical interventions, supervision, and supportive care can be vital during this time. Hydrocodone has a relatively quick duration of action, and typically stops working in the bloodstream in about four hours on average. This means that withdrawal may begin in about eight hours after hydrocodone has last been taken, indicating the need for early intervention and treatment. While withdrawal can begin this quickly, the National Library of Medicine (NLM) publishes that opioid withdrawal, in general, usually starts within about 12 hours after the last dose of an opioid drug.

There are several medications that the US Food and Drug Administration (FDA) approves for use in treating opioid dependence. The White House Office of National Drug Control Policy (ONDCP) publishes that methadone, buprenorphine, and naltrexone are all approved for use during opioid dependence treatment. Methadone and buprenorphine are both opioid substitution medications that can be used during detox to mitigate withdrawal symptoms and reduce cravings. They are long-acting and can be used in lower doses that can then be tapered down over a set period of time during detox.

Buprenorphine is only a partial opioid agonist, meaning that it doesn’t fully activate opioid receptors and therefore shouldn’t produce the same “high” as full agonists like hydrocodone do. Naltrexone is an opioid antagonist, which has the opposite effect, blocking opioid receptors and preventing further abuse of these drugs. Buprenorphine is often combined with an antagonist like naloxone to be used to sustain long-term abstinence from short-acting and more potent opioids. Naltrexone and buprenorphine/naloxone products are generally reserved for later in a treatment program, after hydrocodone is fully flushed from the body. Medications for specific symptoms of withdrawal are also useful during both addiction treatment and detox.

Beyond detox and pharmacological methods, hydrocodone addiction is treated with behavioral therapies and counseling. Both individual and group settings are useful in helping people to improve communication skills, coping mechanisms, and methods for regulating emotions and mitigating cravings. Therapies like Cognitive Behavioral Therapy (CBT) are helpful during addiction treatment, as they can help individuals to recognize destructive and negative thought patterns and what triggers them, and aid people in developing healthier ways of thinking and acting. Self-esteem and confidence levels are often escalated through CBT. Thoughts are directly related to actions, and behavioral therapies help to improve both.

NIDA publishes that drug addiction treatment can take many forms, including both residential and outpatient programs, and programs that are at least 90 days in duration are most beneficial for sustained recovery. Treatment is highly personal, and each individual may benefit from a different level of care with different methods employed. Detailed medical, mental health, and family history evaluations as well as an initial drug screening and regular assessments throughout treatment can ensure that the program is meeting all the needs of the individual. These needs may evolve during treatment, and individuals may move between levels of care as needed. Support groups, relapse prevention and life skills training, and aftercare services all help to sustain long-term recovery.