As a powerful and short-acting opioid narcotic, hydrocodone can be habit-forming even when used as directed with a legitimate prescription, Mayo Clinic warns. Often distributed as a combination product also containing an over-the-counter analgesic like aspirin or acetaminophen (e.g., Vicodin, Norco, Lortab, Lorcet, etc.), hydrocodone products are most often prescribed to treat pain.
Opioid drugs work to reduce pain sensations by binding to receptor sites in the brain and along the central nervous system, which in turn disrupts some of the neurotransmitters that send messages and signals throughout the body. Pleasure is increased, and anxiety, stress, and pain sensations are minimized. With regular disruption by a drug such as hydrocodone, the brain will actually stop moving around, absorbing, and even producing some of these chemical messengers in the same manner, as a dependence on the drug is formed. Circuitry is rewired to some areas of the brain, affecting reward processing, short-term memory, impulse control, and mood regulation.
As hydrocodone wears off, about eight hours after taking it, the brain may struggle to restore balance without the drug. The brain then undergoes what is called withdrawal, which can be uncomfortable with both physical and emotional side effects. As the brain and body detox from hydrocodone, withdrawal symptoms can be significant.
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Timeline and Symptoms of Hydrocodone Withdrawal
Withdrawal affects individuals who are dependent on a particular substance and typically starts when that substance stops being active in the bloodstream. The National Library of Medicine (NLM) publishes that for most opioid drugs, this is around 12 hours or so after the last dose.
The Substance Abuse and Mental Health Services (SAMSHA) reports that acute opioid withdrawal generally lasts around 4-10 days. Acute withdrawal refers to the bulk of the most intense symptoms. Side effects generally peak during this time and then start to taper off. Emotional symptoms and drug cravings may continue for several days or weeks beyond the acute withdrawal timeline, and this is sometimes referred to as protracted withdrawal. On average then, hydrocodone withdrawal starts within several hours after the last dose, peaks in about a week, and symptoms slowly dissipate over a few weeks.
Although withdrawal may differ from person to person, in general, the hydrocodone withdrawal timeline and subsequent side effects, may look something like this:
8-12 hours after last dose
- Muscle aches
- Runny nose
- Teary eyes
- Abdominal cramps
- Dilated pupils
- Joint and bone pain
- Chills and goosebumps
- High blood pressure
- Rapid and irregular heart rate
- Difficulties feeling anything, especially pleasure
- Mental “fogginess” and confusion
After day 10
- Difficulties sleeping
- Emotional blunting and mood depression
- Trouble thinking clearly and concentrating
Withdrawal Is Different for Everyone
Withdrawal side effects will vary in intensity and duration for each person during detox. Someone who uses hydrocodone less frequently and in smaller doses may be less dependent on the drug and therefore suffer from milder withdrawal symptoms that will wear off more quickly than someone taking larger amounts more often, for example. Age, biological makeup, any underlying mental health or medical disorders, and environmental factors like exposure to trauma and high levels of stress can also impact the severity and duration of withdrawal.
Opioid painkillers are some of the most widely abused drugs in the United States with around 4.5 million adults (aged 12 and older) abusing them at the time of the National Survey on Drug Use and Health (NSDUH) in 2014. Any time hydrocodone is taken without a prescription, or in a way other than as intended with a licit prescription, it is considered abuse. Altering hydrocodone tablets by chewing or crushing them and then taking the drug in a way other than via ingestion, such as snorting, smoking, or injecting it, can more rapidly lead to drug dependence and make detox more difficult. Taking hydrocodone with other drugs or alcohol can also impact withdrawal, potentially complicating the process and leading to more difficult side effects.
Abusing hydrocodone regularly can not only lead to drug dependence, but it may also devolve into addiction. Addiction is a brain disease that causes individuals to lose control over the amount of hydrocodone they take and how often they take it. Individuals battling addiction are unable to stop taking hydrocodone even when they know that taking the drug will have a multitude of negative consequences. The American Society of Addiction Medicine (ASAM) reports that nearly 2 million people in the United States suffer from prescription opioid addiction, according to data compiled in 2014.
Addiction to hydrocodone can influence the severity of withdrawal and how difficult the cravings and psychological symptoms may be. Relapse after detox can be especially dangerous, as individuals may attempt to return to abusing hydrocodone at previous levels; however, their tolerance has likely dipped and the drug may rapidly overwhelm the system, leading to a toxic overdose. The Centers for Disease Control and Prevention (CDC) publishes that nearly 80 people die from an opioid overdose in America every day.
Hydrocodone withdrawal symptoms are complicated. They can be unpredictable and even potentially dangerous, making medical detox the optimal method for helping the body and brain to process out the toxins safely.
Reducing Risk during Withdrawal
Stopping hydrocodone suddenly after building up a dependence on the drug can cause the central nervous system to rebound as it rushes to restore balance without the drug, leading to dangerous and intense withdrawal symptoms. The Journal of the American Medical Association (JAMA) Internal Medicine publishes that nearly 100,000 Americans visited an emergency department for a negative reaction involving a hydrocodone combination product in 2011.
Again, to avoid complications and minimize the risks of withdrawal, medical detox is generally recommended. Medical detox can even potentially shorten the withdrawal timeline, as symptoms are managed and reduced. Typically, medical detox is provided in a secure facility that offers medical supervision and mental health support around the clock for an average of 5-7 days, though the total withdrawal process may continue for weeks or months if a tapering schedule and/or substitution medications are used. Medications and supportive measures can help the brain to slowly restore itself while detoxing from hydrocodone, and help to prevent relapse and other potential complications that may arise.
Since hydrocodone is a short-acting opioid, it may be replaced with a longer-acting one during medical detox. Methadone and buprenorphine are both long-acting opioid drugs regularly used during medical detox to wean a person off opioid drugs. These drugs still activate opioid receptors in the brain, which helps to reduce cravings and keep withdrawal symptoms from being as intense, but they can be used in smaller amounts less frequently. They are then slowly tapered off over a set period of time and under close medical supervision by trained professionals.
Additional medications are often used on an off-label basis to treat hydrocodone dependence and manage withdrawal symptoms during detox. For example, clonidine is a blood pressure medication (an adrenergic antagonist) that aids in reducing cravings and minimizing opioid withdrawal symptoms when used during opioid dependence treatment and detox, per the Supplement to the Journal of Managed Care Pharmacy (JMCP). Medications and supplements targeting specific side effects of hydrocodone withdrawal (like sleep aids for insomnia or mood stabilizers for anxiety and/or depression) are beneficial during medical detox as well.
Medical detox can help individuals to reach healthy physical balance while minimizing withdrawal symptoms, thus providing a stable foundation for entrance into an addiction treatment program.