According to the Drug Enforcement Administration (DEA), hydrocodone is the most often prescribed, diverted, and abused prescription opioid in the United States. Hydrocodone is a powerful and potent opioid drug, with cough suppressant and pain-relieving effects, and it is combined with over-the-counter pain medications like acetaminophen to produce combination products such as Vicodin. Other hydrocodone/acetaminophen products include Lorcet and Lortab.
Vicodin is prescribed to individuals who need relief from moderate to severe pain. According to the manufacturer, Vicodin is released in three different strength formations: Vicodin (containing 5 mg of hydrocodone), Vicodin ES (containing 7.5 mg of hydrocodone) and Vicodin HP (containing 10 mg of hydrocodone. All contain 300 mg of acetaminophen as well. On the street, Vicodin is sometimes called hydro, magnum, or vikes.
Specifics on Vicodin Abuse
The 2014 National Survey on Drug Use and Health (NSDUH) reports that in the month leading up to the survey, approximately 4.3 million Americans (aged 12 and older) were considered to be current abusers of prescription strength painkillers. NSDUH also indicates that the highest percentage of people who abused prescription pain relievers were those between the ages of 18 and 25.
The Monitoring the Future Survey (MTF), as published by the DEA, found that between 2002 and 2011, double the amount of high school seniors abused Vicodin than OxyContin, a non-combination prescription opioid painkiller containing oxymorphone. The MTF survey found that in 2015, close to 5 percent of 12th graders had abused Vicodin in the past year, the National Institute on Drug Abuse (NIDA) publishes. In 2014, hydrocodone combination products, including Vicodin, were reclassified from Schedule III to Schedule II controlled substances by the DEA, as they were shown to be just as readily abused and potentially addictive as the non-combination opioid painkillers that were already classified at the tighter regulation level.
When adolescents abuse prescription medications, they most frequently get them from a relative or friend for free, NIDA reports. The DEA publishes that individuals may also obtain hydrocodone through theft, “doctor shopping” practices (visiting more than one doctor to try and get prescriptions), over the Internet, or through fraudulent prescriptions. When someone uses a prescription drug in higher amounts than prescribed, for longer than the prescription is intended, in a manner outside the prescribed purpose, or for a reason other than as prescribed, it is considered drug abuse.
Vicodin slows down some of the functions of the central and autonomic nervous system, reducing anxiety and stress levels, as well as slowing body temperature, heart rate, respiration levels, and blood pressure. It also creates a backlog of some of the brain’s neurotransmitters like dopamine, which are related to how a person feels pleasure, by filling opioid receptors and preventing the natural reuptake and transmission of these chemicals. This is what creates the “high,” or intense burst of euphoria, a person may feel when they abuse Vicodin.
Vicodin tablets may be chewed, or crushed to then be smoked, snorted, or injected to produce this high. Altering the method in which the drug is taken can increase possible side effects, especially the risk for overdose and the potential for creating drug dependence that may lead to addiction.
Opioid drugs like Vicodin are thought to be extremely addictive. In the prescribing information for Vicodin, the manufacturer publishes warnings regarding the drug’s habit-forming nature, stating that drug dependence may set in after as little as a few days of using it, even when used as directed through a licit prescription. The American Society of Addiction Medicine (ASAM) reports that over 2.5 million people in the United States suffered from a substance use disorder involving an opioid drug (including both prescription opioids and heroin) in 2014.
One of the perils of Vicodin abuse is that of a potentially fatal overdose, usually the result of the drug slowing down a person’s respiration rate so much that they actually stop breathing altogether. The Centers for Disease Control and Prevention (CDC) calls prescription opioid drug overdose an epidemic in the United States, with around 14,000 people dying from an overdose in 2014. Hydrocodone products like Vicodin are among the top three drugs involved in these prescription drug overdose deaths (the others being methadone and oxycodone or OxyContin), the CDC further reports.
Signs of an opioid overdose include trouble breathing, pinpoint pupils, low or weak pulse, feeling cold to the touch, lack of alertness, significant drowsiness or loss of consciousness altogether, severe confusion, seizures, constipation, nausea and/or vomiting, and a bluish color to the lips, nails, and/or skin.
When Vicodin is altered – chewed or crushed for other methods of abuse (snorting, smoking, or injection) – the typical manner of absorption is changed. Instead of the drug being absorbed into the bloodstream through the gastrointestinal system as it is when the drug is swallowed, it is instead sent rapidly across the blood-brain barrier. This increases the potential for the drug to overwhelm the system and lead to a toxic overdose. Opioid overdose can be intensified with the introduction of alcohol or other drugs, especially those that also suppress the central nervous system, like benzodiazepines or antidepressants.
Additional Hazards of Vicodin Abuse
Overdose is not the only potential risk factor when abusing a drug like Vicodin. The Drug Abuse Warning Network (DAWN) publishes that more than 82,000 individuals were treated in an emergency department (ED) for an adverse reaction to hydrocodone in 2011. The acetaminophen component in Vicodin can create health issues too, such as possible severe liver toxicity, the Philadelphia Media Network warns. Early signs of liver damage include a loss of appetite, nausea, and vomiting, and may progress to liver failure or even death, the US Food and Drug Administration (FDA) states.
Vicodin can make people feel dizzy and nauseous. It can cause increased stomach pain and impair the ability to think clearly or make intelligent decisions. Someone under the influence of Vicodin may be more likely to participate in dangerous activities or have questionable sexual encounters. Mood swings, cloudy thinking, and short-term memory lapses are potential side effects of Vicodin use and abuse as well.
Abusing Vicodin intravenously (when the drug is injected, known as “IV drug use”) can lead to collapsed veins, scarring or “track marks,” skin infections, or even the potential for contracting an infectious disease, such as hepatitis or HIV/AIDS. Snorting the drug can cause chronic nosebleeds and a runny nose from damage to the sinus and nasal cavities. Respiratory infections may be side effects of both snorting or smoking Vicodin.
Other possible side effects of Vicodin, as published in the prescribing information, include skin rash, headaches, constipation, anxiety, fear, lethargy, drowsiness, inability to urinate normally, feeling lightheaded, nausea and vomiting, and trouble breathing. Malnutrition may also be a result of Vicodin abuse as the drug can change a person’s appetite.
Signs of Physical Dependence and Addiction
Opioid drugs are considered to be very physically and psychologically addictive. Physically, a person can develop a tolerance to a drug like Vicodin very easily. Generally, drug tolerance will set in before dependence does, and a person will feel the need to keep taking more Vicodin in order to produce the same effects as the drug caused before. Increasing dosage heightens all possible side effects, including the risk for overdose and the potential for creating a physical dependence.
Since Vicodin works to change some of the brain chemistry and circuitry involved in how a person regulates emotions, feels pleasure and processes reward, motivation, short-term memory, and willpower, with time, these changes may become fixed. This means that Vicodin will actually circumvent and change the method of production, transportation, and re-absorption of some of the brain’s naturally occurring neurotransmitters. With repeated use of Vicodin, these brain changes become more set, creating a physical dependence on the drug. When dependence has formed, individuals may not be able to feel “normal” without Vicodin. In addition, withdrawal symptoms, which are often the opposite of the feel-good sensations of the drug’s effects, can set in.
Addiction is a brain disease with both physical and psychological components. At the point physical dependence sets in, a person may be willing to go to great lengths to obtain the drug, suffer from intense drug cravings, and not be able to control their drug use. Vicodin likely becomes the center of their existence, and individuals may spend most of their time thinking about the drug, finding a way to get it, using it, and recovering from its effects. A person who is battling Vicodin addiction may try on many occasions to stop using the drug and not seem to be able to refrain from going back to it. They may use it even though they know that doing so will have great consequences.
Risk-taking behaviors may increase with Vicodin addiction, and legal and/or financial troubles may crop up. A person who struggles with a Vicodin addiction may have difficulties keeping up in school or at work, and work production or grades may drop. Other obligations may also be ignored or overlooked.
An individual’s social circle likely changes, as they are less likely to want to participate in activities they used to enjoy, and they may spend most of their time with others who also use Vicodin or other drugs, or on the Internet in drug abuse forums. Sleep patterns may change drastically, and a person’s physical appearance may decline. Loved ones and family members may notice increased secrecy, withdrawal, out-of-character behaviors, and frequent mood swings. Pill bottles in easy-to-reach locations may be further evidence of a Vicodin abuse problem as well as the presence of drug paraphernalia like syringes, rubber tubing, mirrors or other flat surfaces, rolled-up paper or dollar bills, open ballpoint pens or straws, and powder residue.
Treatment Options for Vicodin Abuse
Since Vicodin impacts so many parts of a person’s existence, treatment needs to be comprehensive in order to address issues. Facets of a complete substance abuse treatment program usually include the following:
- Medical management
- Behavioral therapies
- Group and individual counseling sessions
- Family involvement
- Holistic and complementary methods
- Stress management techniques
- Educational programs
- Life skills training
- Relapse prevention programs
- Support groups and/or 12-Step programs
- Aftercare and potentially transitional services
Detox, pharmaceutical tools, holistic methods, nutritional meal planning, fitness programs, and complementary medicine techniques, such as massage therapy, mindfulness meditation, and yoga, can help a person to heal physically. Therapies and counseling sessions can aid in restructuring brain chemistry that has been impacted by drug abuse and help to positively modify detrimental and harmful thought patterns and behaviors. Long-term recovery is enhanced by learning new life skills and ways to successfully manage stress, support groups, aftercare programs, and tools for helping to prevent relapse.
Vicodin addiction treatment may be provided in either an outpatient or inpatient setting, depending on the specific needs of the individual. A thorough assessment is done prior to admission to help families to decide what type of treatment program is right for them. Evaluations can also be done periodically throughout treatment, as individuals may move between levels of care as treatment and recovery progresses.
The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that close to 8 million adults in the United States battle two disorders at one time, or suffer from co-occurring disorders. A comprehensive substance abuse treatment program can address and treat multiple disorders at the same time in an integrated fashion to ensure that both disorders are managed simultaneously. Polydrug abuse, or abuse of more than one substance, can also be managed in a complete treatment program.
Transitional housing may be helpful after an inpatient treatment program, as it can provide a kind of in-between place for individuals. Transitional housing, often called “sober living homes” or “halfway houses,” are for individuals who wish to remain abstinent from drugs and alcohol and need help with the transition from structured treatment to everyday life. Relapse prevention tools, support groups, aftercare programs, and 12-Step groups can all help to prevent a return to drug use, or relapse.
Vicodin Withdrawal and Detox
Opioid drugs can induce a significant withdrawal syndrome that often requires the aid of medical detox to safely process the drugs from the body. In this respect, detox is often an important aspect of Vicodin abuse treatment programs. Medical detox uses both supportive and pharmacological methods to manage withdrawal, and it is generally performed in a secure and specialized facility. Detox, on average, lasts 5-7 days, although each person’s specific circumstances may affect the detox timeline a few days in either direction. Vicodin is considered a short-acting opioid drug, meaning that it stops being active in a person’s bloodstream rather quickly – in about 4-6 hours. Withdrawal symptoms can start as soon as the drug wears off. The National Library of Medicine (NLM) reports that opioid withdrawal syndrome generally starts within about 12 hours of the last dose on average.
Early withdrawal symptoms, which usually within the first 6-12 hours after the last dose through the first day or so, include yawning, tearing up, agitation, irritability, insomnia, runny nose, anxiety, muscle aches, and sweating. After a day or two, physical symptoms will peak and may include irregular heart rate and blood pressure, shallow breathing, joint and back pain, stomach cramps, nausea and vomiting, depressed appetite, diarrhea, dilated pupils, goosebumps, tremors, and weakness. Psychological symptoms of withdrawal, such as depression, restlessness, drug cravings, difficulty concentrating, anxiety, mental cloudiness, and mood swings, may continue for longer and require ongoing treatment to manage. Withdrawal duration and intensity are influenced by how physically dependent on Vicodin a person is. The length of time a person used it, higher doses, and other biological, genetic, and environmental factors can all play a role in drug dependence. The detox and withdrawal timeline can therefore be highly individual.
During medical detox, longer-acting opioid agonist medications may be substituted for the short-acting Vicodin in order to keep withdrawal symptoms from being as intense. Long-acting opioids like methadone or buprenorphine can be introduced, and then their levels slowly lowered over a period of time, called “tapering,” until they are completely stopped. Buprenorphine is a partial opioid agonist that does not fully activate the opioid receptors and therefore should not produce the same euphoric “high” even if it were to be abused. Many formulations of buprenorphine also contain the opioid agonist naloxone, which remains dormant unless activated by abuse or introduction of more opioids. Opioid agonists block opioid receptor sites, preventing their activation.
Many other medications may be useful during Vicodin detox as well, to manage specific symptoms of withdrawal, such as insomnia, depression, stomach upset, and some of the hyperactivity of the autonomic nervous system. Vitamins and supplements may be beneficial to improve overall physical health as well. The main goal of medical detox is to achieve a safe and healthy physical balance before moving on into a complete drug abuse treatment program.