Vicodin has gone from being one of the most prescribed drugs in America to one of the medications that is most often mentioned in connection to the opioid epidemic that has spread across the country. The long-term effects of Vicodin make it a popular drug for people seeking pain relief, but they also raise the risk that its chronic use can cause serious health problems and increase the potential for physical and psychological dependence.
How Vicodin Works
The term Vicodin refers to the brand name for a combination of two painkilling drugs: paracetamol (also known as acetaminophen) and hydrocodone, the latter of which is an opioid derived from codeine. As an opioid, hydrocodone works by increasing the threshold of pain perception and reaction; a person who takes hydrocodone feels less pain because the brain is under the influence of a very powerful opioid that pushes the perception of pain out of reach. As part of its painkilling properties, hydrocodone produces a feeling of intense calm and pleasure in people after it is consumed. People who are in severe pain usually find this state very desirable as a welcome change from their discomfort. The acetaminophen present in the combination increases the effects of hydrocodone, but it is not as strong as the hydrocodone, which is a very powerful substance.
The Drug Enforcement Administration considers pure hydrocodone a Schedule II substance, which means that it has a strong possibility of causing physical and psychological dependence in its users, but it also has an acceptable medical use. For this reason, hydrocodone is rarely administered on its own; instead, it is combined with other drugs, like paracetamol, to make Vicodin.
The Drug Enforcement Administration had treated Vicodin as a Schedule III drug, meaning that there was both an accepted medical use and a minimal potential for abuse, so prescribing and marketing standards were laxer than the drugs in Schedules I and II. However, because of the rise in prescription painkiller abuse, the DEA upgraded Vicodin to a Schedule II drug, increasing restrictions on how the drug can be prescribed to patients. For example, patients must now present a written prescription to a pharmacy to receive their Vicodin, ending the days of doctors simply calling in a prescription to the pharmacy. MedPageToday notes that prescription refills are prohibited, so a patient who wants to get more Vicodin will have to submit a brand new prescription (with their doctor’s signature) to a pharmacist.
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Effects and Side Effects
As an opioid, using Vicodin carries the risk of effects found in other similar drugs, whether prescription or recreational. An opioid works by binding to specific opioid receptors in the brain, causing the initial burst of pleasure and calm and then preventing the brain from receiving pain signals passed along the central nervous system. These are the desired effects from a prescription of Vicodin; patients not only feel less pain or even no pain at all, but the euphoria provides a much-needed break from the stress of their physical pain. Such effects will be felt in both people taking Vicodin for legitimate medical uses and people who abuse Vicodin recreationally.
The desired effects of Vicodin come with side effects, which include:
- Nausea and constipation
- Difficulty breathing
- Persistent drowsiness
- Unpredictable mood changes
- Disorientation and impaired decision-making
Some level of these side effects is an inevitable discomfort of taking Vicodin, but if the medication is taken as prescribed, their duration and potency should be minimal. Abusive or recreational use will likely result in more severe side effects, which can include respiratory problems and even loss of consciousness.
Using Vicodin for a Long Time
As a habit-forming substance, especially among people who have health issues that require the administration of powerful opioids, it can become very difficult to discontinue use of Vicodin. The compulsion to keep taking Vicodin over a long period of time, even after the initial pain has been controlled and even in spite of the negative side effects, is one of the clearest characteristics of dependence on the medication. The hydrocodone in the Vicodin overwhelms the brain’s reward system, making patients feel supremely good about taking more Vicodin beyond normal parameters.
One result of this kind of long-term use is that patients and users become increasingly tolerant to Vicodin. This means that even prescribed use of the medication will not offer the same benefits and effects as it previously did. Users will have to consume more and more of the drug in order to derive the same feelings of euphoria and painlessness. As this happens, their physical and psychological need for Vicodin deepens to the point of a complete addiction. They will likely continue to abuse Vicodin even as related problems mount. They run out of money, they lose interest in work and family obligations, they ignore warnings and consequences, and their failing health is not a deterrent. Being on Vicodin becomes the new normal, such that stopping Vicodin intake causes painful withdrawal symptoms. These can be so distressing that they drive a patient back to the Vicodin.
Examples of Vicodin withdrawal symptoms include:
- Stomach cramps, nausea, vomiting, and diarrhea
- Muscle pain
- Irregular heart rate
- Alternately sweating and feeling chills
- Unpredictable mood swings
- Intense craving for more Vicodin
- Anxiety and agitation
Withdrawal symptoms typically start within a few hours of the last amounts of the hydrocodone/paracetamol leaving the bloodstream. They are at their worst between seven and 10 days after that point, and they can persist for a few weeks. The temptation to go back on Vicodin under the belief that even a single dose will alleviate all those symptoms is very strong; therefore, someone attempting to discontinue Vicodin intake after long-term use should not do so alone. The safest way to go off Vicodin is to do it at a drug addiction treatment facility, where medical staff are on hand to ensure that withdrawal symptoms are carefully managed.
Factors of Withdrawal
How long Vicodin withdrawal is experienced can depend on a number of factors – how long the consumption has been going on, how much of the medication has been consumed, if there are other drugs in the person’s system, any medical or mental health issues at play, and how the drug has been taken. For instance, although Vicodin is primarily used for its pain-blocking properties, the drug also interferes with how certain chemical transmitters in the brain regulate moods, emotions, motivation, and the anticipation of pleasure. As a person takes Vicodin for longer periods of time, tolerance levels of the drug increase, so the person takes more and more Vicodin. This means that the natural production of the chemical transmitters is disrupted, and the brain has to produce unnaturally high levels of the chemicals when Vicodin is removed.
The result is that a person who has a higher tolerance to Vicodin (and has thus been taking Vicodin for a long time) is likely to suffer from severe disruptions to moods and emotions during the withdrawal process. Someone who has been on Vicodin for a comparatively shorter period of time is unlikely to experience such pronounced disruptions and withdrawal symptoms, but they may have other, related factors that influence the length and severity of the withdrawal phase.
Health Problem and Vicodin
As more of the brain’s systems are unbalanced by the constant influx of Vicodin, there are other effects that arise. They can include:
- Opioid-induced hyperalgesia, where the user has an increased perception of pain even when none exists (and therefore takes more Vicodin to “treat” that “pain”)
- Difficulty remembering things
- Being in a constant state of drowsiness and fatigue
Doctors have noted other health problems that arise from the long-term use of Vicodin. ABC News noted that “a significant number of patients who have become addicted to Vicodin have gone completely deaf.” People taking as much as 75 pills every day, over a short period of time, develop rapidly progressive hearing loss, eventually leading to a state of deafness so comprehensive that even standard hearing aids cannot help. A doctor writing for ABC News pointed out that Vicodin is “ototoxic,” a term that refers to the chance of a drug causing damage to the ear. Some Vicodin users report symptoms of tinnitus, such as a persistent ringing in their ear. While this is a normal side effect of Vicodin use, chronic use of hydrocodone/paracetamol can destroy the sensory neural hair in the inner ears, leading to permanent deafness.
One of the biggest dangers of long-term consumption of Vicodin is that the hydrocodone/acetaminophen combination is no longer sufficient to induce the initial high that the user felt when first taking Vicodin as the tolerance for opioids grows. This might lead to a desire for more Vicodin, but it can also lead to the user wanting stronger opioids. As the Vicodin becomes insufficient or financially infeasible, cheaper alternatives like heroin (which, as an opioid, is chemically similar to Vicodin) are usually sought out. Abusing prescription medication is “a risk factor for heroin use,” warns the National Institute on Drug Abuse, and The New York Times noted that abuse of opioids like Vicodin is seen as a “gateway” to harder drugs like heroin.
The Importance of Treatment
Even when taken properly, Vicodin is a powerful medication that needs to be carefully monitored. If a person takes Vicodin recreationally or takes the drug too much out of a desperation for pain relief, it can lead to significant physical and psychological problems, a decline in lifestyle and relationships, and death. In 2012, the Drug Enforcement Administration logged 36 deaths in the United States as a result of hydrocodone abuse, a number that has exponentially grown with the rise of prescription drug abuse across the country. Tens of thousands more people have had to receive emergency medical treatment because of overdoses or other related problems.
This speaks to the necessity for comprehensive treatment for people who have been using Vicodin too much for too long. Abuse not only harms the user, it harms the people in their life. Rehabilitation will not only help the user overcome the addiction to Vicodin, it will also provide friends and family members with a foundation to heal and grow from the situation.
Treating a Vicodin addiction starts with the detox process, where the user will be paced through withdrawing from the drug. Withdrawal is an uncomfortable and potentially dangerous period, so it is important that this not be attempted without medical supervision. Doctors should be ready to intervene if the withdrawal symptoms are too distressing. More often than not, the individual will be given medications to lessen some of the extremes of opioid withdrawal. Such drugs include those that have buprenorphine as the active ingredient, of which the American Journal on Addictions noted that 97 percent of opioid withdrawals using buprenorphine “were successfully managed,” and as much as 62 percent of patients experienced “no symptoms of opioid withdrawal” when treated in that way.
It can take as long as 30 hours for the Vicodin detox process to complete, by which point the patient no longer has a physical craving for hydrocodone. However, clinical therapy is a necessary component of recovery, as a counselor can help the individual address the mental health fallout of the Vicodin abuse, as well as teach the person how to employ coping skills and strategies to offset the psychological dependence.
A proper course of treatment will cover both physical, psychological, and social elements of rehabilitation. The process is not an easy one, but with patience and application, individuals can put the days of their long-term Vicodin use behind them and enjoy rich and fulfilling lives free of its effects.