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Hydrocodone: The Most Prescribed Opioid

Hydrocodone: The Most Prescribed Opioid

Table of Contents

What is Hydrocodone?

Hydrocodone is an opioid similar to morphine that is synthesized from codeine. Unlike naturally occurring opioids such as morphine and codeine, hydrocodone is created in a laboratory. It’s typically used in the treatment of moderate to severe pain and acts as both an antitussive (cough suppressant) and an analgesic (pain reliever). It is legally prescribed in the United States as a pain medication, however, it carries a high risk of abuse and addiction.

What is Hydrocodone Used For?

Hydrocodone was first developed in the 1920s by a German pharmaceutical company named Knoll. It was initially used as a cough suppressant and a pain reliever as it was thought to work better than codeine for coughs and as well as morphine for pain relief. Although the intention was that this drug would be less addictive than morphine and codeine, statistics show that it’s just as addictive as other opioids.

Hydrocodone is also used frequently for non-medical illicit purposes. Because it’s the most prescribed opioid in the United States, it is fairly easy to obtain. Users will obtain the drug by getting false prescriptions, stealing other peoples’ prescriptions, using prescriptions that aren’t for them, altering prescriptions, and purchasing the drug online. Hydrocodone is abused for its euphoric effects and feelings of “high” that the substance produces. It’s typically abused orally, with users often combining it with other substances.

How is Hydrocodone Used?

Hydrocodone comes in the form of extended-release (long-acting) capsules and tablets that are taken orally. The capsule is typically taken once every 12 hours and the tablet is typically taken once a day. Hydrocodone also comes in hundreds of combination medications such as Vicodin and Lortab which are made up of hydrocodone and acetaminophen.

What Are Its Brand Names?

Some of the brand names for hydrocodone are:

Hycodan

Lorcet

Lortab

Norco

Vicodine

Vicoprofen

Zohydro

What Are Its Street Names?

Some of the names used to describe illicit forms of hydrocodone are:

Hydros

Lorris

Tabls

Vicos/Vikos

Vics

Watsons

How Many Prescriptions Are Written?

Hydrocodone is the most prescribed opioid in the United States. Over the last three decades, the United States has been going through an opioid crisis. The over-prescription of opioid medication, as well as its highly addictive properties, have meant that more and more people have started to overdose and die from the misuse of opioids.

Presciption Use

In 2013, over 136.7 million prescriptions for hydrocodone and hydrocodone combination products were dispensed. In 2016, 93.7 million prescriptions were dispensed and in 2017, 83.6 million were dispensed.1 Due to the increasing efforts to combat the opioid crisis, increased awareness around the addictiveness of opioids, and stricter clinical guidelines for prescribing opioids, the rates of prescriptions dispensed has been started to go down over the years.1 This is a positive sign, however, opioid abuse is still a big problem in the U.S.

Misuse

In 2015, the National Survey on Drug Use and Health reported that a startling 7.2 million people over the age of 12 reported misusing hydrocodone. In 2016 and 2017, this number decreased to 6.9 million people and decreased again in 2018 to 5.5 million people.1 Considering that as many as 5.5 million people abuse hydrocodone alone, you can only imagine how many people are abusing other opioids and prescription medications, painting a concerning picture about the rates of opioid abuse in the U.S.1

According to the Drug Enforcement Administration (DEA), approximately 24.4 million people over the age of 12 have used hydrocodone for non-medical reasons, with a large portion of these people being teenagers.2

Drug Class and Drug Schedules

Drug Class

Hydrocodone belongs to the class of drugs known as opioids. Opioids are typically used in the treatment of moderate to severe pain, such as that experienced after surgery. Other common opioids include morphine, codeine, fentanyl, and oxycodone.

Drug Schedule

Hydrocodone is a controlled substance that is a Schedule II substance in the Controlled Substances Act.2 A Schedule II substance is one that has both a medically legitimate purpose but also carries a high potential for abuse. It also means that there are quotas on how much can be produced, restrictions on the number of prescriptions, and punishments for illegal use.2

When hydrocodone is combined with other medications such as acetaminophen or ibuprofen, it is considered to be a Schedule III substance.2 A schedule III substance has a legitimate medical purpose and carries a moderate to low risk of abuse. In other words, pure hydrocodone is considered to be riskier in terms of developing a dependence on the substance.

Effects of Hydrocodone

Short-Term Effects

When using hydrocodone, there is a risk that you might experience the following side effects:

Back pain

Constipation

Constricted pupils

Drowsiness

Dry mouth

Feelings of euphoria

Headache

Itchiness

Muscle tightening

Nausea

Rashes

Seizures

Slowed breathing

Stomach pain

Swelling in the face/throat/foot/leg/ankle

Trouble falling/staying asleep

Vomiting

Long-Term Effects

Some of the side-effects that you might experience if you use this drug for a long period of time are:

Brain damage

Coma 

Death 

Death 

Hypoxia 

Increased risk of heart attack 

Increased risk of infection 

Irregular menstruation 

Sexual dysfunction 

Substance abuse disorder 

Some of the more specific chronic health problems that can result from the prolonged use of hydrocodone are:

Gastrointestinal Problems

Excessive use can lead to chronic constipation which damages the bowels. This could result in hemorrhoids, tearing of the skin in and around the anus, ulcers, gastrointestinal bleeding, and other problems.

Respiratory Damage

Excessive use over a long period can reduce your breathing rate which reduces the amount of oxygen your body takes in. This can result in organ damage and even sudden death. Crushing and smoking the drug can also lead to lung damage.

Endocrine System Damage

Chronic use can decrease your hormone levels which can cause fertility problems. Lower hormone levels can also increase your risk of depression, anxiety, fatigue, osteoporosis, and bone fractures.

Hyperalgesia

Hyperalgesia occurs when you develop increased sensitivity to pain. Chronic use can damage the opioid receptors in your brain which impacts your brain’s response to pain. This may cause you to feel excessive pain because you are more sensitive to pain.

Brain Damage

Long term use can affect how the brain releases and absorbs chemicals. Over time this can impact the structure of the brain, resulting in changes to emotional controls, rationality, memory, and the ability to learn.

Liver Damage

Combination hydrocodone medication that includes acetaminophen or ibuprofen poses a high risk of liver damage or liver failure.

Can You Overdose on Hydrocodone?

Yes, you can. As with all other opioids, taking too much at once can result in an overdose. Symptoms of an overdose include:3

Slowed breathing

Tiredness

Muscle weakness

Cold and clammy skin

Narrowed or widened pupils

Slowed heartbeat

Coma

Death

In the event of an overdose, it is extremely important to seek emergency medical assistance. Overdosing can be fatal so it is important to seek help immediately and to administer naloxone if available. Naloxone is a mediation that is used to reverse the life-threatening effects of an overdose.3 You will still need to seek emergency medical help even after administering naloxone. If you administer one dose of naloxone and symptoms of an overdose return after a few minutes, another dose of naloxone should be administered.3

Is Hydrocodone Addictive?

Hydrocodone is considered to be highly addictive. This is for a couple of reasons. Firstly, it can make you experience the following feelings:

Euphoria

Increased sense of well-being

Numbness of physical and emotional pain

Relaxed and free of stress

Some people will misuse this drug to feel positive effects, while some will use it to numb any physical or emotional pain, or to cope with stress and anxiety.

Developing Dependence

Addiction develops over time, when you use the drug in excessive amounts, more frequently than normal, or for prolonged periods, your body begins to develop a physical dependence on the drug.

In other words, your body and brain learn to function with the drug in your system, therefore causing dependence on the drug. The more you take, the stronger your tolerance to the drug will be, and therefore you will need to take increasingly higher doses to feel the same desired effects. This will most likely result in dependence and addiction, and if you were to stop taking the drug, you would experience withdrawal symptoms.

What are the Signs of Addiction?

The Diagnostic and Statistical Manual of Mental Disorders outlines diagnostic criteria for substance use disorders. Signs that you or someone you know might be struggling with addiction are:

Taking higher doses than intended 

Taking the drug for longer than intended 

Spending a lot of time obtaining and using the drug 

Having strong cravings

Failing to fulfill responsibilities at work, home, or school 

Continuing to use the drug despite problems with relationships 

Not attending or giving up social activities or hobbies 

Putting yourself in dangerous situations to get the drug

Using the drug even when it has negatively impacted your physical or mental health 

Needing to use more of the drug to feel the same effects 

Developing withdrawal symptoms when not using the drugs 

Taking the drug in methods other than prescribed 

How Can You Stop Using Hydrocodone Safely?

The safest way to stop the use of hydrocodone is through medical detox. A medical detox program will help you to stop the drug use safely and comfortably. Typically, your vital signs will be monitored, and medications may be used to help alleviate withdrawal symptoms and prevent relapse. Medications will help to decrease cravings while lowering your tolerance. Medical detox can occur at inpatient or outpatient programs and will be tailored to each individual.

Hydrocodone Withdrawal

Depending on how long you have been taking hydrocodone and the dosage that you have been taking, you may experience withdrawal symptoms when you stop taking the substance. Typically, the withdrawal will begin between 6-12 hours after taking your last dose. Withdrawal symptoms usually peak within 72 hours and can last from between a week to a few months. For people who abuse hydrocodone and take it in excess amounts, withdrawal symptoms will usually be more severe. The best way to avoid withdrawal symptoms is to gradually taper off of drug use, as instructed by your physician.

Withdrawal Symptoms

When you have taken hydrocodone for a prolonged period of time, suddenly stopping taking the drug can cause you to experience withdrawal symptoms. Withdrawal symptoms occur when your body has developed tolerance and dependence. When your body learns to function with hydrocodone in your system, stopping its use will cause your body to react to its absence, producing withdrawal symptoms. Withdrawal symptoms include:

Anxiety 

Chills 

Diarrhea 

Fast heartbeat 

Irritability 

Loss of appetite 

Muscle aches 

Nausea 

Restlessness 

Runny nose

Sweating 

Teary eyes

Trouble sleeping 

Vomiting 

The safest way to stop the use of hydrocodone is to gradually lower the dose that you are taking. This should be done following your doctor’s instructions. If you are taking the drug illicitly, consider seeking out a medical detox to stop the use, or at the very least, lower the dose that you are taking gradually over the span of a few weeks or months, depending on how high the dosage you have been taking is.

Treatment Options for Hydrocodone Addiction

Treatment options for substance use disorder typically involve some form of counseling or therapy and medication-assisted therapy.

Medication

Medications that might be used in the treatment of hydrocodone addiction are buprenorphine, naloxone, methadone and naltrexone.4

Naloxone can help to reverse the effects of an overdose and can also be used in combination with other drugs such as buprenorphine during the treatment process to help alleviate withdrawal symptoms. Buprenorphine, methadone, and naltrexone all work to reduce cravings and withdrawal symptoms and to reduce to risk of relapse. These medications ‘replace’ hydrocodone in a sense, to help users adjust to the absence of hydrocodone.

Therapy

In addition to medication-assisted therapy, a major component of substance abuse disorder treatment is counseling, therapy, or peer support groups Counseling can occur in an inpatient facility or an outpatient facility.

To overcome substance use disorder, it is important to tackle the underlying reasons that started your substance abuse. Counseling and therapy will help to identify patterns surrounding use, problematic behaviors, and ways to improve on healthy habits and creating a healthier lifestyle. Treatment programs that include counseling will help patients to:

Learn relapse prevention skills, healthy boundaries, and communication skills 

Engage in alternative recreational activities 

Adopt skills that help to rebuild and maintain relationships 

Receive education surrounding substance abuse disorders 

Develop coping skills 

Develop coping skills 

Peer Support

Peer support groups such as Narcotics Anonymous also exist for people who struggle with substance use disorders and are looking to connect with other people who are experiencing the same thing. While peer support groups are not medical treatments, they help people to not feel alone in their experience and to help keep them accountable in their treatment.

The treatment of substance use disorders must address the whole person, their physical and mental health. Substance use disorder is often linked to various other aspects of a person, their personality, their mental health, their physical health, their personality traits, their relationships, and more. It is also very important to have the support of family and friends as recovery can be a long and hard journey, and it is essential to have a strong support group.