Hydrocodone is a prescription opioid medication prescribed as a cough suppressant and pain medication. Hydrocodone is the most frequently prescribed opioid in the United States with over 83.6 million prescriptions dispensed for products containing hydrocodone in 2017. There are brand name and generic hydrocodone products marketed in the United States. A lot of hydrocodone products are combination products, combining hydrocodone with other cough medicines or other pain relievers, such as acetaminophen and ibuprofen. Many people may be familiar with the brand names of hydrocodone products: Vicodin, Norco, Vicoprofen and Hycodan. The most frequently prescribed combination is hydrocodone and acetaminophen.
Hydrocodone is abused for the euphoric “high” experienced by the user due to its opioid effects. Hydrocodone is currently classified as a Schedule II controlled substance in the United States because it has use as a medicinal pain reliever and cough suppressant, it also has a high abuse potential, which may lead to addiction.
So, how addictive is hydrocodone? In short, the drug is very addictive. Hydrocodone addiction can be devastating and can lead to the use of other substances. Understanding the addictive characteristics of hydrocodone and being aware of the signs and symptoms of hydrocodone addiction are vital to providing intervention and appropriate treatment to begin the path to recovery and prevent potentially tragic outcomes.
How Is Hydrocodone Abused?
Hydrocodone is commonly abused orally; however, it has become more common for experienced hydrocodone users to achieve the desired effects by snorting hydrocodone, smoking hydrocodone or injecting hydrocodone. Smoking, snorting, or injecting hydrocodone will cause a stronger high than when taken orally; however, these methods of abuse carry a significantly higher risk for overdose.
The euphoric sensation and feelings of relaxation caused by the use of hydrocodone begin to wear off three to four hours after use. It is common for people addicted to hydrocodone to use hydrocodone multiple times in a day to prevent withdrawal symptoms.
Signs of Hydrocodone Abuse
Hydrocodone addiction symptoms include physical and behavioral effects. Developing physical dependence and tolerance are possible with hydrocodone use. Physical dependence, resulting in withdrawal symptoms, may develop within a few days of hydrocodone use but is more common with regular use for several weeks or more. Because it is possible for tolerance to occur, people addicted to hydrocodone may need to gradually increase the dose and frequency of use to achieve a euphoric high and prevent withdrawal symptoms. Habitual hydrocodone users may swing back-and-forth between a relaxed state and an irritable state when withdrawal symptoms start. Knowing the signs of hydrocodone abuse and addiction is important in recognizing a substance use disorder and providing a path to recovery from hydrocodone abuse.
The physical signs of hydrocodone addiction and abuse include the physical effects of using the substance and also the physical symptoms of withdrawal.
The physical effects of hydrocodone use include:
- Pinpoint pupils
- Nausea and vomiting
- Slowed breathing
- Slowed heartbeat
- Slowed digestion leading to constipation
- Poor coordination
- Nausea and vomiting
- Slurred speech
- Dry mouth
The physical symptoms of withdrawal from hydrocodone include:
- Muscle or bone pain
- Feeling itchy
- Feeling nervous
In addition to the physical signs of hydrocodone’s use, certain behaviors can indicate substance use disorder. The behavioral signs of hydrocodone abuse and addiction include drug-seeking behaviors associated with addiction as well as behaviors resulting from the psychological effects of hydrocodone. Because hydrocodone is only available by prescription, there is widespread diversion and theft caused by people attempting to obtain the highly regulated medication.
Behaviors due to psychological effects of hydrocodone include:
- Mood changes; happiness and passiveness during the high followed by irritability and aggressiveness from the onset of withdrawal
- Slowed thinking and poor decision making
- Hiding needle marks from the view of others
- Increased risk-taking behavior
- Decreased motivation
- Abandonment of routine responsibilities
Drug-seeking behaviors associated with hydrocodone addiction include:
- Disregarding personal safety or interpersonal relationships to use hydrocodone
- Compulsive desire to use hydrocodone to alleviate withdrawal symptoms
- Stealing money or belongings to maintain the financial means to buy hydrocodone
- Seeing different doctors to get prescriptions for hydrocodone, also known as “doctor-shopping”
- Filling prescriptions at different pharmacies, especially pharmacies in different bordering states to evade detection on state-based prescription monitoring programs
- Stealing prescription pain medications from the medicine cabinets of friends and family
Side Effects of Hydrocodone Abuse
Hydrocodone side effects include short-term and long-term effects. The extent of the negative side effects of hydrocodone misuse depends on the extent of use, the dose of hydrocodone used and the other drugs, if any, used with hydrocodone.
When hydrocodone enters the brain, it binds to certain receptors called opioid receptors and causes a rush or a high and diminishes pain sensations. However, the rush of pleasurable feelings is accompanied by multiple short-term effects of hydrocodone, including:
- Warm flushing of the skin
- Slowed and clouded mental functioning
- Stomach pain
- Dry mouth
- Nausea and vomiting
- Going “on the nod” — swinging back-and-forth between conscious and semi-conscious state
- Muscle tightening
- Uncontrollable shaking of body parts
- Chest pain
- Possible overdose symptoms including significantly reduced and shallow breathing, coma and death
The long-term effects of hydrocodone are serious, and while some are made worse from frequent and repeated misuse of hydrocodone, some can occur in people who have used hydrocodone for a short time. These long-term effects include:
- Damage to the nose from sniffing or snorting
- Liver disease due to chronic ingestion of acetaminophen (commonly found in combination with hydrocodone)
- Constipation and stomach cramping
- Sexual dysfunction for men and irregular menstrual cycles for women
- Kidney disease
- Muscle breakdown
- Mental disorders including depression and personality disorders
- Development of tolerance which results in the person needing more frequent and higher doses
- Physical dependence leading to withdrawal symptoms
- Desire to use other substances, such as heroin, to continue to achieve a euphoric high
A common practice with hydrocodone misuse is to take it with other substances, such as alcohol, stimulants, muscle relaxants, benzodiazepines or other opioids. This practice is called polysubstance abuse and it is very dangerous. Polysubstance abuse can mask or worsen the symptoms of an overdose.
The CDC recently released results from a study indicating that hydrocodone and alcohol are commonly abused together and that more than half of Americans ages 12 and older who misused prescription pain medications also engaged in excessive alcohol consumption. Because of the likelihood of a person developing tolerance from repeated misuse of hydrocodone, the practice of mixing hydrocodone and oxycodone has become popular. Mixing hydrocodone with alcohol or oxycodone is dangerous because the substances all cause sedation and shallow breathing, which heightens the risk of overdose.
Because hydrocodone is commonly formulated with acetaminophen, the misuse of acetaminophen and hydrocodone carries a high risk for severe liver damage and impairment. Acetaminophen does not have any opioid or desirable effects; however, an accidental overdose on acetaminophen due to the frequent use of hydrocodone products containing acetaminophen is possible and dangerous.
Causes of Hydrocodone Addiction
In many cases, hydrocodone addiction does not start with an individual consciously seeking the drug out for abuse. Usually, hydrocodone addiction starts with the misuse — possibly unintentionally — of a legitimate prescription intended for short-term relief of pain due to injury or surgery.
Risk factors for hydrocodone abuse include:
- Taking high daily doses of prescription pain medication
- Unknowingly or knowingly obtaining overlapping prescriptions from multiple doctors and pharmacies
- Having a co-occurring mental illness or a history of alcohol or other substance abuse
- Living in rural areas and having a low income
Hydrocodone Withdrawal Symptoms
Hydrocodone withdrawal is uncomfortable and this feeds into the compulsive drug-seeking behaviors that are consistent with hydrocodone misuse and addiction.
Hydrocodone withdrawal symptoms include:
- Muscle or bone pain
- Feeling itchy
- Feeling nervous
Hydrocodone withdrawal after short-term use is possible because physical dependence may develop within a few days of hydrocodone use. However, experiencing withdrawal is more common with regular use over several weeks or more. Withdrawal symptoms can be managed through supportive care measures and can be mitigated by certain medications, such as clonidine, methadone and buprenorphine.
It is helpful for hydrocodone withdrawal to be managed by an experienced healthcare professional to ensure that all the physical and psychological needs of the individual are met, ensuring the best chance for a successful recovery.
Hydrocodone Abuse Facts and Statistics
The opioid epidemic affects people of all demographics and backgrounds. In 2016, it was estimated that 48.5 million people in the United States, or 18% of all people 12 years and older, reported using illicit drugs or prescription drugs in the previous year. Additionally, an estimated 2.2 million people in the United States received treatment during 2016 to address prescription drug use and misuse. Understanding hydrocodone statistics and the prevalence of hydrocodone misuse can help prevent continued misuse.
- Prevalence in men
Reported misuse of opioids, including hydrocodone, is consistently higher among males than females. According to the National Institute on Drug Abuse, research indicates that men are more likely to use larger doses and are more at risk for experiencing a fatal overdose. Misuse is highest among people between the ages of 18 and 34.
- Prevalence of abuse in women
Even though men are more likely to misuse opioids, women are more likely to be diagnosed with chronic pain which could contribute to high rates of opioid prescriptions dispensed among women of reproductive age. Also, although deaths from overdoses are more common among men, the number of deaths from overdose increased more rapidly for women compared to men — sevenfold versus fourfold — between 1999 to 2016. Women are also more likely to misuse prescription opioids for self-treating other problems such as tension, sleep disturbances or anxiety.
- Teen abuse
Potentially the most concerning of hydrocodone statistics and prescription opioid misuse, is the prevalence of misuse among teenagers. Prevalence rates declined from previous years. However, in 2018, the prevalence of reported misuse among 8th, 10th and 12th graders was 0.6%, 1.1% and 1.7% respectively. It is important to ensure that prescription pain medications are secured so that members of the household who are more prone to experimenting with opioid misuse are unable to do so.
- Senior citizen abuse
Every age group, including the elderly, are affected by hydrocodone misuse. Senior citizens are more at risk for inappropriate use secondary to lapses in memory regarding taking the medication and greater effects from smaller doses when compared to younger people. It is important for someone to monitor and assist elderly patients with their medications if it is suspected that medications are being taken inadvertently or inappropriately.
Hydrocodone Abuse and Treatment Trends in South Florida
Florida experienced a surge in drug overdose deaths with a majority involving the misuse of opioids. According to the National Institute on Drug Abuse, the age-adjusted rate of drug overdose deaths in Florida is higher than the national average and increased by 5.9% in Florida from 2016 to 2017 — from 23.7 per 100,000 to 25.1 per 100,000. The conscious and continued effort by physicians to reduce prescribing opioid pain relievers has helped buffer this increase; however, opioid abuse remains a prominent concern.
Hydrocodone overdoses are dangerous and can cause serious injuries and death. The chance of surviving a hydrocodone overdose is directly linked to how quickly someone receives medical aid. Narcan (naloxone) is a medication that reverses respiratory failure resulting from hydrocodone overdose. Naloxone works quickly, however the amount needed to reverse an overdose is dependent on the drugs and doses causing the overdose.
Hydrocodone overdose symptoms include:
- Pale or ashen skin
- Shallow or slow breathing
- Loss of consciousness
- Limp body
If you or someone you know is experiencing the signs of a hydrocodone overdose, it is important to call 9-1-1 and seek immediate medical attention. A hydrocodone overdose is a life-and-death situation and the sooner that appropriate medical care is rendered, the better the chance of survival.
How to Help Someone Abusing Hydrocodone
Recovery is possible for hydrocodone addiction. Great strides have been made in hydrocodone addiction treatment. When deciding to break the cycle of addiction, it is best to seek the help of trained healthcare professionals. Specially trained healthcare professionals can provide a personalized approach including medication-assisted treatment, appropriate psychological support and effective treatment for any conditions that may have developed.
To start the path to recovery, a stimulus is sometimes necessary. Because hydrocodone addiction can take complete control of an individual’s life, an intervention from family and friends may be necessary to convince the individual that recovery is achievable. A coordinated intervention can show a person struggling with hydrocodone addiction that his or her safety, health and happiness is important to the people who care about him or her. Guidance from a trained addiction specialist on how to properly carry out an intervention can help ensure the best outcome from the intervention.
Hydrocodone Addiction Treatment Options
There are a few different options for hydrocodone addiction treatment, including:
During a medical hydrocodone detox, a person’s body is cleansed of drugs and alcohol while under the care of medical professionals who help to manage various withdrawal symptoms. Although it is not always necessary to begin rehab with medical detox, many rehab centers do so because it promotes a commitment to recovery and reduces physical discomfort.
- Residential treatment
This type of treatment is provided in a setting where a person lives on-site at a rehab center to receive intensive levels of care. Residential treatment is ideal for people who are just starting recovery and may require a higher degree of monitoring and support.
- Outpatient treatment
This treatment program affords people more freedom during treatment because people live at home and participate in program sessions at a rehab center during the daytime. This form of treatment allows people to maintain a job and keep up with most of their current day-to-day responsibilities. The number of sessions that a person needs depends on their recovery plan but can range from part-time sessions occurring once or twice per week to a full-time outpatient program with daily sessions.
- Dual Diagnosis
It is common for people suffering from substance use disorders and addiction to have co-occurring mental illnesses. A person with dual diagnosis has an addictive disorder as well as a mental illness or mood disorder such as anxiety, bipolar disorder or depression. The mental illness or mood disorder may be the reason a person developed a hydrocodone addiction. Therefore, appropriate treatment of the mental illness or mood disorder is crucial to a successful rehab program.
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Key Points: Understanding Hydrocodone Abuse
Regarding hydrocodone abuse in general, keep the following key points in mind:
- Hydrocodone is a prescription opioid medication and has been identified as the most frequently prescribed opioid in the United States
- There are many brand name and generic hydrocodone products and many of them are combination products. The most frequently prescribed combination is hydrocodone and acetaminophen
- Brand names of hydrocodone products include Vicodin, Norco, Vicoprofen, and Hycodan
- Hydrocodone is currently classified as a Schedule II Controlled Substance in the United States because, although it has widely accepted use as a medicinal pain reliever and cough suppressant, it also has a high abuse potential which may lead to psychological and physical dependence
- Hydrocodone addiction symptoms include physical and behavioral effects
- Physical dependence and tolerance are possible with hydrocodone abuse. Physical dependence may develop within a few days of hydrocodone use but is more common with regular use for several weeks or more.
- Hydrocodone withdrawal is uncomfortable and feeds into the compulsive drug-seeking behaviors that are consistent with hydrocodone misuse and addiction.
- Hydrocodone withdrawal symptoms can include sweating, muscle or bone pain, chills and vomiting.
- Overdosing on hydrocodone is possible and can lead to serious injuries and death
- Hydrocodone overdose symptoms include pale or ashen skin, shallow or slow breathing and loss of consciousness. If you or someone you know is experiencing signs of a hydrocodone overdose, it is important to call 9-1-1 and seek immediate medical attention.
- Recovery from hydrocodone addiction is possible and there are many treatments, including medicines and behavioral therapies, that have been proven effective for successful rehab programs.
If you struggle with hydrocodone addiction and are considering treatment for recovery, call The Recovery Village Palm Beach at Baptist Health to speak with a representative who can get you started on the path to recovery. You deserve a healthier future, call today.
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Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.