Hydrocodone Addiction and Abuse

What is Hydrocodone?

Hydrocodone is a prescription opioid painkiller that is usually prescribed for moderate to severe pain. Hydrocodone is a semi-synthetic opioid, unlike morphine and codeine, which are natural opiates. Hydrocodone goes by the brand name Vicodin and is commonly prescribed to treat pain following dental surgeries and injuries. It is also used to reduce fevers. Hydrocodone is similar in strength to morphine and is only intended for short-term use while the person heals; however, like an opioid, it has high addiction potential and often becomes abused. The usual recommended dosage is 1-2 tablets every 4-6 hours. Hydrocodone comes in two forms, immediate-release, and extended-release. Other brand names include Norco and Lortab. There also exists a variety known as Zohydro, which lacks the non-opioid pain reliever acetaminophen. Hydrocodone is often known by the street names like Watson-387, hydro, and fluff. 

Hydrocodone Addiction and Abuse

In 2011, up to 131 million Americans were prescribed Vicodin. In 2014, hydrocodone was changed from a Schedule III to a Schedule II controlled substance in response to lawmakers recognizing the increasing dangers of misuse. Prescribing rates in the U.S. increased following this change. The Food and Drug Administration (FDA) later announced that manufacturers were to cease marketing products containing more than 325mg of acetaminophen. This change was brought about due to increased cases of liver damage and accidental overdoses with previous formulations that were made with 500 to 750 mg per pill. This has caused some debate, as acetaminophen is thought to lower hydrocodone’s risk of abuse. 

The FDA approved Zohydro, which lacks acetaminophen completely, despite advice to the contrary from its scientific advisory board, who voted 11-2 in opposition to the new drug’s approval. Zohydro is usually only prescribed to counter severe and chronic pain, especially in those who have become opioid-tolerant and are not responding well to other treatments. Over 6.2 billion hydrocodone pills were dispensed or sold in the United States in 2016, and prescription opioids such as hydrocodone are currently the most commonly abused prescription drugs in the United States.

Norco is a variety of hydrocodone that initially had the lowest amount of acetaminophen before the FDA’s changes. Because of this, some addicts would use Norco rather than other painkillers to avoid the risk of overconsuming acetaminophen. However, after the acceptable levels of acetaminophen changed, Norco now contains the highest percentage of it.

Hydrocodone Addiction

Like other opioids, hydrocodone works by binding to pain receptors known as mu-opioid receptors. This weakens or even blocks pain signals completely, and also creates positive reinforcement in the user’s brain. The euphoric sensations produced by hydrocodone encourage repeat use, and a dangerous cycle begins. Repeated use of opioids affects the brain’s frontal cortex, weakening the user’s decision-making skills and emotional control. Genetics play a role in the development of addiction, and some people misuse hydrocodone without ever developing an actual addiction. For others, as little as two weeks of abuse is enough to get them addicted. Some people develop hydrocodone addictions by accident because they’ve become tolerant to the drug’s effects and feel they need to take more to manage their pain adequately.

People who abuse prescription drugs will often take more pills than prescribed, continue taking them longer than they’re supposed to, or consume them through alternative methods such as snorting or injections. Often hydrocodone addicts will prioritize drug abuse over personal and professional responsibilities. Tolerance to hydrocodone also builds up over time, causing the addict to take larger and larger doses to avoid withdrawal symptoms. This increases the risk of an overdose as well as the financial burden on the addict.

Symptoms of Addiction

Long-term hydrocodone abuse causes structural changes in the brain that can have lasting effects on a user’s thoughts and personality even after usage has stopped. Excessive hydrocodone use can cause both physical and psychological dependence. Misuse of hydrocodone carries with it a variety of symptoms that include blurred vision, confusion, constipation/diarrhea, dry mouth, itchy skin, lightheadedness, nausea, drifting in and out of consciousness, constricted pupils, slowed breathing and heart rate, back pain, loss of appetite, shivering, chest tightness, seizures, drowsiness, slurred speech, ringing in the ears, headaches, vomiting, flushed skin, insomnia, liver and kidney problems, depression, and anxiety. The organ damage done by hydrocodone abuse can be challenging to reverse. A hydrocodone overdose can induce death within only a few minutes through oxygen deprivation as the person stops breathing. Mixing hydrocodone with other drugs like marijuana, alcohol, and Xanax is especially dangerous and can lead to death. 

Addicts often want to stop using; however, they often find themselves unable to reduce their dosages. They will usually continue misusing hydrocodone in spite of the symptoms, as mentioned earlier. They may even turn to street dealers if doctors refuse to file any more prescriptions for them. Street hydrocodone is often mixed with more powerful substances such as fentanyl, which increases the risk of a fatal overdose.

Treatment and Rehab

To begin treating someone for hydrocodone addiction, they must first undergo a detoxification phase in which the person endures withdrawal symptoms until the drug is out of their system. The longer they were addicted, the longer this process takes. The intensity of the addiction will also affect withdrawal symptoms. Withdrawal often involves symptoms such as muscle pain, sweating, irritability, anxiety, weakness, nausea, vomiting, fast heartbeat, insomnia, and dilated pupils. Symptoms like these result partly from the brain no longer knowing how to function appropriately without hydrocodone. 

Through treatment, addicts relearn healthy living. Drugs used to assist the detox phase include methadone and buprenorphine. These drugs relieve cravings and help keep withdrawal symptoms at bay. Stopping hydrocodone use too fast can significantly worsen withdrawal symptoms and make detox more difficult. Cognitive-behavioral therapy helps patients recognize the causes of their drug dependency and develop healthier coping mechanisms. Both inpatient and outpatient programs can treat hydrocodone addiction, and the social stigma surrounding addiction, in general, has been decreasing due to greater public awareness.