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Hydrocodone:

America's Most Popular Narcotic

Hydrocodone:

America's Most Popular Narcotic

Introduction

Do you know someone who is hooked on pain killers like Hydrocodone? In 2017, more than 17% of people in the United States had at least one prescription that contained an opioid medication.​​​1 Hydrocodone is the most commonly prescribed. Abuse of opioid pain medications has become a large problem in the United States. This article will discuss hydrocodone: what it is, how people use and abuse it, and what treatment options are available for addiction.

United States Prescriptions in 2017 Containing Opioids
17%

What is Hydrocodone?

Hydrocodone is a narcotic medication that changes the way the brain and nervous system respond to pain. It is made by adding synthetic chemicals to codeine, which comes from the opium poppy plant. Because hydrocodone is based from codeine, it is considered to be an opioid medication. Hydrocodone is available legally by prescription and is usually combined with other medications such as acetaminophen or antihistamines.

Hydrocodone, in combination with other medications, is available through dozens of prescription drugs. Some of the brand names more commonly prescribed include:

Anexia©

Hycomine©

Norco©

Dicodid©

Lorcet©

Tussionex©

Vicoprofen©

Hycodan©

Lortab©

Vicodin©

Extended release versions of hydrocodone include:

Hysingia©

Zohydro ER©

According to the U.S. Department of Justice Drug Enforcement Administration, hydrocodone is the most frequently prescribed narcotic in the United States. Research has shown it to be a more effective cough suppressant than codeine and almost as potent a pain reliever as morphine.

Hydrocodone Addiction by the Numbers

Trends show that the legal use of hydrocodone in the United States is decreasing.2 This trend amounts to a decrease of 53.1 million prescriptions. The figure is misleading, however, as this change is most likely due to an upgrade by the federal government in the classification of hydrocodone to a Schedule II narcotic in October 2014.3 This action resulted in a decrease in the number of hydrocodone/acetaminophen combination prescriptions, with a corresponding increase in the number of prescriptions for other narcotic medications that were not on the Schedule II list, such as codeine/acetaminophen (Tylenol© 3). Because of this offset, the overall number of opioid medication prescriptions did not decrease after the hydrocodone status change.

Possibly due to the decline in prescriptions for hydrocodone, abuse of it has also decreased in recent years. The National Survey on Drug Use and Health reported that 6,924,000 people aged 12 and over abused hydrocodone in 2016,4 while 6,262,000 abused it in 2017. This shows a decline of 662,000 people over the span of one year. However, hydrocodone remains the most abused prescription pain reliever, with 2.3 percent of the U.S. population aged 12 and older abusing hydrocodone in 2017. This percentage is higher than that of oxycodone abuse, which ranked second at 1.4 percent in 2017.5

History and Uses

Hydrocodone was first produced in Germany in the 1920s and was marketed under the brand name Dicodid©. This form of drug was used in Germany for many years but is no longer manufactured. It was first approved for use by the U.S. Food and Drug administration (FDA) in 1943 and was approved for use in combination with acetaminophen in 1998.​​​6 As other countries have discontinued the manufacture of hydrocodone and heavily regulate its use, most consumers of the drug live in the United States.

Use as a Pain Reliever

Hydrocodone has two primary uses. First, it is prescribed as a pain reliever for moderate to severe pain, usually in combination with acetaminophen or ibuprofen. Extended release versions of hydrocodone have recently become available as well. Combination versions of the medication are often prescribed for severe acute pain following injuries or surgeries. A common example is the use of Vicodin© by pro athletes who have sustained sports injuries, so that they can continue playing as they recover.

Use as a Cough Suppressant

Second, hydrocodone is prescribed in combination with antihistamines for chronic, non-productive cough and other symptoms of upper respiratory tract infection. The effects of hydrocodone last 4 to 6 hours, depending on factors such as weight, metabolism, liver function, other medications in a person’s system, and long-term use.​​​7

While hydrocodone is a highly effective pain reliever, it is usually used as a last resort for the treatment of chronic pain. This is because the effects decrease over time as the body builds up tolerance to the medication. When this happens, more of the drug is needed to achieve pain relief. Just like other opioid medications, hydrocodone is highly addictive and long-term use for chronic pain can lead to addiction and possible overdose.

How Abuse Starts

Abuse of hydrocodone often follows the legitimate use of the medication for treatment of severe pain. An individual who has sustained an injury or undergone surgery is prescribed a hydrocodone/acetaminophen combination medication for pain. The person builds up a tolerance to the medication over the course of treatment, leading them to take more medication than prescribed without first consulting their physician. As the body heals, the person continues to take more of the medication even though the pain from the initial injury or surgery has subsided. The person now finds that they are craving the drug and they go to more and more extreme lengths to get it, including visiting multiple doctors to get new prescriptions or purchasing pills from drug dealers.

Teenagers also abuse hydrocodone, as it is a drug that is easily obtained. Most teenagers begin abusing hydrocodone or other prescription drugs by stealing pills from the prescriptions their parents have for pain management. These prescriptions might be left over from prior injuries or surgeries and might not be missed by the people who used the medications in the first place. This is also how many people obtain hydrocodone to sell to others.

Side Effects

The side effect of hydrocodone that abusers find appealing is euphoria. This is the “high” that people who misuse pain killers often seek. One side effect of hydrocodone is sleepiness. Hydrocodone also suppresses pain, which is frequently was results in it’s abuse. Other side effects of hydrocodone include:

Slower Breathing

Agitation

Dizziness

Constipation

Nausea

Mental "Fog"

Headache

Abnormal Bloating

Diarrhea

Vomiting

Since it is a narcotic and is highly addictive, a person using hydrocodone long-term may find that the effects do not last 4 to 6 hours like the instructions say, resulting in the need to take the medication more often to avoid unpleasant side effects such as nausea.

Hydrocodone and Alcohol

When hydrocodone is combined with alcohol, its effects last longer in the body. Alcohol and hydrocodone are synergistic, meaning that one increases the effects of the other. However, since both are depressant medications, combining hydrocodone and alcohol can lead to fatal respiratory depression.​​​8 Other medications also interact with hydrocodone, enhancing its effects. These medications include:

Antidepressants (MAO inhibitors and tricyclic)

Anti-anxiety medications

Antihistamines

Other narcotic medications

Liver Damage

Hydrocodone is processed in the liver, just like all other narcotic medications. Research has not definitively linked it to liver damage. However, long term use or abuse of hydrocodone/acetaminophen combination medications can lead to acute acetaminophen liver damage. People who have been prescribed a hydrocodone/acetaminophen medication may begin taking more of the drug or taking it more often to increase its effects, or someone who abuses hydrocodone may take it too often to achieve a “high.” This can lead to toxic levels of acetaminophen in the liver. The FDA has now placed warnings on any hydrocodone/acetaminophen combination medications that contain more than 325 mg per tablet.​​​9

Withdrawal

Stopping hydrocodone after long term use can lead to withdrawal. The symptoms of withdrawal are similar to the symptoms of withdrawal for other opioid drugs, including:

Fast heartbeat

Fast breathing or shortness of breath

Restlessness

Irritability

Insomnia

Joint pain and muscle cramps

Sweating

Chills

Widened pupils causing sensitivity to light

Vomiting

These symptoms can last for several hours or days, depending on how long a person has used hydrocodone. Mild symptoms can be managed at home with help from a family member or friend. People with long term addictions or severe symptoms may need medical management to help them through the detoxification process to remove the drug from their systems. This usually occurs in an inpatient setting where symptoms can be monitored and medications can be used to prevent a severe health crisis.

Treatment for Hydrocodone Addiction

Addiction to hydrocodone can be prevented in a couple of ways. 

First, people who have been prescribed it for a health condition should take the medication exactly as prescribed. Taking more pills than prescribed or taking the medication more often than prescribed can lead to addiction.

Second, people who have been prescribed a hydrocodone medication should notify their doctors immediately if the effects of the medication are not as strong, if the medication stops working all together, or if they start craving the medication even when pain is not as severe. Physicians have access to many different types of pain-relieving medications, and a change in pain management treatment might be indicated rather than increasing the dose of hydrocodone.

Third, once a person no longer requires hydrocodone for severe pain, the remaining pills should be disposed of by taking them to a nearby prescription drug collection center. This is usually located at the local police department. Disposing of unused pills prevents them from falling into the hands of people who either abuse it or sell it to others.

If a person does become addicted to hydrocodone, the course of treatment is similar to treatment for other opioid addictions. Detox usually happens first, followed by treatments to help the person avoid use in the future. Here are some of the options available for treatment of hydrocodone addiction:​​​10

Behavioral Treatments

Behavioral treatments focus on changing the patterns of thinking and behaviors that lead to drug use. These can be accessed through either inpatient or outpatient treatment programs, depending on the severity of the addiction and the recommendation given by the person’s physician. Techniques used during behavioral treatment include:

Cognitive Behavioral Therapy

Counseling that helps a person identify the thought patterns that lead to drug use and gives the person strategies to help change those thought processes.

Marital and Family Counseling

Includes family members in the rehabilitation process and helps to repair or build relationships between the person and family members.

Contingency Management

Establishes a concrete reward system for abstaining from drug use. Vouchers that can be exchanged for items that have monetary value or prize incentive programs where people can earn chances to win prizes are often used.

Medications

Medications to ease the symptoms of withdrawal and to prevent future drug use are now readily available to people with hydrocodone addiction. These medications include:

Methadone: A synthetic medication that acts on the same receptors of the brain as hydrocodone, but at a lower intensity and longer duration. Methadone is used to reduce cravings and relieve the symptoms of withdrawal. Methadone is only available through specially licensed treatment programs for opioid addiction.

Buprenorphine: Another synthetic medication that acts on the same receptors of the brain as hydrocodone. Buprenorphine is not as highly regulated as Methadone, so it can be prescribed by certified medical personnel in an outpatient office setting. An injectable long-term release version of Buprenorphine was approved by the FDA in 2017, allowing people who require the medication to get an injection once per month rather than a daily dose. The number of patients that each physician can accept for buprenorphine treatment is capped by the federal government at 275. This is an increase from the previous limit of 100.

Naltrexone: This medication prevents hydrocodone from binding to the receptors of the brain, making it ineffective. Naltrexone is also available in an injectable, long-term formula that has been shown to be helpful to people who have difficulty taking medication regularly.

Medication Assisted Treatment is Effective in Treating Hydrocodone Addiction

Medications are highly effective in treating hydrocodone and other opioid addictions, but currently only 21 percent of people admitted to treatment programs for opioid addiction receive medications as a part of their treatment programs. This is due to the regulations limiting the use of methadone and buprenorphine. Research is ongoing to improve the incorporation of medications into the treatment of opioid addiction.

Opioid Treatment Patients that Receive Medicaitons as Part of Treatment
21%

While prescriptions for pain relievers containing hydrocodone seem harmless, habitual long-term use can lead to addiction. If a person slides into the addiction trap, viable treatment options are available. People struggling with addiction should not give up but should seek the help they need.

Resources

    1. “Opioid Overdose.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 19 Dec. 2018, www.cdc.gov/drugoverdose/data/prescribing.html.
    2. “Hydrocodone.” U.S. Department of Justice, Drug Enforcement Administration, Oct. 2018.
    3. Seago, Susan, et al. “Change in Prescription Habits after Federal Rescheduling of Hydrocodone Combination Products.” Proceedings (Baylor University. Medical Center), Baylor Health Care System, July 2016, www.ncbi.nlm.nih.gov/pubmed/27365868.
    4. Ahrnsbrak, Rebecca, et al. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health.” 2016 NSDUH Annual National Report | CBHSQ, Substance Abuse and Mental Health Services Administration, Sept. 2017, www.samhsa.gov/data/report/key-substance-use-and-mental-health-indicators-united-states-results-2016-national-survey.
    5. Bose, Jonaki, et al. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.” 2017 NSDUH Annual National Report | CBHSQ, Substance Abuse and Mental Health Services Administration, Sept. 2018, www.samhsa.gov/data/report/2017-nsduh-annual-national-report.
    6. “Hydrocodone.” National Institutes of Health, U.S. Department of Health and Human Services, 1 July 2019, livertox.nih.gov/Hydrocodone.htm.
    7. Cafasso, Jacquelyn. “How Long Does Hydrocodone Stay in Your System?” Healthline, Healthline Media, 29 Sept. 2018, www.healthline.com/health/how-long-does-hydrocodone-stay-in-your-system#withdrawal-symptoms.
    8. Ibid.
    9. “Hydrocodone.” National Institutes of Health, U.S. Department of Health and Human Services, 1 July 2019, livertox.nih.gov/Hydrocodone.htm.
    10. National Institute on Drug Abuse. “How Can Prescription Drug Addiction Be Treated?” National Institute on Drug Abuse, National Institute of Health, Dec. 2018, www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/how-can-prescription-drug-addiction-be-treated.