Hydrocodone Addiction and Abuse

Hydrocodone is a semi synthetic, moderately potent opioid with a strong potential for abuse and addiction within a very short period.

Hydrocodone addiction | Table of Contents

Understanding Hydrocodone

Hydrocodone is a type of prescription painkiller widely prescribed for the treatment of mild to severe pain. This drug falls within the semisynthetic opioid category, unlike natural opiates such as morphine and Codeine, and is generally used to alleviate short-term pain followed by dental surgeries or injuries.

Vicodin, Narco® and Lortab® are a few versions of Hydrocodone. Each version of this opioid contains Hydrocodone and the non-opioid pain reliever, acetaminophen. The brand version that does not include acetaminophen is named Zohydro.

Types of Hydrocodone


Vicodin is a white tablet that has the dosage debossed on one side, and the word Vicodin with ES or HP debossed on the other.

Each Vicodin pill carries 300mg of acetaminophen and is available in three different Hydrocodone dosage levels, such as 5mg, 7.5mg, and 10mg. Under general circumstances, this drug is prescribed to be taken every four to six hours.

In 2011, around 131 million Americans were prescribed Vicodin, often in needless strengths and dosage. As a result, in 2014, lawmakers comprehended the growing dangers of Hydrocodone combined products and relisted them from Schedule III to Schedule II controlled substances. Following this, the Food and Drug Administration (FDA) ordered manufacturers to cease the production and market of products that contained more than 325mg of acetaminophen due to the damages it caused to livers and the imminent risks of an accidental drug overdose. The prior formulations consisted of 500mg to 700mg of acetaminophen in each pill.


Narco pills are available in three primary colors. The white one with orange specks is debossed with the word Watson on one side and 913 on the other. The orange pill has Narco® 729 debossed on one side, while the other side is bisected. The yellow pill comes with Narco 539 debossed on one side, and the other side bisected.

Although Vicodin is the most common Hydrocodone prescription, Narco is also reasonably common in the industry. This drug is mostly prescribed in two strengths – 7.5mg or 10mg of Hydrocodone with 325mg of acetaminophen.

Before the FDA took measures to reduce the acetaminophen levels in medications, Narco had the lowest concentration of acetaminophen. As a result, most addicts started to rely on Narco over other prescription painkillers to diminish the risks of ingesting too much acetaminophen. At present, Narco now has the highest levels of acetaminophen amongst the Hydrocodone variants.


Lortab is available in many colors, such as white with pink, green, or blue speaks or wholly pink, depending on its strength. The pills are debossed with the word ucb on one side, while numbers such as 901, 902, 903, or 910 are debossed on the other.


Zohydro is a capsule that is available in white, light green, dark blue, or dark brown, with the words Z3## (dosage) in black ink.

Zohydro is a pure Hydrocodone medication that shot to fame right after being the first to be approved by the FDA in 2013. This approval was announced against the advice of the FDAs scientific advisory board, which voted 11 2 in denial of the approval. The presence of acetaminophen is believed to reduce the risks of Hydrocodone abuse, which led many to question the agencys approval of Zohydro.

As pure Hydrocodone has a higher risk of abuse, Zohydro is only prescribed to alleviate severe chronic pain in individuals who are extremely tolerant of opioids and do not show any progress with other alternatives.

Immediate Effects of Hydrocodone Misuse and Abuse

Hydrocodone is a powerful, addictive opioid with a high risk of abuse, misuse, and addiction. Taking this drug for five consecutive days can lead to physical dependency. Below mentioned are a few immediate effects and symptoms of Hydrocodone misuse or abuse:

  • Disorientation
  • Blurry vision
  • Constipation
  • Diarrhea
  • Dry mouth
  • Euphoria or “high” feeling
  • Itchy skin
  • Lightheadedness
  • Nausea
  • Pinpoint pupils
  • Labored breathing
  • Seizures
  • Drowsiness
  • Slow heartbeat
  • slurred speech
  • Vomiting
  • Flushed skin
  • Frequent episodes of unconsciousness

Hydrocodone Addiction and Its Effects on the Body

Similar to most opioids, Hydrocodone operates by binding to the brain’s pain receptors and blocking or debilitating the pain signals completely. The mu receptors (pain receptors) function by altering different physiological functions and are accountable for the “high” generated through drug-taking. The euphoric sensations that follow drug abuse are produced here, encouraging individuals to indulge compulsively in the consumption of the drug. With frequent use, the opioids’ reaction in the frontal cortex disables the individual’s ability to make decisions and regulate mood.

Since most Hydrocodone addictions begin through the exploitation of prescriptions supplied by doctors, it can be quite challenging to identify the signs of addiction. However, prescription drug abuse begins when an individual ingests more pills than what is prescribed, continues to take the pills beyond the instructed timeframe and ingests the medicine in unusual ways (such as snorting or injecting them). Despite knowing the harmful nature of Hydrocodone, addicts tend to compulsively engage in its consumption.


Does hydrocodone make you sleepy?

Taking hydrocodone could make an individual feel tired and drowsy. However, it can also cause disrupted sleep patterns and insomnia.

How much hydrocodone is too much?

The dose is usually not more than six tablets per day. Norco® is one tablet every 4 to 6 hours as needed. Anything more is considered too much.

Does hydrocodone have codeine in it?

Hydrocodone is a synthetic opioid derivative of codeine.

Recognizing the Signs of Hydrocodone Addiction

The American Psychiatric Association (APA) has identified the criteria for substance use disorders and presented the information on its Diagnostic and Statistical Manual of Mental Disorders (DSM 5) A substance use disorder can range from mild, moderate, and severe. In the latest manual of DSM-V, the symptoms of opioid addiction include:

  • Taking Hydrocodone in higher doses or for longer than instructed.
  • Attempting to reduce or quit Hydrocodone use but failing miserably.
  • Investing large amounts of time in purchasing, using, and recovering from Hydrocodone use.
  • Experiencing intense cravings or urges to use Hydrocodone.
  • Neglecting obligations at work, home, or school due to Hydrocodone use.
  • Compulsively using Hydrocodone, although it clearly harms the individual’s relationships and health.
  • Losing interests in important social, occupational, or recreational activities or pastimes due to Hydrocodone use.
  • Continuing to use Hydrocodone, even though the individual has a physical or psychological problem that could worsen with Hydrocodone use.
  • Developing a tolerance to Hydrocodone and needing more of the drug to attain the desired effects.
  • Encountering withdrawal symptoms, which usually disappear after taking more Hydrocodone.
  • Ingesting Hydrocodone in any other methods or forms than as prescribed.

Dangers of Hydrocodone

Hydrocodene’s potential to cause tolerance and dependence within a very short period can increase the risks of overdose drastically. Long-term use of Hydrocodone can rewire the brain’s functions and cause deep-rooted effects on the individual’s mood, thoughts, and health. Individuals may often not recognize chronic health issues caused by long-term consumption of Hydrocodone until he/she undergoes detox.

Some of the health concerns include:

Gastrointestinal problems

Chronic constipation due to Hydrocodone addiction can result in bowel damages. This, in turn, can lead to

  • Hemorrhoids
  • Damages to the skin around and inside the anus
  • Fecal impaction, and rectal prolapse
  • Nerve damage and ulcers around the anus
  • Gastrointestinal bleeding
Respiratory damage

The long-term use of Hydrocodone decreases an individual’s breathing rate and directly restricts the amount of oxygen that reaches the brain. This could result in dire complications to the brain and other various organs as well as increase the risks of sudden deaths in individuals with sleep apnea and lung diseases. The method of consumption can also result in severe consequences as those who snort or smoke the drug can damage their lungs by inhaling the harsh chemicals.

Endocrine system damage

Heavy use of Hydrocodone reduces hormone levels in the body. Since some of these hormones include testosterone and estrogen, it can lead to fertility issues in men and women. Low hormones can also result in high risks of depression, anxiety, chronic fatigue syndrome, osteoporosis due to loss of muscle mass and bone fractures. A study has found that the levels of estrogen in women addicted to Hydrocodone were 30 to 70 percent lower than what was normal.

Hyperalgesia (Increased pain responses)

Individuals with an addiction to Hydrocodone are at a high risk of damaging opioid receptors in the brain, affecting how the brain perceives and responds to pain. Numerous studies have reported that individuals with a long-term addiction to Hydrocodone are much likely to experience excruciating pain. These individuals develop a heightened sensitivity to pain, making them require a longer period to recover from injuries or surgeries and experience intense cravings to use Hydrocodone to alleviate the pain.

Brain damage

A heavy addiction to Hydrocodone can alter the release and absorption of chemicals in the brain, specifically of the mood-regulating neurotransmitters named serotonin and dopamine. When one takes large doses of Hydrocodone for a significantly long period of time, huge amounts of feel-good neurotransmitters start to flood the brain. With time, this effect will modify the structures associated with emotional control, rational thinking, memory, and learning.

Long-term oxygen deprivation can also implicate the structure of the brain. Some of these damages are treatable with time, while some are not entirely reversible. The risks of irreversible brain damage as a result of reduced blood flow following a respiratory failure from Hydrocodone overdose are also imminent.

Loss of limbs

The lack of blood flow that occurs during Hydrocodone overdose may mandate the amputation of one or more limbs.

Liver damage

Most Hydrocodone variants containing acetaminophen pose a high risk of liver damage or failure. Studies have found that regular consumption of more than 4,000mg of acetaminophen can result in acute or chronic liver injury – which includes cirrhosis and liver failure. As a result, the Food and Drug Administration (FDA) restricted the approved levels of acetaminophen to 325mg in Hydrocodone products.

Hydrocodone Addiction Statistics

  • In 2014, doctors wrote 120 million prescriptions for Hydrocodone.
  • After the relisting of Hydrocodone from Schedule III controlled substances to Schedule II, there was an increase in seven pills per patient prescription rate throughout the US.
  • In 2015, about 12.5 million Americans had used Hydrocodone in the past year, and around 2 million had formed an addiction to it.

What is Hydrocodone Withdrawal?

Compulsive abuse of Hydrocodone will eventually result in physical dependency and addiction. As a consequence, Individuals will undergo agonizing withdrawal phases when attempting to quit or reduce the doses of Hydrocodone.

Hydrocodone withdrawal occurs primarily due to the drug’s effects on the brain’s reward and pleasure systems. Since the body received pleasure signals throughout the consumption of Hydrocodone, the brain stops its own production of natural feel-good chemicals. As a direct result, when Hydrocodone is no longer consumed, the individual may experience severe discomfort when the body and brain begin to function without the chemicals. This process is known as withdrawal.

Certain withdrawal symptoms can be detrimental if not monitored appropriately by a medical professional.

Symptoms of Hydrocodone Withdrawal

The abrupt cease of Hydrocodone consumption may cause distressing withdrawal symptoms on those who form a dependence. Blood pressure, respiration, body temperate, and heart rate may spike up simultaneously after quitting Hydrocodone use. Apart from these, the most common symptoms of physical and psychological Hydrocodone withdrawal symptoms are:

  • Anxiety
  • Agitation
  • Diarrhea
  • Dilated pupils
  • Fever
  • Insomnia
  • Depression
  • Muscle pains
  • Nausea and vomiting
  • Runny nose
  • Profuse sweating
  • Teary eyes
  • Yawning

Hydrocodone Withdrawal Timeline

First, 48 hours

Mild stomach and muscle pains, nausea, anxiety, depression, and flu-like symptoms may appear within the first 24 hours of withdrawal. Many find cravings and anxiety as the most challenging symptoms during this period.

Day 3 - 5

Acute withdrawal symptoms such as muscle aches, vomiting, diarrhea, and profuse sweating usually peak around the third day. For most individuals, withdrawal begins to fade during the fifth day, while emotional symptoms tend to remain but may improve as physical sensations begin to improve.

Day 6 - 14

As most of the physical symptoms subside, psychological symptoms such as anxiety, depression, and a strong urge to relapse will emerge during this period. Most patients will also start to feel remorseful and embarrassed about the things they did or said while being high.

After the first two weeks

Post-acute withdrawal symptoms may persist during this period depending upon the severity of the addiction. Psychological withdrawal symptoms such as anxiety may persist for 18 or 24 months after quitting the drug. Post-acute withdrawal symptoms may require further therapy and long-term treatment.

Addiction Recovery at Detox and Rehab Centers

Detox centers are primarily located at rehab centers to treat withdrawal symptoms and intense cravings in individuals with drug habits. After its successful completion, detox is typically followed by inpatient or outpatient rehab, depending on the severity of the addiction, the presence of any underlying co-occurring disorders, and the specific needs of the patient.

What to Expect from Detox for Hydrocodone Withdrawal

Detox is a process to help individuals undergo withdrawal in a safe and comfortable manner while flushing out the drug from their bodies. It is the preliminary stage of most Hydrocodone addiction treatment programs and is an excellent process that reduces the symptoms of withdrawal and diminishes the risks of relapse.

A Hydrocodone detox program will initially aim to stabilize an individual physically, which will take around a week to complete. Hydrocodone detox should include both pharmaceutical and holistic methods such as healthy diet plans, fitness programs, medications, spa, yoga, massage therapies, and structured sleeping timetables. Providing medical detox is vital for Hydrocodone addiction due to the severity of withdrawals.

Detox will most likely progress smoothly and as planned if all physical elements and psychological side effects are carefully addressed.

Inpatient Rehab for Hydrocodone Addiction

Inpatient or residential rehabs are revered as the most effective path for a faster and sustainable recovery, as they systematically detach the patient from his/her drug-encouraging environment. Forcing them to dedicate their time solely to overcome addiction.

A standard residential rehab comprises of individual psychotherapy sessions, group therapy, family therapy, and certain therapeutic amenities such as yoga, art, and music therapy. Doctors are usually available around the clock within the premises, as there could be individuals who might require specialized care due to co-occurring medical or mental conditions such as hypertension, diabetes, seizures, PTSD, ADHD, or depression.

Outpatient Rehab for Hydrocodone Addiction

Outpatient treatment programs are offered through designated facilities for a pre-agreed set of hours and days per week. Outpatient rehabs are the ideal treatment structures for individuals with demanding or unavoidable responsibilities, such as work or family.

Outpatient programs tend to vary in scope and other aspects, but the three key categories are:

  • Partial Hospitalization Programs (PHPs) – Partial Hospitalization Programs require the patients to check in five to seven days a week for six to eight hours per day. They often include accommodation options as well.
  • Intensive Outpatient Programs (IOPs) – Intensive Outpatient Programs require the patients to check in three to five days a week for three hours per day.
  • Standard Outpatient Programs (Ops) – Standard Outpatient Programs comprise of one group session a week and one individual session the next week.

Outpatient treatment programs also demand patients to engage in one-on-one counseling sessions, group therapy, and other recovery-focused activities and tasks. Dedication to the treatment plan, support groups, and mediation-assisted therapies can significantly minimize the risk of a relapse.

Hydrocodone Addiction Treatment Medications

Sustaining one’s recovery after a successful Hydrocodone detox most often requires the intervention of medication-assisted therapies, also known as MAT.

MAT for hydrocodone addiction comprises of the following medications:


Although this medication falls under the opioid category, when adhered to a strictly prescribed dose, Methadone works a miracle in safely and effectively disconnecting an individual from addiction.

Methadone operates by barricading the pain signals and euphoria that is generated through other opioids. It is usually available in pill, liquid, and wafer form and is prescribed mostly to be taken every 24 hours. As per the regulations in force, Methadone can only be distributed by an opioid treatment program approved by the Substance Abuse and Mental Health Services Administration (SAMHSA).


As a partial opioid agonist, Buprenorphine tends to mock the effects of opioids such as Hydrocodone but in a slightly weak manner. The effects of Buprenorphine may peak at a certain point, after which it will show no significant effects upon taking it.

Buprenorphine is usually prescribed as a tablet that dissolves under the tongue. In most scenarios, it is instructed to be taken three to seven times per week.

Buprenorphine is highly useful during the detox process and long-term treatments. Several Buprenorphine drugs, including Subutex®, Suboxone®, Zubsolv®, Sublocade®, and several other generic brands, are also used explicitly to treat dependency.


Naltrexone is an opioid-blocking medication that is utilized widely to support the maintenance of recovery and the treatment of alcohol or opioid addictions.

The pill and injectable form of this medication operate differently to Methadone and Buprenorphine, which suppress cravings by triggering opioid receptors. In contrast, Naltrexone completely shuts down opioid receptors to avoid patients from getting high. Theoretically, this mechanism should make Hydrocodone undesirable for addicts.

Naltrexone is only prescribed for individuals who are firm-set on recovery, as the responsibility of taking the medication falls solely on the patient – the pill is required once a day, while the injectable is prescribed once a month

There is a high risk of accidental overdose when a patient relapses while taking Naltrexone. This happens when the individual takes large doses of Hydrocodone in an attempt to ward off the effects of Naltrexone. Subsequently, when Naltrexone wears off, the effects of Hydrocodone may linger on and cause an overdose.

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