white pillsHydrocodone is a synthetic opioid drug that is used to treat pain. The drug acts on neurotransmitter sites in the brain that are involved in the suppression of the experience of pain.

Hydrocodone is primarily used in the relief of pain but does also occur in formulations as a cough suppressant. Hydrocodone is a Schedule II controlled substance, indicating it has a high potential for abuse and addiction.

Hydrocodone is a commonly prescribed drug in the United States. Estimates have indicated that over 90 percent of the worldwide supply of hydrocodone is in the US. It appears in combination with other medications in over 60 drugs, such as Vicodin, Norco, and Lortab.

Effects of Taking Hydrocodone

 
Aside from being a narcotic (pain reliever) and cough suppressant, taking hydrocodone products can result in some relatively common side effects that include:

  • Difficulty urinating
  • Constipation
  • Nausea
  • Changes in mood
  • Constricted pupils
  • Vomiting
  • Irregular respiration
  • Tightness in the chest
  • Drowsiness
  • Anxiety
  • Rash
  • Itching
  • Physical dependence
  • Addiction
  • Dizziness or lightheadedness

The Potential for Physical Dependence

 
All narcotic medications carry the potential for the development of physical dependence.  Physical dependence to a drug occurs as a result of two processes: tolerance and withdrawal.

Tolerance is a relatively common effect of taking any drug or medication for a significant period of time. As one takes the drug over a lengthy period, the body becomes habituated to the effects of the drug, and the person will require a higher dose of the drug to achieve the same effect that was achieved at lower doses. Tolerance can be a significant problem when individuals are taking drugs that have serious risks associated with their use.

Physical withdrawal occurs with only certain types of substances. This is a result of the body learning to operate efficiently only when the drug is in the system. When the drug is stopped and the levels of the drug in the system begin to decline, the body loses its sense of homeostasis or balance. There are disruptions in the levels of hormones, neurotransmitters, and other important substances that are experienced when the individual stops taking the drug. Severe physical withdrawal symptoms occur for drugs like alcohol, opioid medications, benzodiazepines, and a few others.

The Difference between Physical Dependence and Addiction

 

It is important to quickly mention the distinction between physical dependence and addiction. Individuals who take medications that contain hydrocodone for any significant period of time risk potentially developing a physical dependence on the drug. Just having physical dependence on a drug does not necessarily signify that the individual has a substance abuse problem or addiction issue. For instance, people who suffer from severe chronic pain due to physical injury or as a result of disease may take medications with hydrocodone in them for very lengthy periods of time.  These people will often become physically dependent on the drug. As long as they use the drug under the supervision of their physician and according to the specifications of their prescription, these individuals are not considered to have substance abuse issues or substance use disorders (addictions).

Addiction represents a chronic disordered condition where individuals engage in the nonmedical use of some type of drug (e.g., taking it to get “high” as opposed to relieving pain) and their use of the drug leads to a number of issues with functioning. Thus, addiction represents misuse of a drug, and it may or may not include the syndrome of physical dependence, whereas just being physically dependent on a drug does not indicate that one has an addiction.

Withdrawal from Hydrocodone

 

The length of hydrocodone withdrawal symptoms and their intensity will depend on a number of factors, including:

  • How long the person was taking the drug: People taking the drug for longer periods of time most often experience a longer withdrawal timeline.
  • How much tolerance the person has developed to the drug: Having a greater tolerance usually indicates that the person was taking higher dosages of the drug, and this may result in a longer withdrawal timeline and more intense withdrawal symptoms.
  • The person’s age: Typically, older individuals will experience more severe withdrawal symptoms and longer periods of withdrawal than younger individuals.
  • The psychological makeup of the individual: Some individuals are psychologically and emotionally better at coping with physical pain than others. If the person suffers from any co-occurring mental health issues, withdrawal can be more complex.
  • How the drug is stopped: Individuals who quit taking the drug abruptly will experience more severe and protracted withdrawal symptoms than individuals who undergo medical detox where withdrawal symptoms can be managed or a maintenance medication may be used.
  • The presence or use of other drugs: Individuals are dependent on multiple drugs will often have more difficulty with the withdrawal process.

 
Because of these intervening factors, it is virtually impossible to outline a specific timeline for withdrawal from hydrocodone or any other opioid drug. In general, the timeline for withdrawal will occur over a few days to a week to 10 days; however, in some instances, withdrawal may last weeks or months. The process often looks like this:

  • An acute phase that lasts 1-2 days: The symptoms in this phase are particularly distressing and will lead to the individual craving hydrocodone. Individuals are at a high risk for relapse if not supervised during withdrawal from hydrocodone, and the most critical period is within the first few days after discontinuing the drug. Hydrocodone products have an average half-life of about four hours. This means that individuals with severe physical dependence may experience acute symptoms within 4-8 hours after they stop taking the drug. Others may not experience these effects for an entire day. On average, withdrawal symptoms appear after about 12-16 hours following discontinuation of the drug.Once the symptoms kick in, the individual can expect:
  • Muscle aches
  • Flulike symptoms
  • Diarrhea
  • Cold clammy skin or chills
  • Profuse sweating
  • Anxiety
  • Mental confusion
  • General feelings of malaise
  • Pains
  • An extended but less intense period that occurs around day 3 and may last until the days 5-7: These symptoms are usually less intense. They consist of:
  • Chills
  • Shivering
  • Insomnia
  • Vomiting and abdominal cramping
  • Residual mood changes
  • Feelings of exhaustion
  • Mild symptoms through day 10: These symptoms may include feeling weak, jittery, moody, etc.
  • Long-term psychological symptoms: Post-acute withdrawal syndrome may occur in some individuals who suffer from severe addiction to hydrocodone. For many individuals, the physical withdrawal effects of hydrocodone have resolved by the end of the 10th day. Following the physical withdrawal period, some individuals may experience prolonged psychological symptoms that include cravings, mood swings (e.g., feelings of depression, anxiety, etc.), general feelings of malaise, issues with motivation, and so forth. These psychological symptoms may last for months and even last years in some cases.

Going through withdrawal from hydrocodone is not considered to be physically damaging or potentially fatal in the same way that alcohol withdrawal can be physically damaging; however, anyone experiencing the distressful effects of withdrawal is at risk for accidents and self-harm.

Quitting Cold Turkey or Using Medical Detox?

 
As with all opiates, medical detox is recommended for hydrocodone withdrawal. There are several reasons for this, including:

  • A physician-supervised medical detox program can lessen the intensity of physical withdrawal and therefore reduce the risk of relapse during the early period of recovery. Physicians can administer medications to deal with cravings, withdrawal symptoms, and mood issues. This can make the withdrawal process easier to manage.
  • A physician can slowly taper down the dose of the drug over a period of time, often via the use of a replacement medication like buprenorphine, to allow the individual to taper off the drug. This can result in a drastic reduction of withdrawal symptoms and a reduction in cravings for the drug.
  • With 24/7 supervision and no access to substances of abuse, relapse is less likely. The support offered in medical detox begins to set the foundation for comprehensive therapy in treatment.

Medical detox should always be followed with complete addiction treatment. Individuals who do not get involved in a treatment program after undergoing the physical withdrawal process are at a very high risk for relapse even after they complete detox.