Treatment for Vicodin Addiction and Risks of Abuse


Vicodin is a previously-available brand name prescription formulation of hydrocodone and acetaminophen. This prescription painkiller combines an opioid, hydrocodone, with the antipyretic/analgesic, acetaminophen.1 Acetaminophen is widely available in many over-the-counter pain relievers as well as cold and cough preparations (in generic formulations and under the brand name Tylenol, for example).

The hydrocodone component of Vicodin is the real heavy hitter of this combination pain pill, and it works by binding to and activating opioid receptors to influence the way the brain responds to pain. Vicodin was previously dispensed in both extended- and immediate-release tablet formulations, though the primary active component hydrocodone is available in several formulations, including a liquid/oral solution form.2

Even when used as prescribed, some of the side effects of Vicodin may include:1,3

  • Sedation / drowsiness.
  • Dizziness / lightheadedness.
  • Constricted (narrowed) pupils.
  • Respiratory depression.
  • Nausea / vomiting.
  • Constipation.

More serious side effects of hydrocodone include hallucinations, confusion, agitation and other changes in mood or mental state, pain in the stomach/abdominal area, and complications during urination. It is rare, but some people may develop an allergic reaction to Vicodin. Medical help should be sought right away if experiencing difficulty breathing, swelling in the tongue or mouth, or a rash.4

Symptoms of a Vicodin overdose may include:1,5

  • Shallow, irregular, or stopped breathing.
  • Cold, clammy skin.
  • Blue-tinged lips, fingernails.
  • Low blood pressure / weak, thready pulse.
  • Circulatory collapse (in severe instances).
  • Extreme somnolence.
  • Muscle flaccidity.
  • Loss of consciousness.
  • Coma.

Vicodin overdoses can be deadly and could require emergency medical attention. If you suspect that you or someone nearby is experiencing the severe effects of Vicodin toxicity or overdose, call 911 immediately.

Risks

Hydrocodone-containing drugs, such as Vicodin, are Schedule II controlled substances—meaning that they have a known liability for abuse and dependence.6

Guidelines on pharmaceutical labeling urge medical practitioners to carefully assess patients—including inquiries about any prior substance abuse issues—to better assess the risk of diversion and/or misuse and to limit the abuse of opioid drugs like Vicodin.1

Non-medical misuse that involves excessive doses or dosing schedules, as well as use in conjunction with other substances, such as alcohol, may increase these risks as well as the risk of dangerous side effects such as pronounced respiratory depression.7

Vicodin can increase the sedating effects of alcohol or other medicines that cause drowsiness, such as CNS (central nervous system) depressants; additionally, combining alcohol with Vicodin or other acetaminophen-containing pharmaceuticals can increase the risk of liver damage.8

Older adults and young children may be more sensitive to the effects of the medication. Women who are pregnant or nursing must speak with their physician prior to taking Vicodin since use of the medication during pregnancy may result in acute opioid withdrawal in newborns—a condition known as neonatal abstinence syndrome.5,8

How Vicodin Affects the Body

The primary active component of Vicodin is hydrocodone. Like other opioid agonist drugs, hydrocodone is thought to exert many of its various physiological effects as a result of its interaction with and activation of opioid receptors throughout the central nervous system. It is primarily through this action that Vicodin exerts its analgesic effects, which additionally may be accompanied by drowsiness, changes in mood, and mental clouding.1 Vicodin also contains acetaminophen, which additionally acts as a mild analgesic and antipyretic (fever reducer) due to its inhibition of prostaglandin synthesis.1

Despite the therapeutic effects of hydrocodone and acetaminophen, both of these drugs can have dose-dependent adverse effects on several organ systems, including:1,9,10

  • LiverVicodin has acetaminophen in it. At high enough doses the acetaminophen in Vicodin could lead to liver injury. Safety guidelines point to taking no more than 4 grams per day to avoid the potential for hepatotoxicity. Taking Vicodin in doses that exceed prescribed guidelines increases this risk. Concurrent use of alcohol lowers this margin of safety, and could more quickly lead to painful hepatic necrosis and irreversible liver damage.
  • Intestines and stomachMany people experience decreased gastrointestinal motility and slowed GI transit times as a result of Vicodin use. Nausea, vomiting, and constipation may be associated with this effect. Chronic constipation and its accompanying complications (bowel obstruction, bowel perforation) may be more likely in people who use or misuse opioids like Vicodin in the long-term.
  • LungsOpioids suppress respiratory drive and can lead to slowed or stopped breathing at high enough doses. Respiratory depression may be associated with an increased risk of pneumonia. The risk of fatal respiratory arrest may be increased when opioids like Vicodin are misused at high doses and/or in combination with alcohol or other respiratory depressing drugs such as benzodiazepine sedatives.
  • Kidneys: Renal toxicity may develop in the context of inappropriate use. Acute kidney injury may be more likely in cases of pre-existing dehydration, hypotension, rhabdomyolysis (muscle injury), and urinary retention (such as that associated with an enlarged prostate).

Behavioral Changes Associated with Addiction

There are several telltale behavioral signs that could point to the development of an opioid use disorder involving Vicodin. Such changes might include a person dedicating increased amounts of time and energy to maintaining a supply of Vicodin. Other signs of Vicodin addiction include strong cravings for the drug and use of the drug in hazardous settings such as driving a car or operating machinery.11

People may appear to be tired all the time, or even intermittently lose consciousness (i.e., “nodding off”) if prescription opioids are being misused. Other addiction-related developments might include worsening financial issues from procuring the drug through illicit means. It is often difficult to keep up with commitments due to the demands of substance abuse, and people may experience a decline in work or school performance, as well as troubles in their personal relationships.

Treatment

Recovery from prescription opioid addiction is possible with comprehensive treatment. Medical detox for drugs like Vicodin is commonly sought by people with substantial levels of physical opioid dependence, as acute opioid withdrawal is often exceedingly unpleasant and difficult to manage alone.

When dependent individuals slow or stop taking opioids, they may experience withdrawal symptoms, such as:1,4

  • Insomnia.
  • Restlessness.
  • Stomach cramps.
  • Nausea.
  • Loss of appetite.
  • Muscle aches.
  • Joint pain.
  • Chills.
  • Sweating.
  • Yawning.
  • Runny eyes and nose.

While opioid withdrawal symptoms are seldom life-threatening, they can be incredibly uncomfortable. Left unmanaged, the often intense symptoms of withdrawal may be more likely to compel a quick return to opioid use. Medical detox can help to alleviate that discomfort to better ensure individuals do not relapse to Vicodin use during early recovery. In some instances, FDA-approved treatment medications, such as buprenorphine, may be used to first stabilize and, later, to maintain someone in recovery from opiate addiction. Supervising physicians will determine if the use of such medications is appropriate for each individual.

Treatment for Vicodin addiction takes many forms, such as inpatient rehab, outpatient treatment, partial hospitalization programs, intensive outpatient programs, and ongoing aftercare. Various therapies are used in different treatment programs, and particular therapies should be chosen based on the individual’s specific situation and progress in recovery. As with any successful addiction treatment program, treatment should be tailored to each client, ensuring that care is customized to best serve the individual.

When choosing a treatment program, an individual should consider the type of care needed. For example, those suffering from co-occurring conditions, such as a comorbid mental health issue (like depression, anxiety, or a personality disorder) or medical issue, may benefit from treatment programs equipped to handle or experienced in integrated treatment for a dual-diagnosis or co-occurring conditions.

One also needs to consider the location and pricing structure of a potential treatment facility, ensuring it fits best with the potential client’s financial and family situation. Many facilities offer family therapy as part of their offerings; if families wish to partake in this, they should opt for a facility that is closer to the family home to make transportation and therapy involvement more feasible.

References

  1. U.S. Department of Health and Human Services—Food & Drug Administration. (2006). Labelling-Medication Guide: Vicodin.
  2. Hamilton, RJ. (2019). Tarascon Pocket Pharmacopoeia, 2019 Deluxe Lab-Coat Edition. Jones & Bartlett Learning.
  3. U.S. National Library of Medicine—MedlinePlus. (2019). Hydrocodone Combination Products.
  4. U.S. National Library of Medicine—MedlinePlus. (2019). Hydrocodone.
  5. U.S. National Library of Medicine—MedlinePlus. (2018). Hydrocodone and acetaminophen overdose.
  6. U.S. Department of Justice—Drug Enforcement Administration Diversion Control Division. (2020). List of Controlled Substances.
  7. National Institute on Drug Abuse for Teens. (n.d.). Drug Facts—Prescription Pain Medications (Opioids).
  8. Mayo Clinic. (2020). Drugs and Supplements—Hydrocodone and Acetaminophen (Oral Route).
  9. National Institute on Drug Abuse. Opioids Act on Many Places in the Brain and Nervous System.
  10. Mallappallil, M., Sabu, J., Friedman, E. A., & Salifu, M. (2017). What Do We Know about Opioids and the Kidney?International journal of molecular sciences18(1), 223.
  11. Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.


About The Contributor

Scot Thomas, M.D.
Scot Thomas, M.D.

Senior Medical Editor, American Addiction Centers

Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More


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