Vicodin is a Schedule II controlled medication that consists of two active agents. One agent is a synthetic narcotic painkiller (hydrocodone) and the other is an analgesic medication that does not require a prescription by itself (acetaminophen). Acetaminophen is found in many over-the-counter medications, including popular drugs like Tylenol. Hydrocodone is an opioid medication that is found in over 60 different products.
The primary therapeutic use of Vicodin is to treat pain, specifically to dull the experience of pain. This effect is accomplished by both medications in the drug. Vicodin is often prescribed to individuals recovering from surgery or to those who have chronic pain from some medical condition or injury.
How Does Vicodin Work?
The narcotic component of Vicodin, hydrocodone, attaches to the receptor sites in the brain that are involved in the experience of pain reduction. This results in a person experiencing an increased pain threshold as well as some mild euphoria, overall feelings of wellbeing, and sensations of pleasantness. Acetaminophen works in a similar manner. It also amplifies the effects of hydrocodone and has the added benefit of lowering fever.
With the long-term use of prescription pain relievers like Vicodin, tolerance can develop. Users eventually need more of the drug (higher dosages) in order to receive the same pain-relieving effects.
Over time, users can become dependent on the medication. As people continue taking the drug over time, the body learns to adapt to having the drug in its system and cannot function at a relatively “normal” level unless the drug is present. Once people stop taking the drug and the body begins to eliminate it from its system (mostly through the liver), the cellular mechanisms lose their sense of balance (homeostasis). This results in withdrawal symptoms.
Physical dependence occurs as a result of an individual developing a tolerance to the drug and experiencing withdrawal when going without it. Long-term use of Vicodin will produce some level of physical dependence in nearly everyone.
Withdrawal from Vicodin
There are several factors that will affect the exact symptoms and timeframe associated with withdrawing from Vicodin. These include the following factors:
- The length of time the person was taking the drug will affect both intensity of the symptoms and the duration of the withdrawal process. A person who has only taken Vicodin for few months will most likely not have as lengthy a period of withdrawal and as intense symptoms as someone who has taken it for years.
- Individuals who are taking higher dosages of the drug will have developed increased tolerance and most likely will have more serious withdrawal symptoms. In general, the dosage comes in three configurations:
- Vicodin (acetaminophen 300 mg/hydrocodone 5 mg): Individuals on this regimen are limited to eight daily tablets.
- Vicodin ES (acetaminophen 300 mg/Vicodin 7.5 mg): The maximum daily dosage is six tablets.
- Vicodin HP (acetaminophen 300 mg/ hydrocodone 10 mg): The maximum daily dosage is six tablets.
- Individual factors, such as the person’s metabolism, personality factors, stress, and so forth, will also affect the intensity of withdrawal symptoms and the timeline for withdrawal.
Individuals who abuse Vicodin do not merely take the maximum recommended daily dosages. Those who abuse the drug may have developed a very high tolerance to it, which may result in them taking many times the maximum suggested daily dosage. If the drug is discontinued, this will lead to severely intense withdrawal symptoms that will need to be closely monitored.
There is no standard timeline for withdrawal from Vicodin. The length and effects of the withdrawal process depend on the factors mentioned above and several other intervening factors. In general, withdrawal from Vicodin develops according to the following course:
Days 1-2: For many individuals, the first two days of abstinence are extremely challenging. The drug will start to leave the system immediately as the half-life of Vicodin is about four hours. Individuals who take fairly large amounts of Vicodin will begin to experience withdrawal symptoms within the first few hours of abstinence. Others, who have taken smaller or recommended dosages may not experience withdrawal symptoms until after the first day of abstinence. These initial symptoms may include:
- Loss of appetite
- Intense cravings for Vicodin
- Mental confusion
Days 3-5: The above symptoms may last for as long as a week but usually begin to subside within the first five days of abstinence. Other symptoms may be more prevalent between days three and five. These symptoms include:
- Intense cravings for Vicodin
- Abdominal pain
- Aches and pains in the muscles and joints
- General malaise
- Feelings of jitteriness or anxiety
Days 5-10: For most people, physical withdrawal symptoms peak between five and seven days and typically have resolved between five and ten days. During days 5-10, many individuals will still experience the following:
- Mood changes
- Occasional anxiety
- Feelings of emptiness
Beyond Day 10: There is a potential for individuals who were taking Vicodin for long periods of time or taking large amounts of Vicodin to experience long-term psychological issues associated with a more chronic withdrawal syndrome; this is sometimes referred to as post-acute withdrawal syndrome. This most often consists of symptoms like depression, anxiety, a poor outlook on life, and irritability. This syndrome may wax and wane for years in some individuals. People who experience these symptoms may be at a higher risk for relapse even years after they stopped taking the drug.
Withdrawal from Vicodin is not considered to be potentially fatal or physically harmful, but individuals in distress during the withdrawal process are at risk for self-harm.
Individuals are highly susceptible to relapse in the early stages of withdrawal from Vicodin due to the combination of physical withdrawal symptoms and cravings for the drug. People will experience almost immediate relief from the symptoms of withdrawal and cravings if they begin taking Vicodin during the withdrawal period. Thus, withdrawal from drugs that produce physical dependence is best negotiated with the assistance of some form of medical supervision. This can be performed in an inpatient or outpatient setting, but it is extremely important to have a physician monitor an individual’s withdrawal from Vicodin. Medical professionals can:
- Assist in reducing the physical effects of withdrawal by using medications such as benzodiazepines, antidepressant medications, methadone, buprenorphine, and medications to decrease nausea
- Assist in reducing cravings for Vicodin with medications such as naloxone, Suboxone, and others
- Be available to assist with any medical emergencies that arise
There is a large body of research that has repeatedly supported the notion that individuals who go through supervised medical detox programs have significantly lower relapse rates in the early stages of recovery than individuals who attempt to complete the process via the “cold turkey” process.
In addition, individuals who choose to participate in residential treatment programs (inpatient treatment) during the acute phases of recovery from drugs that are highly prone to produce physical dependence also appear to lower their risk of relapse compared to individuals who initially approach their early recovery in an outpatient treatment program. This may be due to the residential programs actually isolating individuals from certain environmental influences that produce strong triggers to relapse (e.g., friends who use drugs, boredom, stressful situations, etc.) or due to the close supervision these individuals receive.
Recovery after the Withdrawal Process
Simply going through a process of medical detox or going through withdrawal from Vicodin on one’s own is not sufficient to ensure recovery from Vicodin abuse or addiction. Individuals will need to participate in therapy, ideally as part of a comprehensive addiction treatment program, as well as long-term aftercare programs, such as the use of support groups (e.g., 12-Step meetings) or ongoing individual or group therapy. Relapse rates are relatively high, even for individuals who stay in formal treatment for lengthy periods of time; however, individuals who just go through the withdrawal process without engaging in long-term treatment for substance abuse relapse at significantly higher rates than those who engage in formal treatment programs.