Hydrocodone (Vicodin, Lortab, etc.) abuse, addiction & recovery

Opiates are considered natural, because nature creates the active ingredient molecules. Common opiates include opium, morphine, and codeine, which are made directly from poppy plants. An opioid is a substance (molecule) that is synthetic or partly synthetic. This means the active ingredients are created chemically. Hydrocodone is not considered an opiate because it is derived synthetically.

People often ask, “does hydrocodone have codeine in it?” The answer is yes and no. Hydrocodone is a semi-synthetic drug derived from codeine or thebaine—natural alkaloids derived from the resin of poppy seeds. So, you could say hydrocodone is made from codeine. It is currently one of the most commonly prescribed drugs in medical practice.

Hydrocodone is more potent than codeine but retains the same cough suppressant properties. Because of this, it is also prescribed as a cough suppressant for adults.

Hydrocodone was first patented in 1923, and the long-acting formulation was approved in the U.S. in 2013.

Hydrocodone is a Schedule II opioid analgesic with abuse risk similar to other drugs in its class, the Extended-Release/Long-Acting Opioid Analgesics.

Because of its high potential for abuse, hydrocodone is subject to certain controls including a requirement that patients have a written prescription from their doctor each time it is filled.

Over 99% of the global consumption of hydrocodone occurs in the U.S.; this is because hydrocodone is not widely available or used internationally.

Common side effects of hydrocodone are nausea, vomiting, constipation, drowsiness, dizziness, lightheadedness, anxiety, abnormally happy or sad mood, dry throat, difficulty urinating, rash, itching, and contraction of the pupils. Serious side effects include slowed or irregular breathing and chest tightness, and a high potential for addiction.

Hydrocodone is one of many opioid medications developed as a prescription to relieve severe pain and chronic pain. It’s potential for addiction is a serious side effect. The National Institute on Drug Abuse estimates that over two million Americans have misused or are dependent on opioid pain relievers.

Since hydrocodone can be habit-forming even when used as prescribed, do not share it with anyone—especially someone with a history of substance abuse or addiction. Keep hydrocodone in a place where others cannot get to it and properly dispose of it when you are finished.

Opioid pain relievers like hydrocodone are generally safe when taken for a short time and as prescribed by a doctor—but because they produce euphoria in addition to pain relief, they can be misused. People who are prescribed hydrocodone or other prescription opioids develop an addiction when they take increasingly larger amounts than the prescribed. Other times, they want to achieve the euphoric effect that comes with initial use. Hydrocodone addiction can be a serious problem.

People who are drawn to the euphoric effects of opioids may crush their medication and snort or inject it, releasing the active ingredients more quickly. Nearly any drug takes effect faster when introduced into the body through the lungs or bloodstream instead of the stomach.

Symptoms of abuse or addiction to hydrocodone include: constant drowsiness, unexplained bursts of euphoria, pinpoint pupils, chronic constipation or nausea, drunken behavior, tolerance or dependence on the drug, constantly requesting prescription refills, ignoring everyday responsibilities, losing money or personal property for unexplained reasons, and ignoring priorities like work or family.

Symptoms of hydrocodone withdrawal can be very unpleasant; however, they are not life threatening. Tapering can help reduce or eliminate withdrawal signs and symptoms. Symptoms can include runny nose, tearing eyes and yawning, restlessness or anxiety, irritability or mood change, increased pain, goose bumps, chills or sweating. Other symptoms are stomach cramps, nausea, vomiting or diarrhea, muscle cramping or aches and joint pain, tremors or muscle twitching, rapid heart rate, trouble sleeping, and thoughts of suicide.

Symptoms of hydrocodone overdose may include the following: narrowed or widened pupils, slow, shallow, or stopped breathing, slowed or stopped heartbeat. Other symptoms include cold, clammy, or blue skin, excessive sleepiness, loss of consciousness, or seizures.

Call for emergency medical help if you experience withdrawal or overdose symptoms in conjunction with taking hydrocodone or another opioid—and, after the emergency is over, look immediately into addiction detox and treatment options.

detoxification from hydrocodone dependence or addiction (or from other similar opioids) can be extremely uncomfortable if done without medical supervision and intervention. It can be life-threatening if the individual is also abusing other drugs such as alcohol or a class of medications known as Benzodiazepines (Xanax, Klonopin, Alprazolam, etc.).

Withdrawal symptoms generally start as soon as 8 to 12 hours after the last dose, but they are typically not severe in the first 24 hours. The time of onset, severity, and duration of withdrawal symptoms will vary based on the hydrocodone formulation used (immediate-release or extended-release), amount of drug used, over what period of time, and what route of administration (swallowing pills, smoking, injecting).

detox can begin prior to the onset of withdrawal symptoms based on history, drug testing, and constant symptom monitoring. RCA will monitor the patient around-the-clock, continually evaluating physiological and psychological symptoms and will use medications to control many of these symptoms.

Medications that may be used include those to wean off the hydrocodone and palliative or “comfort” medications such as Clonodine, Robaxin, Trazadone, Phenobarbital, Ativan (in case of seizure), Bentyl, Librium, Tigan, and others.

Physical/medical aspects of detox may last up to 10 days, but patients typically become medically stable after 6-7 days. This doesn’t mean they don’t still have symptoms—just that those symptoms may not require around-the-clock, constant medical attention.

Unfortunately, psychiatric symptoms and cravings for hydrocodone can continue for many months.

During evaluation, RCA staff administer the assessment in a calm environment, providing something to eat and beverages to keep the individual comfortable. If the patient cannot concentrate, has an onset of withdrawal symptoms, or finds it difficult to participate, the assessment can be divided into smaller sections. Comfort medications can be provided as soon as the nursing assessment and some tests are done

RCA staff provide a clear orientation to the treatment choices, the process, program rules, and expectations for participation to ensure each patient knows their options and to assist in decreasing any externally related anxiety about the process.

A controlled tapering of the drug, alleviating most withdrawal symptoms with medications (as noted previously) and wellness services is the safest, most tolerable method, resulting in the least discomfort.

As with any disorder, it’s also very important to involve family. During the initial assessment and intake processes, RCA identifies family members or significant others who will support the patient and their treatment goals and get them involved immediately.

Through wellness seminars, life skills workshops, and various therapies, RCA focuses patients on developing a balanced lifestyle that includes restoring healthy eating and sleeping habits, participation in physical exercise and recreational activities, as well as building healthy relationships and a healthy support group to get them started on the road to long-term recovery.

For patients who plan to detox fully from opioids, injectable Naltrexone sold under the trade name VIVITROL®, a form of long-term blocker, can be especially helpful. VIVITROL® are opioid “antagonists,” meaning they blocks the effects of opioid medications.

VIVITROL® binds to the receptor that opioids use to provide pleasurable feelings and does not allow the opioid to have its effect. In fact, its strength in binding to the receptor is so much greater than the opioids ability, it will knock the opioid off the receptions even if they were there first. Therefore, you should have 1-2 weeks without any opioid use to start vivitrol, as using it will put an active opioid user into complete withdrawal. It has also been shown to decrease cravings for both alcohol and opioids.

For patients who start with detoxification/treatment and find that complete abstinence is not tolerable for them due to cravings or difficulty functioning without medication, opioid replacement therapy is another method of ensuring that the opioid receptors remain at least partially engaged in a measured way while reducing these symptoms.

The main/active ingredient in Suboxone is buprenorphine. Buprenorphine is a partial agonist.  An agonist is a medication that binds to the receptor site—hydrocodone, heroin and other opioids are “full agonists,” they bind to the receptors and activate them fully producing the euphoria users seek. Suboxone is a partial agonist – it binds to and activates the same receptors as other opioids but has only part of the effect that a full agonist such as hydrocodone will have on the user.

Suboxone remains active in the bloodstream for longer and does not produce quite the same euphoric effects as full agonists like hydrocodone. The “high” is not as intense if these partial agonists are taken in higher doses, and buprenorphine even has a ceiling so that after a certain amount is taken, it no longer increases in effect.

Interestingly, Suboxone also contains the medication naloxone (that’s where the “oxone” portion of its name comes from). Naloxone, when given alone, is an opioid antagonist (completely blocks the effects of an opioid). If the Suboxone is taken as prescribed, the Naloxone will be inert (cause no effect). If, to get all the medication into the bloodstream at one time, the user crushes and injects the sublingual tablet, the naloxone effect dominates, and the medication blocks the receptors causing opioid withdrawal. This decreases the likelihood that the Suboxone will be abused.

Methadone is another form of medication-assisted treatment. A synthetic opioid, methadone is a longer-acting opioid replacement medication, it binds with the opiate receptors but without quite the euphoria as heroin and other opioids. Methadone is typically taken as a liquid medication and people taking it generally report to a clinic specializing in medication-assisted treatment at least 5 days per week.

Among other benefits, methadone maintenance gives users a daily, stable dose of opioids, decreases the likelihood that users will be injecting drugs, therefore getting Hepatitis or HIV, eliminates the need to find ways to pay for their opioids and helps people take the first steps toward getting back to normal life.

Although it is not entirely without its own health concerns, and dependence that is similar in strength to heroin, methadone is considered effective and safe and is included in the World Health Organization’s (WHO) list of Essential Medications.

One thing all treatment providers agree on—medications alone are not the complete answer for achieving long-term abstinence. Addiction is a brain disease that affects many aspects of a person’s physical and mental well-being as well as their personal, family and social relationships.

RCA also includes behavioral therapies, pragmatic workshops, counseling sessions, and long-term support groups when helping those with opioid abuse and dependency issues.