According to the Drug Enforcement Administration (DEA), hydrocodone is the most commonly prescribed opioids and also one of the most diverted and abused opioid drugs in America. The American Academy of Family Physicians (AAFP) reports that there were 135 million hydrocodone product prescriptions filled in 2012.
Hydrocodone is often prescribed as a narcotic pain reliever in combination products that also contain the over-the-counter painkiller acetaminophen in forms such as Vicodin, Lortab, or Lorcet. In 2014, the DEA reclassified hydrocodone as a Schedule II controlled substance up from a Schedule III drug. This means that it is now more tightly regulated and federally controlled, in part because of its high potential for diversion, abuse, and addiction. In 2014, over 4 million American adults (older than age 11) abused prescription painkillers, such as hydrocodone products, in the month leading up to the National Survey on Drug Use and Health (NSDUH).
How Hydrocodone Is Processed by the Body
Hydrocodone is similar in action to codeine and has a half-life of about 4.5 hours, according to the Food and Drug Administration (FDA). This means that the drug generally stops being active around this point.
How a person takes the drug may influence how quickly it takes action and also potentially how fast it wears off as well. For example, crushing and then injecting, smoking, or snorting hydrocodone will send it more rapidly into the bloodstream for a quicker onset of action than swallowing the tablets or capsules. These methods of use may also increase a person’s tolerance to the drug faster. As tolerance builds, more of the drug will be needed with each dose to keep feeling the drug’s effects, and with increased dosages, drug dependence forms.
When a person is dependent on a drug like hydrocodone, some of the chemical pathways in the brain that are involved in feeling pleasure, motivation, and memory are disrupted. The drug may become necessary for “normal” functioning. When a dependency forms, an individual may experience withdrawal symptoms when the drug is removed from the bloodstream. Withdrawal can start as soon as the drug stops being active in the body. Due to the potentially harmful side effects of opioid withdrawal syndrome, it is not recommended to stop taking hydrocodone without professional help, optimally provided through a medical detox program.
Side Effects and Complications of Hydrocodone Withdrawal
Hydrocodone is a potent opioid drug that acts as a central nervous system depressant. This means that it slows down a person’s breathing, heart rate, body temperature, and blood pressure while reducing stress, anxiety, and pain sensations. Opioids fill opioid receptors in the brain and cause a backlog of some of the neurotransmitters related to feeling pleasure, like dopamine. High levels of dopamine in the brain cause the “high,” or sense of euphoria, that opioids like hydrocodone can produce.
Once a dependence to hydrocodone is present, negative withdrawal symptoms that are both physical and psychological may ensue when the drug wears off. These symptoms include:
- Watery eyes
- Runny nose
- Muscle aches
- Bone and joint pain
- Tachycardia (irregular heart rate)
- Abdominal pain
- Hypertension (high blood pressure)
- Changes in appetite
- Shakes or tremors
- Drug cravings
- Dilated pupils
- Suicidal thoughts
Hydrocodone withdrawal is not usually considered life-threatening, although complications may arise. For example, a person may inhale their own vomit into the lungs, called aspiration, and develop a lung infection. Vomiting and diarrhea can also lead to dehydration or an imbalance of electrolytes in the body.
Perhaps the most dangerous physical complication is relapse, or a return to drug use, and the potential for a fatal overdose that comes with relapse. Drug overdose occurs when toxins overwhelm the body and can no longer be broken down or metabolized. Drug overdose is the leading cause of injury death in the United States, and opioid drugs were involved in six out of every 10 drug overdose deaths in 2014, the Centers for Disease Control (CDC) reports.
Relapse after stopping hydrocodone use for any length of time is especially dangerous since a person may try to take the same amount of the drug they were used to taking. Their body may no longer be able to handle it, resulting in a life-threatening overdose. An opioid overdose occurs when respiration levels are dropped too low and a person generally stops breathing. Shallow or labored breathing, a bluish tinge to the nails or fingers, low blood pressure and heart rate, confusion, and loss of consciousness may all be signs of an opioid overdose.
Duration and Intensity of Hydrocodone Withdrawal
Opioid withdrawal syndrome typically starts within 12 hours after the last dose, the US National Library of Medicine (NLM) reports, although since hydrocodone is considered to be a short-acting opioid, withdrawal may begin earlier. Opioid withdrawal symptoms generally peak in about 2-3 days and last 5-10 days on average, the National Highway Traffic Safety Association (NHTSA) publishes.
There are several factors that can impact the duration and severity of withdrawal. For instance, the more dependent a person is on hydrocodone, the more significant the withdrawal symptoms may be. Drug dependence may be influenced by family history of addiction, genetic and biological factors, as well as environmental aspects.
The method of use, any polydrug abuse, and age at first use can also play a role in drug dependence and therefore drug withdrawal. Someone who uses a lot of hydrocodone regularly and who smokes, snorts, or injects it may be more heavily dependent on it, and this may mean a more complicated and prolonged withdrawal period. Underlying, or co-occurring, mental health or medical conditions can also complicate withdrawal and add to the potential symptoms.
Managing Opioid Withdrawal
Hydrocodone withdrawal may occur in two main phases: early and late withdrawal. During the first day or so after stopping the drug, an individual may be irritable, tear up a lot, have a runny nose, sweat, and yawn. A few days after stopping hydrocodone, the rest of the withdrawal symptoms may begin and increase in severity.
Medical detox can help to manage withdrawal symptoms and reduce their intensity. Since opioid drugs are not recommended to be stopped “cold turkey,” often a weaning or tapering schedule may be set up to slowly lower the dosage over a set amount of time. Hydrocodone may be replaced with a longer-acting opioid drug during detox to help minimize withdrawal symptoms. Buprenorphine and methadone are two long-acting opioid drugs that are FDA-approved medications for use in treating opioid dependence, as published by the White House. These drugs act as opioid agonists, still filling up the opioid receptors in the brain, but lasting for longer than hydrocodone does. This means that the doses can be spread out and given less often, while still keeping withdrawal to a minimum during detox. Buprenorphine is also only a partial agonist, which means that it doesn’t produce the same euphoric effects as hydrocodone and other full agonists do.
Other medications may also be useful during detox to manage certain symptoms, like nausea, depression, or anxiety to name a few. One of the benefits of medical detox is that medical and mental health professionals are on hand to address any and all side effects of hydrocodone withdrawal that may crop up.
With a cold-turkey detox approach, the withdrawal timeline may be 5-10 days; however, due to the use of replacement medications, full detox from opiates may take months or even years. Psychological side effects of opioid withdrawal may linger beyond the initial withdrawal timeline, and these issues are addressed in ongoing therapy. Detox should therefore be closely followed with a substance abuse treatment program that includes counseling, therapy, implementation of new coping mechanisms, relapse prevention tools and techniques, and possibly pharmacological management.