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Hydrocodone is a uniquely American drug. Every day, there is a new headline about the ongoing – and worsening – opioid crisis. But in spite of that, US doctors still prescribe powerful painkillers at rates unthinkable in other countries around the world.
Since prescription drugs sparked the opioid crisis, let’s take a closer look at one of the most popular pain medications – hydrocodone.
First Things First—What is Hydrocodone?
Hydrocodone is a semi-synthetic opioid made from codeine, which is itself made from the opium poppy. “Semi-synthetic” means that hydrocodone is a mixture of compounds found in nature and those that are manufactured exclusively in a laboratory.
Hydrocodone was first synthesized in Germany in 1920, in 1943, it gained approval by the Food and Drug administration for sale in the United States.
Available by prescription only, hydrocodone is used medically to treat moderate-to-severe pain, or as a cough suppressant. Although hydrocodone is only 59% as potent as morphine, when taken orally, the two drugs are roughly equivalent at reducing pain.
When taken as a painkiller, hydrocodone begins acting in approximately 10 to 30 minutes, with a duration of effects of between 4 and 8 hours.
Interestingly, although hydrocodone is not as strong as oxycodone, a study of emergency room patients determined that the two drugs were equally effective at treating the pain associated with broken bones.
As a cough suppressant, hydrocodone is superior to codeine.
Hydrocodone Statistics
List of Medications Containing Hydrocodone
Hydrocodone is available in both short-acting and long-acting/extended-release formulations. The American Pain Society recommends using a short-acting opioid for treating breakthrough pain, while long-acting opioids are given for around-the-clock pain.
The appropriate hydrocodone dosage range is between 2.5 mg and 10 mg four times per day.
Hydrocodone is an ingredient in hundreds of brand-name and generic combination medications, including:
The biggest consideration with these medications is how much acetaminophen is contained, because the maximum dosage is 4 mg within a 24-hour period. Acetaminophen is associated with liver damage.
Elixir/Oral Solution – 7.5 mg/500 mg per 15 mL
2.5 Tablets – 2.5 mg/500 mg
5 Tablets – 5 mg/500 mg
7.5 Tablets – 7.5 mg/500 mg
10 Tablets – 10 mg/500 mg
5 Tablets – 5 mg/325 mg
10 Tablets – 10 mg/325 mg
ES – 7.5 mg/300 mg
HP 10 mg/300 mg
The biggest consideration of these medications is how much ibuprofen is contained, because the maximum dosage is 800 mg per dose or 3200 mg within a 24-hour period. Ibuprofen is associated with stomach or intestinal damage.
2.5 tablets – hydrocodone bitartrate 2.5 mg/ibuprofen 200 mg
5 tablets – 5 mg/200 mg
10 tablets – 10 mg/200 mg
What Are the Side Effects of Hydrocodone Abuse?
Like other opioid medications, hydrocodone carries a risk of numerous side effects, such as:
Hydrocodone and Dangerous Drug Interactions
Hydrocodone and other prescription painkillers produce central nervous system depression and should not be used in combination with certain other substances.
Using hydrocodone with alcohol or any of these other medications can magnify CNS depression, potentially to a fatal degree:
Significantly, 75% of all overdoses – and 98% of those that turn fatal – involve more than one substance.
Why Do People Abuse Hydrocodone?
One of the biggest hazards of hydrocodone use or misuse is an extremely high potential for dependence and addiction.
The FIRST reason why people misuse hydrocodone medications is simply because they like getting high. Hydrocodone works by blocking pain messages from the brain. But it also tricks the brain into artificially increasing the production of dopamine– the neurotransmitter associated with pleasure, reward, learning, and motivation.
Elevated levels of dopamine create a euphoric sense of profound well-being in the user – the “high”. Very quickly, their brain learns that taking hydrocodone results in a pleasurable reward, and so the person is motivated to repeat the behavior.
In other words, they choose to take the drug to feel good.
But the SECOND reason why people abuse hydrocodone is much darker – they are compelled to take the drug to keep from feeling bad. Choice isn’t even a factor.
Hydrocodone and Addiction
This artificial over-stimulation has a rebound effect. Soon, the body begins to slow down natural dopamine production. This means that the person has to take more and more of the medication in order to realize the same effects. This is known as tolerance.
Opioid tolerance can occur even when the medication is used exactly as prescribed, but misuse speeds up the development of the problem.
Eventually, natural dopamine production stops altogether, and the only way for the user to experience pleasure – or even feel normal – is to take more hydrocodone. In fact, when the drug is discontinued or isn’t available, their body goes into a kind of shock known as withdrawal.
While not particularly dangerous, hydrocodone withdrawal can be so painfully uncomfortable as to trigger uncontrollable drug cravings and use. Opioid withdrawal can manifest in as little as 12 hours following the last dose.
The habit-forming nature of hydrocodone has been known to medical professionals for decades, with reports of euphoria and habituation published as far back as 1923. In 1961, the first medical report describing hydrocodone dependence and addiction was published.
Celebrities who have struggled with hydrocodone addiction:
Symptoms of Hydrocodone Withdrawal
The symptoms of hydrocodone withdrawal begin 12-30 hours following the previous dosage and typically last about five days. In heavy or long-term hydrocodone users/abusers, some symptoms may persist up to two weeks.
Most people in hydrocodone withdrawal talk about an overall feeling of being ill, as if they have a bad case of the flu. This is why opioid addicts in withdrawal will describe themselves as “sick”.
Fortunately, there are some FDA-approved medications that can help ease the symptoms of hydrocodone withdrawal. Treatment professionals may recommend opioid replacement therapy (ORT) – replacing the abused opioid with a longer-acting and less-euphoric one.
This allows the recovering addict to regain some stability while experiencing fewer symptoms and cravings. With ORT and behavioral counseling, up to two-thirds of rehab clients are able to completely abstain from use, and up to 95% significantly reduce illicit opioid misuse.
ORT has been endorsed by the World Health Organization and the United Nations Office on Drugs.
Warning Signs of Hydrocodone Misuse
Substance abuse does not exist in a vacuum – there are recognizable signs of a developing or existing problem.
Overdose: The Chief Danger of Hydrocodone Abuse
Besides the aforementioned side effects, the biggest hazard of hydrocodone abuse is an increased risk ofoverdose. In 2017, it is estimated that an all-time high of almost 74,000 Americans died because of accidental drug overdoses, and one-third of those were due to prescription opioids like hydrocodone.
Here’s the scary part – while 2017 was a record year for drug poisoning deaths in this country, EVERY recent year has set a new record over the previous year. In fact, if the estimate for 2017 is correct, then the number of drug deaths in America has doubled in the past 10 years. In 2008, there were “only” 36,450 accidental fatal overdoses.
Hydrocodone overdose victims typically die from respiratory depression– they choke to death because they can’t get enough oxygen to supply the demands of their brain, major organs, and bodily systems.
There are three main reasons why this happens:
Recognizing a Hydrocodone Overdose
Hydrocodone overdoses can be especially difficult to distinguish, because during a “normal” high, a user might normally nod off or even pass out. This very typical reaction is virtually identical to an overdose. To ease the confusion, here are some warning signs of a potential overdose:
There are two critically-important things to remember about a possible opioid overdose:
FIRST, someone who is merely “extra- high” will still be able to respond to outside stimulus such as hearing the name, being shaken, pain, etc. Conversely, overdose victims are typically total in unresponsive.
SECOND – people do not normally die immediately during a hydrocodone overdose. In fact, and overdose is progressive, taking between 1 and 3 hours. This is especially important, because there still may be time to save their life – IF the proper measures are taken.
Responding During A Hydrocodone Overdose
Here are some life-saving guidelines, released by the Harm Reduction Coalition.
First Step: Assess the warning signs:
Second Step: If they won’t answer or wake up, try to get a response through direct pain stimulation:
If they respond, try to get them to fully wake up and focus on what you are saying. If they complain that their chest feels tight or they are short of breath, call 911 and Do NOT let them fall asleep again.
If they do NOT respond, this is a medical emergency – call 911.
While waiting for emergency personnel, put the overdose victims in the “recovery position”. Place them on one side, with one knee bent for support. This maintains a clear and open airway and prevents them from accidentally choking on their own vomit and aspirating it into their lungs.
Third Step: If you have any Narcan, administer it immediately. If they do not wake up, you may need to give them multiple doses. Even if they wake up, they will still need medical treatment.
Are There Any Safer Alternatives to Hydrocodone?
The newest prescribing guidelines recommend first attempting to manage pain via non-opioid options, including:
When hydrocodone or another opioid absolutely MUST be dispensed because different pain management methods have proven to be ineffective, they should be given for the lowest dose and the shortest duration possible, with frequent follow-ups by the prescribing physician.
Treatment for Hydrocodone Addiction
Because hydrocodone is so powerfully addictive, effective treatment must be multi-faceted and must address the condition on multiple levels. Needed recovery services may include any or all of the following:
Rehab programs may be needed in some combination of inpatient/residential, intensive outpatient, and long-term aftercare, depending upon the individual needs of the patient.
Recovery from hydrocodone dependence or addiction requires a lot of work, combined with professional assistance and support, but in the end, it is the surest and safest way to successfully regain sobriety, stability, and sanity.