Hydrocodone is an opioid drug that is synthesized from codeine.
Codeine is a substance that originates in the Asian poppy plant (as do all opioid drugs). Hydrocodone has similarities to other opiate drugs, such as morphine and heroin. These drugs attach to specific receptor sites in the brain and result in the deadening of the subjective experience of pain. They also produce other effects, including feelings of euphoria, sedation, decreased thinking speed, poor judgment, and interference with motor coordination.
Hydrocodone is primarily used in a number of different drugs for pain relief, but it is also present in some medications for other medicinal purposes; for example, it acts as a cough suppressant. Hydrocodone is commonly prescribed in the United States and appears in combination with other medications in well over 50 drugs, including Vicodin, Lortab, and Norco.
The United States Drug Enforcement Administration classifies hydrocodone as a Schedule II controlled substance. This classification indicates that hydrocodone is considered to have medicinal uses, but also a very high potential for abuse and the development of physical dependence.
All of the opioid or narcotic medications can result in the development of physical dependence if an individual uses them for a significant length of time.
Physical dependence is a process that occurs as a result of both the development of tolerance to the drug and the development of a withdrawal syndrome.
- Tolerance: Tolerance is a relatively common result of long-term use of a number of drugs. As an individual takes the drug for a longer period of time and the person’s body becomes habituated to the effects of the drug, the person no longer experiences the same effects that they originally experienced at a specific dose of the drug. This results in individuals needing a higher dose of the drug to achieve the effects that were once achieved at lower doses. The development of tolerance to hydrocodone can occur rapidly, and individuals may develop such high tolerance that they take levels of the drug that would be physically dangerous to take otherwise.
- Withdrawal: Withdrawal occurs as a result of the person’s system adjusting to the presence of the drug, such that it recalibrates itself so it can only operate efficiently when the drug is present in the system at a specific level or concentration. When the levels of the drug in the individual’s system decline as a result of the normal detoxification process, the system becomes disorganized and thrown out of balance, and the person experiences a number of unpleasant physical, emotional, and cognitive ramifications.
- How Detoxification Contributes: Detoxification, or as it is sometimes abbreviated “detox,” is actually a natural process of elimination that the body uses to rid itself of waste products and foreign substances, including drugs. The process of detoxification is largely a responsibility of the liver. It is a continual process that occurs whether or not the individual is still using drugs. Once the individual discontinues using the drug or cuts down on the dosage significantly, the ongoing detoxification process can result in the levels of the drug in the system being depleted. This can trigger a withdrawal syndrome in an individual who has already developed physical dependence on the drug.
- The Relationship between Tolerance and Withdrawal: Individuals will inevitably develop tolerance to a drug before they develop a withdrawal syndrome. Tolerance complicates the withdrawal syndrome because individuals need to use increasingly higher doses of a drug to avoid experiencing withdrawal symptoms. In addition, individuals who develop high tolerance levels to drugs may become much more sensitive to small changes of the levels of the drug in their system and may begin to experience withdrawal symptoms very soon after discontinuing use of the drug.
It is important to also clarify the difference between a substance use disorder and physical dependence on a drug. Physical dependence is a physiological process that occurs to certain types of drugs, if people use the drug for a significant length of time. An individual using a drug that contains hydrocodone for pain management and who continues to use the drug as prescribed under the supervision of a physician would not be diagnosed with a substance use disorder (substance abuse or addiction) even though they may develop physical dependence on hydrocodone. This is because substance use disorders (substance abuse and addiction) are defined as the nonmedicinal use of substances that result in a number of dysfunctional effects for the person. The symptoms of tolerance and withdrawal may or may not be part of the syndrome of a substance use disorder. Individuals who develop substance use disorders to drugs like hydrocodone will most likely have developed physical dependence on them also; however, individuals who use hydrocodone for medicinal purposes only and do not abuse the drug will also develop physical dependence on the drug.
Withdrawal from Hydrocodone
The withdrawal syndrome associated with hydrocodone is typically not lengthy; however, the length and the severity of an individual’s withdrawal symptoms are dependent on a number of different conditions:
- Individual variations in drug use/abuse: The length of time the individual used the drug, the typical amount the person took, and how frequently the person used the drug can affect the withdrawal syndrome from hydrocodone. Individuals who used the drug for longer periods of time, took higher doses, and took the drug more frequently will most often experience stronger withdrawal symptoms and a lengthier withdrawal period.
- How the person took the drug: The method of use can affect the withdrawal syndrome. Individuals who inject, inhale, or snort drugs will have more severe withdrawal syndromes than individuals who take them orally in pill form.
- Individual differences: Individual differences, such as age, metabolism, and emotional stability, can affect the withdrawal process.
- Method of quitting: The method of discontinuation will obviously affect the withdrawal process. Individuals who suddenly stop using the drug will have more severe withdrawal symptoms than individuals who slowly taper down their use.
- Multiple drug use: Individuals who abuse multiple drugs at the same time will have much more severe and complicated withdrawal symptoms.
In general, the withdrawal symptoms from hydrocodone can occur within 1-2 days after one stops using the drug and may last up to a week or 10 days, depending on the individual. In some cases, the withdrawal syndrome may last longer. The process of withdrawal from hydrocodone may include:
- The acute phase: The symptoms that occur in the acute withdrawal phase may begin relatively quickly if the individual has significant tolerance. The symptoms in the acute withdrawal phase are typically the most severe. As a result, individuals will experience a strong desire and extreme cravings to begin using the drug to alleviate the symptoms. Relapse during the acute phase is common. On average, the withdrawal process will begin within 12-16 hours after one has stopped using hydrocodone; however, in some individuals, it may occur much quicker, and in others, it may take longer. A number of very intense and distressing symptoms can occur in this phase that can include aches and pains, fever, chills, profuse sweating, nausea, vomiting, diarrhea, stomach cramps, cold clammy skin, pinpoint pupils, insomnia, severe anxiety, irritability, depression, confusion, and extreme cravings. Psychotic symptoms such as hallucinations and delusions are rare but may occur in some individuals. While the symptoms are typically quite distressing, they are not considered to be potentially dangerous; however, some individuals may become very distraught or confused and may be prone to accidents, poor judgment, or even suicidal behaviors.
- Extended withdrawal: For most individuals, the symptoms will begin to subside in their intensity around 2-3 days after they have started experiencing them. When this happens, individuals are moving into a more extended withdrawal period that can last 5-10 days. Individuals will still experience many of the same symptoms, but their intensity will often be significantly reduced. Most individuals in this stage still experience mild to moderate flulike symptoms (e.g., fever or chills, sweating, nausea, abdominal cramping, etc.), issues with sleep, some anxiety, some depression, and overall feelings of exhaustion.
- Residual symptoms: Following the 10th day, an individual may still experience mild jitteriness, moodiness, weakness, and mild nausea.
- Protracted withdrawal or post-acute withdrawal syndrome: Many sources still report that following the formal withdrawal process, some individuals continue to experience a number of symptoms, primarily psychological in nature, that include moodiness, irritability, issues with motivation, depression, anxiety, and intermittent cravings to use drugs. These symptoms may intermittently come and go for weeks, months, or even years. The syndrome is often referred to as post-acute withdrawal syndrome, and it includes an increased vulnerability for relapse. However, none of the major psychiatric or medical organizations accept this as part of a formal withdrawal syndrome even though many individuals in recovery do have long-term issues with depression, anxiety, moodiness, and cravings.
Treatment for Hydrocodone Withdrawal
Individuals may choose to confront the withdrawal process from hydrocodone without medical assistance, or they may decide to become involved in a formal medically supervised withdrawal management program.
- Significantly decreased symptom intensity: A withdrawal management program is supervised by a physician who will administer medications to reduce withdrawal symptoms, cravings, and any other symptoms that occur. These interventions make the withdrawal process far easier to manage and reduce the risk of relapse or the risk of any other potentially hazardous effects.
- A tapering schedule: The withdrawal management process uses a tapering strategy where the individual receives intermittently timed decreasing doses of either the opioid replacement medication or the opioid drug itself to allow the person’s system to slowly adjust as it detoxifies itself. This strategy also reduces the severity of the withdrawal syndrome and the risk for relapse.
- Commitment: Individuals who become involved in formal withdrawal management programs have made a commitment to their recovery that assists them in avoiding issues with relapse and other complications.
- Supervision: While in a recovery program that utilizes withdrawal management, the person is closely supervised and observed. Any complications can be immediately addressed.
- Preparation: Withdrawal management programs also begin treating the individual by using counseling, therapy, and social support to assist them for long-term recovery.
Any individual who successfully gets through the withdrawal process is only in the beginning stages of recovery. All individuals should engage in a comprehensive treatment program and develop a long-term aftercare plan following successful negotiation through the withdrawal period. A long-term aftercare program should include some form of ongoing formal substance use disorder treatment, strong social support (in the form of 12-Step groups or other community groups), family support, and other interventions as needed in the individual case, including medical management of other medical conditions and/or psychological disorders. If this long-term treatment and after program is not initiated following the withdrawal process, individuals are at a significantly higher risk for relapse.