Norco (hydrocodone and acetaminophen) contains the narcotic pain reliever hydrocodone, which is a full opioid agonist similar to drugs such as morphine, and acetaminophen, a nonprescription pain reliever that is found in drugs like Tylenol.
Norco is primarily used in the treatment of postoperative pain and chronic pain. Because Norco contains hydrocodone, it is classified as a Schedule II controlled substance by the United States Drug Enforcement Administration. This means that while it is considered to have medicinal uses, it is also considered to be a drug that carries a significant risk for abuse and the development of physical dependence.
Norco acts in the same manner as other similar narcotic medications by occupying certain receptor sites in the brain and increasing the amount of stimulation required to experience the sensation of pain. In this way, it controls pain perception in the person, and it also suppresses the functions of the central nervous system. All narcotic drugs also produce experiences of euphoria and wellbeing to some extent in people who take them and are often abused for this reason.
Norco and Vicodin
Norco and Vicodin are similar narcotic medications that are prescribed for pain control. The difference between Norco and Vicodin relates to the ratio of acetaminophen to hydrocodone in each drug. Norco will always consist of 325 mg of acetaminophen and differing ratios of hydrocodone, whereas the different levels of Vicodin involve altering both the amounts of acetaminophen and hydrocodone. The addition of acetaminophen to hydrocodone results in more effective pain control and the potential to offer fever reduction in some cases. This gives physicians different options to treat pain and use different combinations of these two medications.
- How Norco Affects the Body and Mind
Hydrocodone is a pain-relieving drug developed from codeine and therefore expresses the same properties and effects as other opioid drugs. As mentioned above, in addition to increasing the pain threshold, it also produces feelings of euphoria at moderate to low doses. It will induce very heavy sedation at high doses or when mixed with other drugs, such as other narcotic medications, central nervous system depressants, and alcohol. All of these drugs also have a significant potential for the development of physical dependence in anyone who consistently uses them for a period of more than a few weeks.
- A marked reduction in the sensation of pain
- Euphoria at low to moderate doses, and sedation at higher doses
- Lightheadedness, dizziness, drowsiness, and a sensation of heaviness
- Constipation, mild to moderate nausea, and vomiting
- Changes in thinking that include issues with attention, concentration, and recent memory
The majority of people who begin taking Norco and experience nausea or constipation can expect that these side effects will subside after they have taken the drug for a few weeks.
As the person takes the drug on a regular basis, in addition to many of the above listed effects, they can also experience:
- Issues with autonomic nervous system functioning, such as decreased blood pressure, decreased heart rate, and suppressed breathing
- Issues with balance, decreased reaction times, decision-making, and forming new memories
- Issues with motivation, feelings of lethargy, and feeling as if one is chronically sedated
- The potential to develop issues with or damage to the liver, excretory system, respiratory system, and cardiovascular system
- Psychological problems that can include issues with anxiety and depression, and in some cases, the development of hallucinations (although this is rare)
- The development of physical dependence on hydrocodone
- The development of an addiction (In the case of Norco, this would formally be described as an opioid use disorder.)
- In rare cases, seizure disorders for individuals who take drugs containing hydrocodone for lengthy periods of time
- Liver damage and potential kidney damage due to chronically high doses of acetaminophen
Individuals who take drugs that contain hydrocodone like Norco for lengthy periods will inevitably develop tolerance to hydrocodone. These individuals will also eventually be subject to withdrawal symptoms when they discontinue hydrocodone. Because tolerance develops rapidly to opioid drugs like hydrocodone, people who abuse these drugs often regularly take amounts of the drug that could be dangerous or even potentially fatal in individuals without tolerance.
The potential for abuse and overdose on prescription medications like hydrocodone is very real, according to the National Institute of Drug Abuse, and a major problem. Some of the signs of overdose can include:
- Diarrhea, profuse sweating, cold or clammy skin, yellowish skin, and/or a yellowish tint to the whites of the person’s eyes
- A suppression of breathing, heart rate, and decreased blood pressure (In some cases, cardiac arrest may occur.)
- Extreme anxiety, delusions, and/or hallucinations
- Marked confusion, extreme lethargy, unconsciousness, and/or appearing to be comatose
- Potentially fatal complications due to the depression of the central nervous system
Anyone suspected of overdosing on Norco or any medication containing hydrocodone needs immediate medical attention.
- Issues with Abuse and Addiction
The current clinical designation for both drug abuse and addiction is a substance use disorder where the particular substance involved is identified. For an individual abusing Norco, the classification could either be an opioid use disorder, or for clinicians wanting to be more specific, it could also be addressed as a Norco use disorder. The National Institute of Drug Abuse reports that the abuse of narcotic medications is a significant problem in the United States, and there is a relationship between the number of individuals with heroin use disorders and previous prescription medication abuse, such as abuse of Norco.
Research indicates that people of any age are at risk for the development of substance use disorders; however, the largest proportion of individuals at risk for abusing prescription medications falls between the ages of 18 and 25 years old. Most often, these people know someone who has a prescription for the medication or know someone from whom they can get the medication illegally.
Narcotic medications like Norco are often abused in conjunction with other drugs, such as other opioid medications, other central nervous system depressants, marijuana, and/or alcohol. Abusing Norco with other drugs increases the risks for the development of detrimental side effects, damage to the body, and overdose.
Detox from Norco
As mentioned above, anyone who uses Norco on a consistent basis for more than a few weeks is at risk to develop physical dependence on the drug. Physical dependence on Norco can occur whether or not one abuses the drug. People who have taken it for any reason for lengthy period of time will need to go through a medical detox process if they attempt to quit using the drug. If the individual does not use some strategy to avoid potential withdrawal symptoms, they will most certainly experience some level of withdrawal.
- The first phase will most often begin within 1-2 days after discontinuing Norco. Once the symptoms begin, they are most intense for 24-48 hours. During this phase, individuals will begin to experience issues with agitation, anxiety, nausea, vomiting, diarrhea, loss of appetite, headaches, fever or chills, heavy perspiring, confusion, anxiety, depression, and intense cravings to take Norco. This period is a specifically vulnerable one because individuals can stop these unpleasant symptoms by taking the drug; thus, relapse during the early stages of detox/withdrawal is not uncommon. Withdrawal from Norco is not potentially fatal as withdrawal from alcohol can be; however, individuals who become severely confused, anxious, or depressed are at risk for self-harm due to accidents, poor judgment, and/or suicide attempts.
- In the second phase, individuals will experience a diminishing of the above symptoms, which will typically occur around days 3-5 after stopping use of Norco. There will still be some symptoms, and these most commonly consist of muscle pains, cramps, spasms, mild nausea, abdominal pain, some vomiting, and the sensation of mild anxiety and irritability. Cravings may still continue, and individuals are still vulnerable for relapse.
- A third phase is lengthier but far less intense and may consist of irritability, anxiety, depression, mild nausea, and a potential to engage in drug use due to cravings that are often triggered by reminders of past drug use or being in situations where one used Norco in the past.
Anyone with a physical dependence on Norco should engage in a medically assisted detox program that is supervised by a physician. These programs can use opioid replacement medications and a tapering strategy that can significantly diminish or even totally cancel out any potential withdrawal symptoms.
This type of program significantly reduces any potential for relapse in individuals attempting to discontinue use of Norco or any other drug.
Some sources describe a long-term withdrawal symptom known as post-acute withdrawal syndrome (PAWS) that can extend for periods of weeks to even years. The withdrawal symptoms in this phase are described as primarily psychological and include such things as issues with motivation, periods of anxiety and/or depression, and periods of irritability. In addition, cravings triggered by stress, being in situations where one formally used Norco or other drugs, and other environmental triggers are part of PAWS. While the research indicates that this phenomenon is most likely not a formal withdrawal syndrome, many individuals will experience ongoing issues that can make them potentially vulnerable to relapse. As a result, everyone in recovery from an opioid use disorder should engage in a long-term treatment and aftercare program that addresses the issues that led them to drug abuse, instills a plan of relapse prevention, and provides long-term support.