Hydrocodone is one of the most commonly prescribed pain medications in the US. Although it is very effective for treating pain, it is also highly addictive. The widespread abuse of opioid prescriptions leads to thousands of overdoses per year. Read on to learn more about hydrocodone, its signs of abuse, and how to keep yourself safe.
Disclaimer: By writing this post, we are not recommending this drug. Some of our readers who were already taking the drug requested that we commission a post on it, and we are simply providing information that is available in the scientific and clinical literature. Please discuss your medications with your doctor.
What Is Hydrocodone?
Hydrocodone is an opioid invented in 1920 by two German scientists, originally developed to treat severe pain and cough.
Hydrocodone was adapted from codeine – another highly addictive opioid – in the hopes of creating a less-addictive alternative. Today, it is mostly sold in combination products that include additional substances (such as acetaminophen, aspirin, ibuprofen, or antihistamines) in order to further reduce the likelihood of abuse and addiction .
Common brand names of drugs that contain hydrocodone include Vicodin, Lorcet, and Lortab .
However, a study on the abuse potential of hydrocodone-based combination drugs found that these medications still have a significant potential for addiction. Therefore, one must take care when using any medication that contains hydrocodone .
Due to its high addiction potential, hydrocodone is classified as a schedule II narcotic by the FDA, and therefore requires a prescription for use .
Mechanism of Action
Hydrocodone is a central nervous system depressant that works mainly by binding to opioid receptors.
Opioid receptors are found in the brain, spinal cord, and gastrointestinal tract. They transmit pain signals to the brain and are also involved in coughing and breathing. The effects of opioids on the nervous system involve several different types of opioid receptors :
- Delta receptors (in the limbic regions)
- Mu receptors (involved in pain signaling)
- Kappa receptors (throughout cortex)
- Sigma receptors
The peak effects of a single hydrocodone dose usually occur 60 to 90 minutes after ingestion. People who abuse hydrocodone often crush and snort the pills to speed up the effects, although this greatly increases the risks of negative effects .
The effects of hydrocodone typically last around 4 hours, with some “extended release” pills that can last for up to 12 hours. However, these estimates are based on the average person and vary between individuals .
Approved Uses of Hydrocodone
1) Pain Management
The effectiveness of hydrocodone in reducing and managing pain has been established by a large number of scientific studies.
Twenty patients with cancer experienced pain relief when given oral doses of hydrocodone every 4 hours. This study also showed similar pain relief effectiveness between hydrocodone and morphine, with older patients requiring smaller doses to achieve similar effects .
A study in patients with chronic pain found that daily use of hydrocodone significantly improved pain intensity and quality of life .
A comparative study indicated that hydrocodone reduced pain in chronic pain patients as effectively as oxycodone .
Hydrocodone was able to maintain pain management in chronic pain patients that had formerly taken a mix of hydrocodone and acetaminophen .
In a study on pain management, hydrocodone improved pain, sleep patterns, and ability to perform daily activities in a group of 728 patients with moderate to severe chronic pain .
Hydrocodone reduced pain in 19 out of 26 patients in a study on individuals with chronic pain who had recently stopped using morphine .
A study in patients dealing with severe chronic lower back pain found that hydrocodone significantly reduced pain .
2) Cough Suppressant
Hydrocodone reduced coughing frequency by an average of 70% in a study on patients with advanced stages of cancer .
Studies show hydrocodone in combination with either propofol or midazolam reduces coughing during medical airway exams [16, 17].
Hydrocodone is frequently abused for its “positive” (pleasurable) effects, which often leads to addiction. People take it for :
- Anxiety relief
- A sense of euphoria
The addictiveness of the drug stems from its ability to activate the brain’s most powerful reward system, which increases feelings of pleasure .
Unsurprisingly, this can easily lead to addiction. The euphoria felt from the initial use is temporary and becomes weaker over time. People gradually develop tolerance, often causing them to continually chase a “high” that becomes more dangerous with each subsequent use .
Hydrocodone Side Effects and Withdrawal
This list does not cover all possible side effects. Contact your doctor or pharmacist if you notice any other side effects.
Call your doctor for medical advice about side effects. In the US, you may report side effects to the FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. In Canada, you may report side effects to Health Canada at 1-866-234-2345.
Hydrocodone has many potential negative effects, including :
- Mood changes
- Dry mouth
- Blurred vision
- Elevated blood sugar levels (hyperglycemia)
- Shallow breathing (respiratory depression)
- Slowed heart rate (bradycardia)
- Impaired cognition
- Impaired consciousness
- Seizures (during overdose)
With hydrocodone being the main ingredient in the most commonly prescribed medications in the US, a large population of abusers suffering from opioid addiction is inevitable .
Addiction causes compulsive drug use, drug craving and obsession, and uncontrollable drug-seeking behavior. The addiction becomes more severe the longer the drug is used, and also makes the withdrawal process more unpleasant and difficult.
The most common symptoms of opioid withdrawal include :
- Irregular heart rate
- A headache
- Suicidal thoughts
Some ways to reduce the likelihood of addiction include [22, 23]:
- Using hydrocodone for medical purposes only
- Checking in with your doctor frequently
- Paying attention to the details of your prescription (dose frequency, amount, etc.)
- Avoiding hydrocodone if you have a history of addiction to alcohol or other drugs
Hydrocodone often leads to tolerance. That is, when the same dose produces less noticeable effects the longer it is used. This often makes people increase their dosage over time to maintain the desired effect.
Using opioids can also lead to “cross-tolerance,” where tolerance to one opioid results in tolerance to other ones. This makes it more difficult to achieve the original effectiveness of pain relief, even when switching to other opioid medications .
Due to its addictive nature, addiction and withdrawal can occur regardless of whether it is being used legally or illegally. For this reason, even people who take the drug for medical purposes can experience withdrawal after stopping and have to be closely managed by a doctor .
Medical professionals prescribing hydrocodone, therefore, reduce the dosage frequency slowly to avoid a sudden “cold turkey” scenario .
Common symptoms of hydrocodone withdrawal include :
- Mood swings
- Impaired attention/inability to focus
- Inability to feel pleasure (anhedonia)
- Agitation and restlessness
- Night sweats
- Suicidal thoughts
- Drug craving
- Muscle aches
- Sleep difficulties
- Chills/sudden changes in body temperature
- Elevated blood pressure
- Irregular heart rate
Withdrawal can begin as soon as 6 to 12 hours after the last taken dose; withdrawal symptoms reach their peak at around 72 hours from the last dose. The withdrawal process can last anywhere from 1 week to several months, depending on how long the user was taking the drug, as well as the size of the doses they were taking.
The detox procedure typically lasts a week and is best done under direct medical supervision at a detox clinic to avoid severe medical side effects.
Detoxing frequently involves using other medications to manage the symptoms of withdrawal, such as naltrexone, buprenorphine, and methadone .
Buprenorphine is a partial opioid agonist, meaning it also has the possibility for addiction; this drug should be prescribed with caution .
Thousands of people die every year from opioid overdoses, which are most often caused by recreational abuse. People who abuse prescription opioids often crush the drug up in order to snort it. This causes the drug to be absorbed much more quickly, making the dose more potent, while also greatly increases the risk of overdose .
However, overdose is always a possibility, even when taking pills that were prescribed legally in a normal manner. This is why it’s always extremely important to follow your prescription instructions carefully.
Common signs of overdose include :
- Extremely small pupils
- Low blood pressure
- Slow, shallow, or interrupted breathing (respiratory depression)
- Cold, clammy skin
- Pale skin (especially in the face)
- Bluish lips and nails
- Unconsciousness or unresponsiveness
If you think someone is overdosing, it is important to call 911 immediately. Meanwhile, make sure the individual is kept awake and in an upright position while waiting for help to arrive. Above all, the most important thing is to prevent the person from losing consciousness.
A common method of treating overdoses is giving the patient naloxone. Although it is not clear whether naloxone simply competes for the same receptors, or whether it actively removes opioids from occupied receptors, the drug nonetheless quickly reverses the effects of opioids when given to overdosing patients .
If the medication involved in the overdose contained acetaminophen as well, acetylcysteine (Mucomyst) can also be effective [29, 30].
Contraindications include :
- Any past hypersensitivity to hydrocodone or any ingredients in the formulations
- Past history of respiratory depression
- Any current or past gastrointestinal obstruction (opioids can cause constipation)
- Asthma (opioids can cause respiratory depression)
Pregnancy and Breastfeeding
Women who use opiates while pregnant are at risk of making their unborn baby addicted, which can cause their children to go into drug withdrawal after birth (a condition called neonatal withdrawal).
If taking opiates is absolutely necessary to manage pain during pregnancy, opiate doses should be kept as low as possible, and should only be used under ongoing medical supervision .
Hydrocodone can also be passed on to a child through breast milk. It was observed that babies received about 3% of the dose taken by the mother through breast milk. For this reason, nursing mothers should limit their dose to 30 mg/day or less .
Hydrocodone can interact negatively with many other drugs, making them highly dangerous when mixed.
To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. Talk to your healthcare provider to find out how hydrocodone might interact with something else you are taking.
Hydrocodone can interact with:
- Sedatives: Taking hydrocodone together with sedatives (such as alcohol, Valium, or lorazepam) can prolong and strengthen the effects of sedatives and can also increase the negative effects of the opioid. This results in a much greater risk of overdosing .
- Tryptophan: Tryptophan can increase serotonin production in the brain, which can cause serotonin syndrome .
- St. John’s Wort: Taking this herbal medication with any opiate will reduce the effectiveness of the opioid. This can lead individuals to increase their dosage of the drug, which significantly increases the chances of overdosing .
Hydrocodone can also interact with pre-existing medical conditions, including:
- Asthma/respiratory issues: Compared to regular asthma patients, those with opiate addictions have a higher frequency of sudden death .
- Serotonin syndrome: Having too much serotonin in the brain can lead to symptoms such as agitation, confusion, and muscle breakdown. Serotonin syndrome can be caused by mixing opiates like hydrocodone with other substances that affect serotonin levels (such as tryptophan or SSRI antidepressant medications) [38, 39].
Hydrocodone and Alcohol
Alcohol and hydrocodone are both nervous system depressants that increase each other’s effects when taken together. This makes combining them extremely dangerous, and this combination should always be avoided .
Because of their similar effects on the brain, a history of alcoholism or alcohol abuse is a strong risk factor for hydrocodone abuse and addiction. For this reason, people who have had problems with alcohol use should probably avoid opioids altogether .
Does Hydrocodone Harm the Liver?
There is no solid evidence that hydrocodone causes damage to the liver when it is taken alone. However, many popular forms of hydrocodone (such as Vicodin) include other compounds such as acetaminophen, and there is some evidence that these additives may contribute to liver damage .
A typical dose of hydrocodone is one 10 mg dose per day, combined with 100 mg of acetaminophen .
However, hydrocodone dosage varies from person to person. Patients should follow the advice of the prescribing physician and never change the dose or discontinue the treatment without consulting it beforehand.
Hydrocodone can be detected by urine and blood tests for anywhere from 6 to 48 hours after ingestion. After that, it is in amounts small enough to be undetectable .
Potential Natural Alternatives
It’s no surprise that many people seek alternatives to hydrocodone – the side effects can be troublesome and the potential for addiction is alarming.
Luckily, there are many ways to increase your endorphins (the body’s natural opioids) to combat pain. Some examples include exercise, sun exposure, melatonin, and magnesium.
For a full list of ways to naturally increase your endorphins, check out our article here.
If you’re looking for natural alternatives that work exactly like hydrocodone (by activating the mu-opioid receptor), then take a look at the list below.
Importantly, you should always consult your doctor before changing or stopping your medications and never use these alternatives in place of what your doctor recommends or prescribes. It’s also important to let your doctor know of all the supplements you are currently taking, in case of potential interactions.
Oxytocin is a hormone with some fairly unique effects. It plays a role in social bonding, sex, childbirth, and infant-mother bonding, to name just a few. Oxytocin is also used as a medication to induce labor .
This hormone has an important effect on pain as well .
For instance, a review of 17 clinical trials found that oxytocin significantly reduces the perception of pain .
Studies show that it may also help with migraine pain [46, 47].
Interestingly, oxytocin has different effects on males and females .
For example, one study looked at chronic neck and shoulder pain in 24 individuals. They found that oxytocin increases sensitivity to heat in women, but not in men .
The pain-relieving effects of oxytocin are made possible through several mechanisms .
Animal studies show that oxytocin activates mu- and kappa-opioid receptors, similar to hydrocodone. It can also directly block pain signals in the spine and may interact with cannabinoid receptors [50, 51, 52].
How do you increase oxytocin levels?
Natural ways to increase oxytocin range from yoga to simply petting your dog. Check out our oxytocin article for a complete list of ways to increase oxytocin and all of its potential benefits [53, 54].
It’s no secret that cannabis may provide vital pain relief for many that suffer from chronic pain.
But is this supported by scientific evidence?
A large analysis of 43 clinical trials including 2,437 patients looked at the role of cannabis for pain management. The evidence suggests that cannabis is most useful for neuropathic pain. Its effectiveness in other types of pain is unclear .
Several other reviews have found similar results. All of these reviews raise concerns about side effects and the unknown risks of long-term use [56, 55, 57].
Other studies show that cannabis may also reduce headache and joint pain [58, 59].
Cannabis may also have an “opioid-sparing effect”, meaning it can enhance the effect of opioids, allowing for lower doses to be effective .
For instance, morphine plus THC provides equivalent pain relief compared to morphine alone at a 3.6 higher dose. Similarly, codeine plus THC is as effective as codeine at a 9.5 times higher dose .
Importantly, medical cannabis is not legal in all states and its legal status largely depends on its THC content. You can read through this post to learn what type of cannabis products (if any!) is legal where you live and make sure you’re not breaking any laws.
How does cannabis relieve pain?
Cannabinoids (the active compounds inside marijuana) mainly work on cannabinoid receptors, which are associated with pain sensation .
Cannabinoids, like THC and CBD, may also activate mu- and delta-opioid receptors, according to animal studies .
Acupuncture may provide a number of health benefits, one of the most notable being pain relief .
One study found that traditional Chinese acupuncture increases the binding potential of the mu-opioid receptor. This may increase the effectiveness of opioid drugs, as well as the body’s natural opioids .
Acupuncture has a moderate effect on muscle and joint pain, according to an immense review of 63 studies totaling 6382 people. However, most of the studies were of low quality .
A review of 29 clinical trials found that acupuncture is effective for cancer-related pain, particularly malignancy and surgery-related pain .
Other smaller studies suggest that acupuncture may also help with inflammatory pain and pain after a Caesarean section [67, 68].