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Hydrocodone Facts


Hydrocodone is an opioid medication prescribed for significantly severe pain. Though safe when used as prescribed, the drug is frequently abused and can be addictive. Regular users are also at risk for overdose, and some may switch to heroin if the medication becomes too difficult to obtain.

What Is Hydrocodone?

Hydrocodone in pill form
Hydrocodone is a semisynthetic opioid that is typically used to treat pain.  It may be used in combination with acetaminophen for pain or combined with antihistamines or anticholinergics to treat cough.1  

Hydrocodone is the most frequently prescribed opioid in the U.S. There are numerous brand name and generic hydrocodone products on the market—mostly combination products (i.e., hydrocodone and acetaminophen).  Some of the more commonly encountered brand names include Vicodin and Lortab.2

As a Schedule II drug, hydrocodone has a high potential for abuse, and its use can lead to severe psychological and/or physical dependence.2,3   It is administered in several different forms, including tablets, capsules, and liquids.2,4  

Hydrocodone is most often abused orally. But it may also be crushed and then snorted or injected.5  It may also be used in combination with other substances, such as alcohol, to intensify its effects.2  

Like other opioids, hydrocodone is typically abused for its pleasurable effects, such as a sense of well-being, relaxation, and/or euphoria.5  However, very serious side effects and long-term effects are associated with the use of hydrocodone as well.

Side Effects and Long-Term Effects

The use of hydrocodone and combination products comes with many side effects, including:1

  • Sedation.
  • Respiratory depression.
  • Confusion.
  • Agitation.
  • Nausea.
  • Vomiting.
  • Abdominal bloating.
  • Constipation.
  • Diarrhea.
  • Headache.
  • Dizziness.

Hepatotoxicity, or chemical-induced liver injury, is a very serious effect associated with the use of hydrocodone combination products, especially those that combine hydrocodone and acetaminophen.1,2  The risk of hepatotoxicity increases when a user takes higher-than-prescribed doses of such combination products in short periods of time. It normally occurs with overdose, but the risk goes up over time.2

 

Other long-term effects include severe constipation and androgen deficiency, which may manifest as symptoms of low libido, impotence, erectile dysfunction, and absence of menstruation.6

Another potential risk is the possibility of tolerance, dependence, and eventually, addiction.

Abuse and Addiction

Abuse of hydrocodone and related products occurs when a user takes more of the drug than prescribed, takes it more frequently than prescribed, or uses it through a non-intended route (i.e., grinding up the pills to be snorted or dissolved in solution for injecting).5  

People who begin to compulsively misuse the drug may obtain multiple prescriptions by going to several different doctors, altering prescriptions, or using fake prescriptions.  They might also use others’ prescribed medications, steal pills, or purchase the pills illegally (i.e., on the street, via the Internet).2  

Using such medications in ways other than those prescribed may increase the likelihood of addiction. Some signs of addiction include spending much time and energy on obtaining and using hydrocodone, and continuing to use despite significant negative consequences.7  

Such negative consequences might include:7

  • Poor performance at school or work.
  • Job loss.
  • Tension within relationships due to use.
  • Significant financial issues.
  • Legal issues.

Withdrawal

Tolerance occurs when a user needs increasingly higher doses of a substance to achieve the same effects that were once achieved with lower doses of the same substance.5,7  Tolerance often develops in association with abuse of hydrocodone, as does physiological dependence—but both can also develop in people who take the drug as prescribed. Once a person develops a significant amount of hydrocodone dependence, they must continue to use it to avoid uncomfortable and potentially dangerous symptoms of withdrawal.7,8  

Heroin addict experiencing withdrawal
When the person suddenly stops using hydrocodone or reduces their dose, they may experience some of the following symptoms:8

  • Agitation
  • Anxiety
  • Muscle aches
  • Sleep disturbances
  • Runny/stuffy nose
  • Sweating
  • Goose bumps
  • Dilated pupils
  • Excessive yawning
  • Nausea
  • Vomiting
  • Stomach cramps
  • Diarrhea

Many of these acute opioid withdrawal symptoms begin within 12 hours of last use.8

 

If a user decides to quit cold turkey, they might experience many of the unpleasant symptoms listed above. Left unmanaged, the discomfort of withdrawal can increase the likelihood of relapse. Detox programs and/or inpatient treatment programs can monitor the person and administer medications to reduce the intensity of the symptoms, decrease relapse risk, and help the person start to build a successful recovery.

In addition, pregnant women who use hydrocodone and related products for a significant period of time may give birth to infants with neonatal opioid withdrawal syndrome, which could be life-threatening if not treated. Symptoms of this syndrome include irritability, sleep problems, tremors, vomiting, and diarrhea.6  These women should seek professional medical help from a primary physician and/or addiction specialist when they attempt to quit using.

Overdose

Overdose may occur when someone takes an extremely high dose of hydrocodone or when they mix hydrocodone with other substances such as alcohol or benzodiazepines.5,6  

Symptoms of overdose include the following:4

  • Respiratory depression
  • Blurred vision
  • Ringing in the ears
  • Cold and clammy skin
  • Hypotension
  • Abnormally slow heart beat
  • Cardiac arrest
  • Stopped breathing
  • Coma
  • Death

An overdose can be fatal. In fact, hydrocodone is one of the most common drugs involved in prescription opioid deaths in the U.S.  Approximately 40% of all opioid deaths in the U.S. in 2016 involved a prescription opioid.  That same year, more than 46 people died every day from overdoses involving prescription opioids. It is quite possible that there were even more unreported deaths.9

Treating Overdose

If you see someone overdosing on hydrocodone, you should immediately call 9-1-1.

One of the best ways to prevent an overdose-related death is to administer naloxone, which is a medication that can quickly reverse an overdose. It may be administered as either a nasal spray or an injectable solution.  While naloxone is considered safe, someone who has been given this medication should be monitored for at least a couple of hours after the last dose is given to ensure that their breathing does not slow or stop.10

If someone is overdosing, make sure you seek emergency medical help immediately. After calling 9-1-1, you may need to take action while waiting for emergency personnel to arrive (i.e., perform rescue breathing, put the user in a recovery position).

Switching to Heroin Use

Another concern associated with hydrocodone use is the possibility that the user will eventually switch to using heroin.
When someone is addicted to hydrocodone, it may become difficult to obtain the amount needed to satisfy the addiction. The prescribing doctor may even stop prescribing the medication altogether. Users might turn to heroin as their opioid tolerance grows or if getting a prescription becomes too difficult.5

Unlike hydrocodone, heroin can widely vary in purity and strength. It may also be cut with other substances, including highly potent drugs such as fentanyl, which is an opioid drug 50-100 times more potent than morphine.11  These factors can increase one’s risk of overdosing, as a user might end up taking a drug with a much higher strength than they realize.

Even if the user does not overdose, they are still at risk of other serious consequences such as infections (i.e., HIV) if they use needles to inject heroin.7

The risks associated with hydrocodone abuse and addiction are very serious. However, there is hope. There are many treatment options out there that can help you stop using and guide you toward a successful recovery. It’s not too late to turn everything around.

Sources

  1. National Institutes of Health. (2018). Hydrocodone.
  2. U.S. Drug Enforcement Administration. (2014). Hydrocodone: (Trade Names: Vicodin®, Lortab®, Lorcet-HD®, Hycodan®, Vicoprofen®).
  3. U.S. Drug Enforcement Administration. Drug Schedules.
  4. Drugbank. (2018). Hydrocodone.
  5. National Institute on Drug Abuse. (2014). America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.
  6. Abb Vie Inc. (2017). Vicodin.
  7. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition. Arlington, VA: American Psychiatric Association Publishing.
  8. U.S. National Library of Medicine: MedlinePlus. (2018). Opiate and Opioid Withdrawal.
  9. Centers for Disease Control and Prevention. (2017). Prescription Opioid Overdose Data.
  10. National Institute on Drug Abuse. (2018). Opioid Overdose Reversal with Naloxone (Narcan, Evzio).  
  11. National Institute on Drug Abuse. (2016). Fentanyl.

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