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Hydrocodone vs. Heroin: Differences & Similarities

Hydrocodone and heroin are both semi-synthetic opioids. Although heroin is illegal for any purpose in the U.S. and hydrocodone is available as a prescription, both drugs have a high potential for abuse and addiction.

Both heroin and hydrocodone put users at risk for overdose, which can be fatal. Treatments for opioid addiction, including medication-assisted treatment, can help a person take control of the addiction and gain back their life.

Types of Drugs

Heroin is made from morphine, which is extracted from opium poppy plants. It is a Schedule I controlled substance, which means that it has no currently accepted medical use in the U.S. and has a high potential for abuse.1

Heroin usually comes from South America, Southeast or Southwest Asia, or Mexico. On the street, the drug is also referred to as Horse, Smack, Hell Dust, Black Tar, and Big H. The street supply of heroin is often mixed with other substances, such as starch and sugar. Heroin is available in several forms, but most often comes as a white or brown powder. It can be snorted, smoked, or injected.1

Hydrocodone is prescribed to treat moderate to severe pain. Several formulations contain a combination of hydrocodone and acetaminophen. Hydrocodone is also combined with antihistamines or anticholinergics to treat cough.2

Hydrocodone is taken orally and comes in a variety of forms, such as capsules, tablets, and syrups. It is available under a wide range of trade names, including Vicodin and Norco.2

Hydrocodone is a Schedule II controlled substance. This means that even though it has medical use, it has a high potential for abuse, and its use can lead to severe physical and psychological dependence.1

Hydrocodone to Heroin Use

It is becoming increasingly common for people to switch from prescription opioids like hydrocodone to heroin.

Many people start off using hydrocodone and then switch to heroin either because they build a tolerance to hydrocodone, can’t get a prescription anymore, or because heroin is easier and cheaper to obtain in many communities. Just like prescription opioid abuse, heroin abuse is dangerous because of the risk of overdose and its level of addictiveness.3
Pharmaceutical hydrocodone is carefully manufactured with the intent of being prescribed in distinct doses, so the dose and purity are usually consistent. However, this is not the case with heroin. Heroin is frequently mixed with adulterant substances and other drugs, such as the potent painkiller fentanyl. It can be contaminated with other drugs without the user’s knowledge.3

These factors have contributed to an increase in heroin overdoses in recent years. The number of fatal heroin overdoses increased 50% from the early 2000s to 2010. Because heroin is frequently injected, people that use this drug also have an increased risk of contracting HIV, hepatitis, and other blood-borne diseases from contaminated needles.3


Since heroin and hydrocodone are both opioids, they both have similar effects when abused.

Heroin users may experience a rush of euphoria that is followed by a period of alternating wakefulness and sleepiness. Other short-term effects of heroin include:4

  • Nausea.
  • Drowsiness.
  • A feeling of heaviness in the extremities.
  • Warm flushing of the skin.
  • Dry mouth.
  • Severe itching.

Longer-term effects of heroin include:4

  • Collapsed veins when the drug is injected.
  • Abscesses, which are swollen areas of localized infection after needle use.
  • Infection of the heart lining and valves from injection use.
  • Lung complications, such as pneumonia.
  • Sexual dysfunction in men.
  • Kidney and liver disease.
  • Stomach cramping and constipation.
  • Mental health problems, such as depression.
  • Insomnia.

Chronic heroin use can cause a host of other issues as well. As mentioned above, people who inject the drug are at risk of contracting HIV and other blood-borne infections and diseases. Plus, the additives that are often put into heroin such as powdered milk can lead to blood vessel inflammation, clotting, and other circulatory issues. This can lead to permanent damage to internal organs.4

Though it is a somewhat less potent opioid, hydrocodone can have effects similar to those seen with heroin use. It can also cause the following side effects:5

  • Headache
  • Dry mouth
  • Difficulty falling or staying asleep
  • Tiredness
  • Nausea
  • Stomach pain
  • Muscle tightness
  • Back pain
  • Swelling of the feet, legs, or ankles

Because of the inclusion of acetaminophen, abuse of some hydrocodone combination formulations can lead to acute liver injury. This is most commonly seen in people who are abusing hydrocodone or taking more than the prescribed number of pills to get high.2 Concurrent use of alcohol may further lower the threshold for experiencing this type of liver injury.


Both heroin and hydrocodone can lead to tolerance and dependence. With tolerance, more of the drug is needed to obtain the same effect. Physical dependence develops as the body becomes used to a drug. At this point, when the drug is taken away or decreased, withdrawal occurs.

Symptoms of opioid withdrawal include:6

  • Muscle aches.
  • Nausea and vomiting.
  • Sad or dysphoric mood.
  • Sweating.
  • Pupil dilation.
  • Fever.
  • Insomnia.
  • Diarrhea.

Heroin and hydrocodone are relatively short-acting opioids, and withdrawal symptoms may start within 12 hours after the last dose. Most acute withdrawal symptoms resolve within 7 days after the last dose. However, some less severe withdrawal symptoms such as depression, anxiety, and insomnia can last for months.6

Attempting to stop using heroin or hydrocodone without medical detox can be very risky. The withdrawal symptoms are very uncomfortable. Left unmanaged, their onset may increase the likelihood of immediate relapse. There are also health risks, such as the possibility of becoming dehydrated or experiencing an electrolyte imbalance from severe vomiting.11 


Heroin and hydrocodone can both lead to overdose. Increasing this risk is the fact that heroin is often cut with other substances or mixed with other powerful narcotics, making it difficult for the user to know the purity or strength of the dose.3

A hydrocodone overdose becomes more likely when people take extra doses, use the drug without a prescription, or mix it with alcohol and other drugs.8

Overdoses on opioid drugs are a growing issue. In 2015, more than 33,000 Americans died from an opioid overdose, including from drugs such as hydrocodone, heroin, and fentanyl.13

The symptoms of a heroin or hydrocodone overdose include:

  • Cold, clammy skin.1
  • Slow and shallow breathing.1
  • Making gurgling noises.7
  • Slow heartbeat.7
  • Blue lips and fingertips.1
  • Convulsions.1
  • Unconsciousness from which the person cannot be awakened.7
  • Coma.1

If you suspect that someone has overdosed on hydrocodone or heroin, call 911 immediately.  Opioid overdose is life-threatening, and it requires immediate emergency attention.7

Naloxone is a medication that can reverse the effects of an opioid overdose. It can be given by injection or intranasal spray by medical providers or people who are in contact with opioid users. Naloxone can also be prescribed to patients who are undergoing medication-assisted treatment or who are at risk for an opioid overdose.8


Both hydrocodone and heroin are addictive. The signs of addiction are the same for both, and they are:6

  • Taking more significant amounts of the drug over a more extended period than intended.
  • Experiencing a strong desire or craving to use the drug.
  • Continuing to use the drug in spite of adverse consequences related to drug use, such as the loss of a job or frequent arguments with friends or family members.
  • Using the drug in situations in which it is dangerous, such as driving a motor vehicle or while operating heavy machinery.
  • Giving up important social and recreational activities to use the drug.
  • Continuing to use the drug in spite of a persistent medical or psychological problem that is exacerbated by drug use.
  • Tolerance to the opioid.
  • The emergence of withdrawal symptoms after trying to cut down or stop using the drug. 


Medication-assisted treatment (MAT) is one treatment option for addiction to these substances. Such treatment refers to the use of FDA-approved medications to treat opioid dependence. Typically, longer-acting medication such as methadone and buprenorphine are used in MAT.9

Medications are combined with counseling and behavioral therapies as a whole-patient approach to treating opioid addiction. This combination has been shown to effectively treat the addiction and help people stay clean.9

Behavioral therapies can also help engage a person in drug abuse treatment and provide incentives to help them continue to maintain abstinence. Some of the most common types of behavior therapies include:10

  • Cognitive behavioral therapy. This type of therapy helps people addicted to drugs change their thought patterns and develop coping skills to help them prevent relapse.
  • Motivational enhancement therapy. This therapy helps people develop the motivation needed to make a positive change to stop using drugs and engage in treatment.
  • 12-step facilitation therapy. These programs encourage users to participate in 12-step programs, which use education and peer support to help promote recovery.
  • Family-behavioral therapy. This type of therapy is focused on the family and helps family members provide support to their loved one who is in active recovery.

Overcoming an opioid addiction is hard. However, professional treatment can help you safely beat the addiction and live a healthy, positive life. Call today for more information on programs in your area.



  1. Drug Enforcement Administration. (2017). Drugs Of Abuse: A DEA Resource Guide.
  2. National Institutes of Health. (2018). Livertox: Hydrocodone.
  3. National Institute on Drug Abuse. (2014). America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.
  4. National Institute On Drug Abuse. (2018). What is Heroin?
  5. Medlineplus. (2018). Hydrocodone.
  6. American Psychiatric Association. (2013). Diagnostic And Statistical Manual Of Mental Disorders (5th Ed.). Arlington, VA: American Psychiatric Association Publishing.
  7. Substance Abuse and Mental Health Services Administration. (2016). Opioid Overdose.
  8. Substance Abuse and Mental Health Services Administration. (2016). Naloxone.
  9. Substance Abuse and Mental Health Services Administration. (2015). Medication and Counseling Treatment.
  10. National Institute On Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
  11. U.S. National Library of Medicine. (2016). Opiate and opioid withdrawal.
  12. National Institute on Drug Abuse. (2018). Opioid Overdose Crisis.

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