Facts About Hydrocodone

Hydrocodone is a powerful opiate that’s virtually as potent as morphine and prescribed for the long-term management of severe pain – the kind of pain where other drugs have not been effective, not tolerated, or not strong enough to actually manage the pain and provide relief for the patient.1 This drug is also an effective cough suppressant that has proven more beneficial than codeine. It is the most prescribed opioid pain reliever in the United States.

Hydrocodone is semi-synthetic, meaning it is derived from the poppy plant but is manufactured by modifying the codeine molecule chemically. It is often prescribed in formulations that combine it with other substances like acetaminophen. It is only recently that a pure hydrocodone medication has been approved for medication (Zohydro ER).2

Historical Timeline for Hydrocodone

1920 German company Knoll Pharmaceuticals first synthesized Hydrocodone by molecularly altering codeine, a naturally-occurring base of opium; because they believed that hydrogenizing codeine will make it less addictive and milder on the gut.

1929 – American pharmacologist Dr. Nathan B. Eddy was tasked by the National Research Council to assess the efficacy, side effects, and safety of over 300 drugs, including hydrocodone. During the next 5 years, Dr. Eddy found that hydrocodone was, in fact, an effective painkiller whose side effects are consistent with those caused by other synthetic and semi-synthetic opioids and that has also caused intense euphoria. His tests showed that it even caused euphoria in rats that have already developed a tolerance to morphine. This means that the subject rats needed higher doses of morphine but relatively low doses of hydrocodone to experience the same effect.

1955 – Prescription-only liquid dose Tylenol (Acetaminophen) for children was introduced in the U.S.

1970 – The Controlled Substances Act was passed, listing drugs according to their medical use and potential for abuse. Pure hydrocodone was listed under Schedule II. If in combination with other drugs, it was listed under Schedule III.

1978 – Knoll came out with Vicodin in the U.S. made up of 500mg acetaminophen + 5mg hydrocodone.

1983 – Generic Vicodin became available.

2000 – Hydrocodone-related ER visits went up by 500% since 1990. The FDA warned against drugs containing acetaminophen over risks of liver damage.

2004 – The DEA requested the Department of Health and Human Services to furnish a recommendation for getting products combining hydrocodone with other drugs moved up from Schedule III.3

2006 – In the U.S., a total of 130 million prescriptions were written for drugs containing hydrocodone.

2008 – Abbot failed to get FDA approval to sell a controlled-release version of Vicodin and ended up laying off 200 sales reps, and the HHS finally responded to the 2004 DEA request by ruling that hydrocodone combination products (HCPs) remain as Schedule III drugs. On this same year, hydrocodone and oxycodone were implicated in 14,800 overdose deaths.

2009 – In June, a federal advisory panel voted to recommend that the FDA ban Vicodin and Percocet.

2010 – The equivalent of 42 tons of pure hydrocodone was dispensed in pharmacies all over the U.S.

2013 – In October, Zohydro ER, the first pure hydrocodone formulation was approved by FDA.

2014 – In October, the DEA was finally able to get HCPs rescheduled from Schedule III to Schedule II.4

Brand Names for Hydrocodone

  • Anexsia
  • Co-Gesic
  • Damason
  • Dolacet
  • Entuss
  • Histinex
  • Hycet
  • Hycodan®
  • Hycomed
  • Hycomine
  • Hydrocet
  • Hydrogesic
  • Liquicet
  • Lorcet-HD®
  • Lortab®
  • Lortuss
  • Maxidone
  • Norco
  • Oncet
  • Panacet
  • Panlor
  • Stagesic
  • TussiCaps
  • Tussionex
  • Vendone
  • Vicodin®
  • Vicoprofen®
  • Vituz
  • Xodol
  • Zamicet
  • Zohydro ER
  • Zolvit
  • Zydone

Street Names Hydrocodone

  • 357s
  • Hydro
  • Hydros
  • Loris
  • Norco
  • Perks
  • Tabs
  • Vic
  • Vicos
  • Vikes
  • Watsons

Hydrocodone Drug Type

Hydrocodone belongs to the powerful family of painkilling drugs called opioids.  Opioids can be natural or synthetic and are used to synthesize a family of prescription drugs used to manage cancer pain or severe pain from surgery. Opioids are extremely habit-forming and have been known to cause addiction in just 3 days.

Other examples of opioids include:

Hydrocodone DEA Drug Class

As a Schedule II substance, Hydrocodone:

  • has a currently accepted medical use in treatment in the U.S. or has a currently accepted medical use with severe restrictions
  • has a high potential for abuse
  • may lead to severe psychological or physical dependence when abused

The DEA imposes quotas on its production and there are restrictions on how it is prescribed. There are also higher punishments for its illegal use.

Other examples of Schedule II substances include:

Forms and Routes of Administration

Hydrocodone in all its available formulations (pure or combined with acetaminophen/ibuprofen/aspirin) is available in tablet form for oral administration. It is not available in other non-oral or parenteral forms.7 However, a study indicated that a small percentage of abusers who reported past 30-day use of immediate-release (IR) hydrocodone combination products (HCP) either snorted, smoked or injected the drug. Oral administration remains the predominant route of abuse.8   

Hydrocodone, Pregnancy & Breastfeeding

There is limited information on the effects of hydrocodone on pregnant women and the unborn child. It is therefore wise to avoid hydrocodone during pregnancy.

The drug is excreted in breastmilk, and so the same caution is advised for nursing mothers. 

Hydrocodone Effects and Addiction Potential

As effective as it is for pain relief and the suppression of coughs, hydrocodone like all other opioids induce certain conditions that many people consider desirable, hence the potential for abuse. These desired effects include:

  • Increased sense of well-being
  • Euphoria
  • Lethargy/Sleepiness
  • Numbness
  • Reduced stress

Tolerance to hydrocodone is built much slower than tolerance to other opiates such that the user does not realize they are developing a dependence to it, whether or not they are using it for legitimate medical reasons or recreationally.

Hydrocodone abuse is not exclusive to professionals or the more affluent. It isn’t even restricted to any specific age group, ethnic background or socio-economic background. The DEA reports that some 24.4 million people over 12 years old have reported using hydrocodone recreationally. These people do not even have to obtain the drug illegally. The market is virtually flooded with it that abusers simply have to do any of the following to get their hands on it:

  • Doctor shopping
  • Buying from others who have legit prescriptions
  • Faking/altering prescriptions
  • Buying from pharmaceutical workers and other health professionals including the doctors themselves
  • Swiping from family members, friends, officemates, pharmacies etc.

Hydrocodone Short-term Side Effects

Upon using hydrocodone, people experience mild side effects that may disappear as soon as the dose wears off or serious side effects that may require medical care. Some of the serious side effects may be due to hydrocodone’s depressant properties which slow down some of the body’s normal functions.

Mild

Serious

Anxiety

Breathing problems

Dizziness

Bowel obstruction

Constipation

Irregular or slowed heartbeat

Drowsiness

Vomiting

Headache

Trouble urinating

Fatigue

Severe allergic reaction (hives, rash, itching, swelling)

Nausea

 

Nightmares

 

Trouble sleeping

 

Itchiness

 

Diffuse (widespread) muscle weakness

 


Hydrocodone Long-term Side Effects

As if addiction isn’t a bad enough long-term effect of hydrocodone use and abuse, there are certain physical problems that could surface:

  • Liver damage
  • Acetaminophen toxicity
  • Sensorineural hearing loss

Just as damaging are the adverse effects to one’s personal life:

  • Relationship problems (home/work/community)
  • Problems at work (poor performance/absenteeism/accidents)
  • Mental health problems

Hydrocodone Dependence

Dependence means a person cannot anymore function without taking the drug. The following behaviors can be an indication that dependency on hydrocodone may have already set in.

  • Taking more than the prescribed dose at one time
  • Taking more frequent doses
  • Taking hydrocodone beyond the prescribed period
  • Taking alcohol and other drugs with hydrocodone
  • Faking an injury in order to get a prescription
  • Obtaining and using hydrocodone without prescription

Hydrocodone Withdrawal

Depending on the patient’s physical conditions, the length of time of hydrocodone use, dosage, and use of other substances, the withdrawal symptoms may also vary in severity:

  • Anxiety
  • Body aches
  • Constant shivering
  • Depression
  • Diarrhea
  • Difficulty sleeping
  • Fever
  • Hallucinations
  • Intense sweating
  • Irregular or rapid heartbeat
  • Nausea
  • Vomiting

Hydrocodone Addiction Treatment

Long-term use of hydrocodone can result to very unpleasant or downright harsh withdrawal symptoms that can very easily drive a user right back to the drug just to get relief from all the discomfort.

It would be to the patient’s best interest to seek professional help by considering going to an inpatient treatment center where he/she can be assured of a safe and effective program to handle hydrocodone withdrawal.

Many such programs use other potentially addictive medications to help ease withdrawal pains, so it is critical that the program is strictly monitored and controlled by experienced treatment professionals. Periodic clinical drug testing is part and parcel of the entire physical detox process. It is a key tool by which treatment counselors can gauge the patient’s adherence to the program and whether the treatment is effective or not.

Said counselors will also emphasize the value of talk therapies or group therapies in an effort to discover the underlying reasons why the addiction began in the first place. These therapies may be part of cognitive behavioral therapy or an equivalent mental health treatment that many recovery centers offer. They help patients re-train their minds and teach ways to deal with factors that have contributed to the substance abuse.

Testing for Hydrocodone

The initial effects of taking hydrocodone begin to be felt within 10-20 minutes of intake and reach their peak effectiveness from 30-60 minutes, lasting from 4-8 hours. A typical 10mg dose of hydrocodone has a half-life of approximately 4 hours, meaning it will take 4 hours for the body to flush out half the drug from the system. Hydrocodone dependent individuals will begin to feel withdrawal symptoms from 6-12 hours from the last dose, depending on a number of factors that include the individual’s physical condition, last intake of food and drinks, body mass, the dosage of the drug etc.  

Testing for hydrocodone may be done for a number of reasons:

  • Workplace drug testing – Many companies have an established drug testing policy, and while hydrocodone is not on a standard SAMHSA 5 drug panel, some employers may order specific drug testing panels that include hydrocodone considering that it is one of the most abused drugs in the United States.
  • Insurance purposes – Some life insurance companies require policy applicants to undergo a urine test to get an overall health profile of the person they are insuring. They will be able to tell how much premium to charge someone who may be likely to die during the term of the policy from an underlying/pre-existing risk for a certain disease or from risky behavior like substance abuse.
  • Addiction treatment – Clinical drug testing is a common tool by which drug treatment counselors monitor their patients for adherence to the rehab program’s medication plan.

Testing for hydrocodone may also be done using saliva, hair, and blood but urine testing is still the most widely used because of the easy availability of testing devices for this purpose.

Hydrocodone Cut-off Level and Detection Time in Urine

Specimen

Concentration Cut-off Level

Detection Time

Urine

10 ng/ml

 Up to 3 days


Sources:

1https://www.medicinenet.com/hydrocodone-oral_liquid/article.htm#what_are_the_side_effects_of_hydrocodone_zohydro_er

2 https://drugabuse.com/library/hydrocodone-history-and-statistics/

3https://www.raps.org/regulatory-focus%E2%84%A2/news-articles/2016/1/dramatic-drop-in-hydrocodone-combo-prescriptions-after-dea-rescheduling

4 http://www.about-addiction.com/little-known-facts-about-the-history-of-hydrocodone/

5 https://www.therecoveryvillage.com/drug-addiction/types-of-drugs/#gref

6 https://www.dea.gov/druginfo/ds.shtml

7 https://en.wikipedia.org/wiki/Hydrocodone

8 https://onlinelibrary.wiley.com/doi/full/10.1002/pds.4249

For Further Reading:

http://articles.latimes.com/2003/oct/19/opinion/op-critser19

https://www.pharmacy.umaryland.edu/media/SOP/medmanagementumarylandedu/ControlledSubstanceList.pdf

https://casapalmera.com/top-8-drug-categories/

http://www.treatment4addiction.com/drugs/society/csa/



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