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Hydrocodone Withdrawal and Detoxification

With the opioid epidemic in America maintaining momentum, it is essential to understand the risks that come with prescription painkillers.

Hydrocodone and other prescription opioids have a high potential for abuse which may lead to the development of physical dependence and addiction. If you've been using or abusing them, you may face some very uncomfortable withdrawal symptoms when attempting to quit. These symptoms may last for weeks (acute) or months (post-acute).1

Despite the discomfort, the process is worthwhile; medical detox and professional substance abuse treatment can reduce the distress of withdrawal and ensure your safety throughout.

What Is Hydrocodone?

Hydrocodone is a component of many prescription medications intended for pain management and, to a lesser extent, cough suppression.Several prescription hydrocodone formulations have widely recognized brand names, which include:2

  • Vicodin.
  • Norco.
  • Zohydro.

Opioid pills in prescription bottleStreet names include Happy pills, Hillbilly Heroin, Vikes, Viko, and Hydro.3

As with most medications, adverse effects are possible with hydrocodone. Users may experience:4

  • Stomach upset.
  • Constipation.
  • Dry mouth.
  • Hoarse voice.
  • Headache.
  • Dizziness.
  • Sleep disturbances.
  • Tiredness.
  • Breathing difficulties.
  • Muscle tightening/twitching.

With any opioid, hydrocodone included, overdose is a very serious concern and could be fatal. Someone who has overdosed on hydrocodone may display some or all of the following:4

  • Markedly constricted pupils (i.e., pinpoint or pinprick pupils).
  • Weakness.
  • Extreme sedation.
  • Slowed breathing.
  • Slowed heart rate.
  • Cold, clammy skin.
  • Loss of consciousness.
  • Coma.

Despite the risks, some people intentionally misuse hydrocodone because of its relaxing and euphoric effects.3 These rewarding effects can be incredibly reinforcing, and people may begin to compulsively abuse the drug by:3

  • Taking more of the drug or taking it more often than instructed.
  • Changing the way it is meant to be consumed, such as by crushing the pills and snorting or injecting the powder.
  • Mixing hydrocodone with other drugs or alcohol to enhance or offset effects.

Compounding the potential for misuse of hydrocodone is its widespread availability. Hydrocodone/acetaminophen products topped the list of prescribed drugs in 11 states, according to 2018 data.5 In 2016 alone, 6.2 billion hydrocodone pills were distributed from pharmacies across the county.The U.S. consumes the vast majority of the world’s supply of hydrocodone.6

Am I Addicted to Hydrocodone?

People who repeatedly abuse hydrocodone may easily become addicted to the substance. Addiction is characterized by overwhelming cravings and an intense focus on getting and using the drug, no matter the consequences.1 People with histories of substance abuse or addiction are at a greater risk of developing issues with hydrocodone-containing products.4

Hydrocodone addiction is diagnosed as an opioid use disorder by mental health and addiction professionals. Such a diagnosis is made based on the presence of several signs, symptoms, and behavioral changes. Examples include:1

  • Taking opioids in larger amounts and for longer periods of time than intended or instructed.
  • A strong desired to reduce or stop opioid use without success.
  • Spending a lot of time and energy finding, using, and recovering from opioids.
  • Craving more of the drug when none is currently available.
  • Being unable to fulfill the expected responsibilities at home, work, and school.
  • Giving up certain people and activities that were previously important to focus on the drug.
  • Continuing to use hydrocodone despite the high likelihood of adverse physical, mental, social, or legal outcomes.
  • Needing more of the drug to accomplish the same effects (i.e., tolerance).
  • Experiencing uncomfortable withdrawal symptoms when lowering your dose or attempting to quit.

What Is Hydrocodone Withdrawal?

Person frustrated and awake in bedMany people who are addicted to hydrocodone suffer from withdrawal when attempts are made to slow or stop use. Whether or not an individual will experience the acute opioid withdrawal syndrome is determined by the presence and magnitude of any physical dependence. Dependence is the adaptation of the brain to the regular presence of a substance.8

Once dependence is established, the brain has adjusted to the steady supply of hydrocodone, and if the drug is no longer available, the delicate balance will be disturbed.8 This imbalance will result in the arrival of hydrocodone withdrawal symptoms.

What Are the Withdrawal Symptoms?

All opioids impact the brain in a similar way, so hydrocodone withdrawal symptoms will resemble those of other opioids such as oxycodone and even heroin.1

Hydrocodone withdrawal symptoms may include:1

  • Increased sensitivity to pain.
  • Muscle aches and pains.
  • Nausea and vomiting.
  • Diarrhea.
  • Fever.
  • Excessive sweating.
  • Goose bumps.
  • Runny nose.
  • Watery eyes.
  • Dilated pupils.
  • Yawning.
  • Sleep disturbances.
  • Low mood.
  • Anxiety and irritability.

Are the Symptoms Dangerous?

Opioid withdrawal won't usually put a person's life at risk, though it can be very intense at times. Hydrocodone withdrawal can prove dangerous, though, when:9

  • Vomiting and diarrhea result in choking, dehydration, or imbalance of electrolytes.
  • Preexisting heart conditions are aggravated by the faster heart rate and higher blood pressure that sometimes accompany withdrawal.
  • Existing mental health concerns like anxiety disorders may be worsened, which could result in panic attacks, aggression towards others, and suicidal thoughts or actions.

Acute opioid withdrawal can be extremely unpleasant. People are often compelled to get and use more hydrocodone in an attempt to relieve the symptoms. Because cravings can be so strong during this period, people in early recovery may greatly benefit from detox in an inpatient center where there is no access to the drug.

How Long Will Symptoms Last?

The acute opioid withdrawal experience will be similar for a variety of drugs. However, the intensity, duration, and timeline for the associated symptoms differ according to:9

  • The specific drug being used.
  • The dose, frequency, and duration of use.
  • Physical and mental health status.
  • Genetic determinants (e.g., differences in drug metabolism).

Hydrocodone withdrawal from immediate-release versions will normally begin within 12 hours after the last dose, but extended-release formulations may somewhat delay the emergence of symptoms.1 These acute withdrawal symptoms may peak during the first 3 days and then steadily resolve over a week.1

The end of acute withdrawal should bring enormous relief; however, some symptoms may last for an extended period (sometimes months after the last use). These post-acute withdrawal symptoms may include:10

  • Fatigue/disturbed sleep.
  • Low mood.
  • Anxiety.
  • Depression.
  • Emotional blunting (feeling of apathy/lack of strong emotions).
  • Irritability.

What Happens During Detox?

People at risk of experiencing these symptoms may fare better when utilizing professional detoxification services, where a medical team can use techniques and tools to reduce the discomfort of withdrawal and help them to avoid relapse.9

Hydrocodone withdrawal treatment can include a variety of approaches tailored to the individual, including medical detox and non-medical, or "social," detox.9

Medical Detox

During a medical detox, a physician monitors withdrawal progress, manages symptoms with treatment medications, and addresses any significant medical issues as they come up.9

Like hydrocodone, methadone and buprenorphine are both opioid drugs. These drugs, when taken in accordance with a treatment schedule, can help to curb cravings and alleviate some of the more distressing symptoms.7

Providers may also use other medications to address the needs of the individual. For example:9,11

  • Many of the symptoms of opioid withdrawal—increased heart rate, high blood pressure, chills, sweating—may be relieved with clonidine, a non-opioid hypertension medication.
  • A new FDA-approved non-opioid drug, Lucemyra, may be given to lessen the severity of certain withdrawal symptoms.
  • Additional medications, such as antidepressants, may be prescribed to treat coexisting conditions, such as mood and anxiety disorders.

Medical detox can take place in hospitals or other acute care detox settings, such as inpatient or residential detox centers, but some people with less severe opioid dependence and at lower risk for complications may detox on an outpatient basis.9 These people will make regular visits to their doctor’s office to receive their treatment medications and to have their progress evaluated.

Nonmedical Detox

Some detoxes attempt to manage opioid withdrawal using a social, or nonmedical, approach. The idea behind this form of treatment is that emotional support and a safe environment will be enough to get a person through the worst of acute detox. However, even mild opioid withdrawal symptoms can prove to be very distressing without the use of medications.9

It's important to consider how well you can cope without medical support. Some people falsely believe the narrative that using any medications equates to not achieving real sobriety; however, this is not the case. Use of medications during and after detox can help a recovering person prevent relapse and achieve long-lasting abstinence from hydrocodone.

Can I Detox at Home?

Some people attempting to detox choose to “sleep it off” as a home remedy. While this might be an appealing tactic, it is not an advisable way to get clean. Physical pain and psychological cravings tend to be overwhelming and prevent decent sleep. Few individuals find relief in this approach. Professional treatment centers offer the safety, support, and comfort that is unlikely to be available at home.9

Professional treatment centers offer the safety, support, and comfort that is unlikely to be available at home.

Addiction Treatment Rehab and Recovery

While professional detoxification services help patients manage hydrocodone withdrawal symptoms, it does little to treat substance use and addiction in the long-term.7 Detox treats the physiological impact of hydrocodone dependence, but a substance use disorder is a mental health condition that requires targeted addiction treatment.

Treatment typically includes an in-depth look at factors that first led a person to abuse opioids. These factors may include underlying mental health conditions, poor coping skills, difficulties with family members or a spouse, or trauma.7 Often, there are several contributory factors.

Cognitive therapy addresses these issues and can help people to better manage their stress levels. Behavioral therapy can also help a person altogether avoid or alter the way they react when exposed to negative environments.7 For example, role-playing sessions may be conducted so that newly sober individuals can practice turning down offers for hydrocodone and other drugs.

These services are offered in inpatient rehab centers and outpatient mental health clinics. Your treatment team will work with you to determine the best course of action for you.9

People with strong coping skills and a healthy support system may be referred to an outpatient treatment center that allows them to live at home and work while attending treatment.7 Different outpatient programs may provide a varying range of treatment intensities and time commitments—from weekly hour-long sessions to many hours of therapy each week in the case of partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs), respectively.9

Those with fewer coping skills, limited support systems, and poor treatment success in the past may be referred to inpatient or residential treatment centers. There, they can receive around-the-clock care and support from a trained staff.7 Residential rehabs can last anywhere from a few weeks to many months, depending on the person’s unique recovery needs.7

Drugs like methadone and buprenorphine may be used beyond detox as part of medication-assisted treatment (MAT). One variation of buprenorphine, called Probuphine, is an implant that administers a 6-month supply of the medication.12 Removing the daily requirement of taking medication, Probuphine may help a person comply with their treatment and stay sober.

Naltrexone, also available as an extended-release injection called Vivitrol, is another medication used during MAT. Naltrexone works by blocking the opioids’ activity in the brain, taking the high out of the equation and making abuse of these substances less appealing.7

Treatment for opioid addiction is multifaceted and requires focused, continued effort, but recovery can happen for anyone.

Hydrocodone Information at a Glance1,2
Medication Name Class of Medicine
  • Generic Name: Hydrocodone
  • Brand: Norco, Zohydro ER
  • Class: Prescription opioid
Form, Intake and Dosage Interactions and Complications
  • Drug Forms: Tablet, capsule, liquid
  • Administration Routes: swallowed, snorted, injected
  • Dosage: Varies, no more than 60 mg/day
  • Overdose: Varies based on age, weight, and tolerance
  • Alcohol Interaction: heart failure, heart attack, respiratory distress, pulmonary failure, liver failure, kidney failure, jaundice, amnesia, seizures, blackouts, coma
  • Counterindications: asthma, COPD, sleep apnea, liver or kidney disease, low blood pressure, hypothyroidism, tomach disorder, Addison’s disease, curvature of the spine, mental illness, history of drug or alcohol addiction
Effects and Adverse Reactions Substance Abuse
  • Short-Term: Dizziness, itching, lightheadedness, nausea, sweating, drowsiness, constipation, vomiting, euphoria
  • Long-Term: Hearing loss
  • Risk of Substance Abuse: Moderate
  • Signs of Abuse: Taking hydrocodone in ways other than prescribed, taking medication that does not belong to you, receiving multiple prescriptions from various doctors.
Physiological Problem Signs and Symptoms Dependence and Addiction Issues
  • Withdrawal Syndrome Onset: Within 12 hours
  • Withdrawal Symptoms: Anxiety, depression, increased pain, sweating, increased heart rate
  • Tolerance: Yes
  • Cross Dependence: Yes
  • Physical Dependence: Yes
  • Psychological Dependence: Yes
Legal Schedules and Ratings
  • Controlled Substances Act Rating: Schedule II or Schedule III, depending on concentration

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. Drug Enforcement Administration. (2014). Hydrocodone.
  3. National Institute on Drug Abuse for Teens. (2017). Prescription Pain Medications (Opioids).
  4. U.S. National Library of Medicine: Medline Plus. (2018). Hydrocodone.
  5. GoodRx. (2018). The Most Popular Drugs in America, State by State.
  6. CNN.com. (2018). Opioid Crisis Fast Facts.
  7. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide.
  8. Kosten, T. R., & George, T. P. (2002). The Neurobiology of Opioid Dependence: Implications for TreatmentScience & Practice Perspectives1(1), 13–20.
  9. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
  10. Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal.
  11. U.S. Food and Drug Administration. (2018). FDA approves the first non-opioid treatment for management of opioid withdrawal symptoms in adults.
  12. U.S. Food and Drug Administration. (2016). FDA Approves First Buprenorphine Implant for Treatment of Opioid Dependence.
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