Vicodin Detox and Withdrawal Management

Vicodin is a Schedule II controlled substance that consists of two medications—the primary active component is a synthetic opioid painkiller (hydrocodone) and the other is a fever-reducing analgesic medication that does not require a prescription by itself (acetaminophen).^1,2Acetaminophen is found in many over-the-counter medications, including popular brands like Tylenol, and does not contribute to the physiological dependence nor the withdrawal syndrome associated with Vicodin.

Vicodin is primarily indicated to treat moderate to moderately severe pain.² Vicodin has been widely prescribed in a number of clinical situations, such as for individuals recovering from injury, surgery, or dental procedures.

Vicodin Tolerance and Physical Dependence

With continued use of opioids like Vicodin, tolerance can develop. Tolerant users will come to require more of the drug (higher and/or more frequent doses) in order to receive the desired pharmacologic effects (e.g., decreased pain, euphoric effects).²

Over time, especially when misused in doses that exceed recommended parameters, people are likely to develop some degree of opioid dependence. Due to a phenomenon known as neuroadaptation, as people continue taking the drug over time, changes in the brain result such that a person becomes only able to function at relatively “normal” levels when the drug is present. Once people stop taking the drug and the body begins to eliminate it from its system this new balance is lost, at which point t withdrawal symptoms may arise.

Physical dependence generally only becomes significant after weeks of use, though even a few days of continued use can result in mild physical dependence.² The risk of an unpleasant withdrawal increases as physiological dependence grows.

Individuals who misuse Vicodin may no longer be consuming medical doses. Such individuals may have already developed a very high tolerance to it, which could result in them taking many times the maximum suggested daily dosage—subsequently increasing their likelihood of significant dependence.  Should the drug be abruptly discontinued in physically dependent people, it could give rise to severely intense withdrawal symptoms and, in doing so, complicate recovery efforts.

Acute Vicodin Withdrawal

Though the precise character of withdrawal may vary from one opioid-dependent individual to the next, a number of characteristic symptoms may arise in association with the acute opioid withdrawal syndrome—regardless of which opioid is involved.

Markedly slowing or abruptly quitting opioid use after a consistent period of use (e.g., a few weeks or more) may result in:^3,4

• The length of time the person was taking the drug. For example, a person who has taken Vicodin for only a few weeks will most likely not experience withdrawal to the same degree as someone who has taken it for years.
• Individual factors, such as metabolic differences, personality factors, stress levels, and the presence of any additional mental or medical health issues may also shape the withdrawal experience.

Opioid Withdrawal Timeline

Withdrawal from a relatively short-acting opioid like Vicodin may develop roughly as follows:^3,4,5

First day: The first signs and symptoms withdrawal may begin to develop within 12 hours after the last use.

First week: Symptoms may peak within several days of discontinuation, and gradually subside over the course of a week.

Weeks to months: Less acute symptoms may persist for as long as several weeks to months. Such chronic symptoms might include persistent anxiety, insomnia, dysphoria, or anhedonia.

While withdrawal from Vicodin is seldom directly life-threatening, the distress that people may endure can complicate recovery attempts. People who experience these unmanaged symptoms may be at a higher risk for relapse at any point after the drug is first stopped.

Medical Detox for Vicodin Dependence

All told, the associated cravings and unpleasant symptoms of acute opioid withdrawal can be a challenge to early recovery. Left unmanaged, people in opioid withdrawal may be highly susceptible to relapse. To lessen these risks and to minimize the magnitude of severe or unpleasant symptoms, opioid detox and withdrawal management may be best negotiated with medical assistance.

Medical detox for Vicodin or other types of opioid withdrawal management can take place in either an inpatient or outpatient setting, dependent on patient needs. As part of a medical detox protocol, the treatment team will be available to address any significant medical needs to arise during the withdrawal period. Additionally, medical detox helps to:⁵

• Stabilize a patient in opioid withdrawal with FDA-approved treatment medications methadone and buprenorphine.
• Avail additional symptomatic management with medications such as clonidine or other adjunctive pharmacologic treatment (e.g., for symptoms such as insomnia, nausea, diarrhea).
• Prepare the recovering individual for a period of additional rehabilitation for opioid use disorder.

Recovery After Withdrawal

The completion of a medical detox program for Vicodin dependence should not substitute for additional recovery efforts for substance use disorders. Beyond withdrawal management, individuals may benefit from additional rehabilitation, ideally as part of a comprehensive addiction treatment program, as well as long-term aftercare programs, such as peer or mutual support group participation (e.g., 12-step meetings) or ongoing individual or group therapy appointments.

Relapse rates are relatively high, even for individuals who stay in formal treatment for lengthy periods of time; however, individuals who undergo detoxification alone without engaging in longer-term addiction treatment may be at especially high risk.⁶ For more information about medical detoxification and recovery program options for Vicodin or other opioid addiction, call to speak with a Greenhouse admissions navigator at today.

References

1. U.S. Department of Justice—Drug Enforcement Administration Diversion Control Division. (2020). List of Controlled Substances.
2. U.S. Department of Health and Human Services—Food & Drug Administration. (2006). Labeling-medication Guide: Vicodin.
3. Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
4. U.S. National Library of Medicine—MedlinePlus. (2018). Opiate and opioid withdrawal.
5. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
6. National Institute on Drug Abuse. (2018). Drugs, Brains, and Behavior: The Science of Addiction.