Hydrocodone Withdrawal

What is Hydrocodone?

Hydrocodone is a synthetic opioid drug that is widely prescribed in various formulations to treat moderate to severe pain. As an opioid analgesic, the drug binds to and activates opioid receptors throughout the body to alter the perception of pain.¹

Though hydrocodone is most commonly indicated for pain management, it is sometimes also used as an antitussive, or cough suppressant, in certain prescription formulations.² Hydrocodone is a primary active component of several combination medications. Though some of the brand formulations are no longer available on the pharmaceutical market, the drug is widely recognized under trade names such as Lortab, Norco, and Vicodin.³

Effects of Taking Hydrocodone

In addition to its therapeutic analgesic and cough suppressant effects, hydrocodone use is associated with several adverse side effects, including:⁵

Opioid Tolerance, Physiological Dependence, and Withdrawal

Tolerance is a relatively common effect of taking any opioid drug or medication for a significant period of time. As one takes the drug over a lengthy period, the body becomes habituated to the effects of the drug, at which point the person may require a higher dose of the drug to achieve the same effect that was achieved at lower doses.

Differential tolerance development, with regard to opioid drugs and their analgesic and more subjectively pleasurable effects (tolerance to these may develop fastest) compared with some of the more serious physiological consequences, such as slowed gastrointestinal motility and respiratory depression (tolerance may be differentially slower to develop for these), can worsen some of the risks associated with their use, should a person begin to take increasingly large doses to overcome .⁶

In addition to tolerance to their pharmacological effects, all opioid agonists are associated with physiological dependence. Though some degree of dependence may develop even in people using an opioid analgesic in adherence with prescription guidelines, its development may be hastened by misuse or abuse. A problematic pattern of escalating use itself sometimes begins as an individual attempts to overcome the development of tolerance to the effects of the drug, and begins taking increased doses of a drug, or taking the drug more frequently than intended.

When opioid dependence develops to a drug like hydrocodone, people are at risk of experiencing an acute opioid withdrawal syndrome when use of the drug slows or stops. When the drug is stopped and the levels of the drug in the system begin to decline, the body loses its sense of homeostasis or balance. There are disruptions to the neurochemical balance achieved after consistent drug use that may be experienced when the individual stops taking the drug.

Though opioid withdrawal may not be associated with as potentially severe a withdrawal syndrome as some drugs like alcohol and benzodiazepines, it can still be wildly unpleasant—creating unnecessary hurdles to recovery should it not be managed appropriately with medical detox.

For more information on your medical detox and substance use disorder treatment options call to speak with a Greenhouse admissions navigator, 24/7.

The Difference Between Physical Dependence and Addiction

It is important to quickly mention the distinction between physical dependence and addiction. Even individuals who take medications that contain hydrocodone in adherence with prescription guidelines can develop some degree of physical dependence on the drug. And, though it is one of the diagnostic criteria for an opioid use disorder, dependence alone does not necessarily indicate that the individual has a substance use disorder or addiction issue.

Opioid use disorders, or opioid addiction, are additionally characterized by several other examples of maladaptive behaviors and compulsive patterns of substance use.  Individuals who engage in nonmedical misuse of hydrocodone or certain other psychoactive prescription drugs (e.g., taking them to get “high” as opposed to relieving pain) increase their risk of eventually developing these compulsive patterns of use in addition to significant dependence.

So while dependence itself isn’t synonymous with addiction, it could be more likely to develop with compulsive use and is frequently present in addition to other criteria that together are used to make the diagnosis of a substance use disorder. When opioid dependence is pronounced, as it often is in association with hydrocodone misuse, a person may experience significantly unpleasant withdrawal symptoms when continued use slows or stops.

Withdrawal from Hydrocodone

All opioid agonist drugs, including hydrocodone, are associated with a similar acute withdrawal syndrome. The severity of hydrocodone withdrawal may be influenced by several factors, including:⁷

• How long the person was taking the drug: People taking the drug for longer periods of time may experience relatively more severe symptoms that span a lengthier withdrawal timeline. The average dose and frequency of use may similarly influence the character of withdrawal.
• The person’s mental and physical health: People with certain additional health issues (e.g., significant mental health issues, cardiac illness, etc.) might experience a more difficult withdrawal period.
• How the drug is stopped: Individuals who quit taking the drug abruptly may experience a more swift onset of withdrawal symptoms than individuals who undergo medical detox where withdrawal symptoms can be managed or a maintenance medication may be used.
• The presence or use of other drugs: Individuals with polysubstance dependence may be at higher risk of more severe or complicated withdrawal.

In general, the signs and symptoms of hydrocodone withdrawal may include:^8,9

Quitting Cold Turkey or Using Medical Detox?

Though the withdrawal syndrome associated with opioids may not be as immediately dangerous as that of alcohol and sedative drugs, for the sake of safety and comfort, a period of supervised medical detox is commonly prescribed for managing withdrawal from drugs like hydrocodone.⁷ There are several reasons for this, including:

• A physician-supervised medical detox program can lessen the intensity of physical withdrawal and therefore reduce the risk of relapse during the early period of recovery. Physicians can administer medications to deal with cravings, withdrawal symptoms, and mood issues. This can make the withdrawal process easier to manage.
• A physician can slowly taper down the dose of the drug over a period of time, often via the use of treatment medications like buprenorphine, to stabilize a patient in withdrawal. In the longer term, this can help a person to better manage troublesome withdrawal symptoms as they embark on further recovery efforts.
• With 24/7 supervision and no access to substances of abuse, relapse is less likely. The support offered in medical detox begins to set the foundation for comprehensive therapy in treatment.

Medical detox and appropriate withdrawal management set the stage for more comprehensive addiction treatment. Individuals who forego additional participation in a treatment program after attempting to weather the physical withdrawal process on their own may face unnecessarily high relapse risks and other challenges to their long-term recovery efforts.

For more information about the medical detox and substance use disorder treatment in Texas, call to have a confidential conversation with one of our supportive admissions navigators.

References

1. National Institute on Drug Abuse. (2020). What classes of prescription drugs are commonly misused—opioids.
2. U.S. Department of Health and Human Services—Food & Drug Administration. (2006). Labelling-Medication Guide: Vicodin.
3. U.S. National Library of Medicine. (2019). Hydrocodone Combination Products.
4. United States Drug Enforcement Administration. (n.d.). Drug Scheduling.
5. U.S. Department of Health and Human Services—Food & Drug Administration. (2019). Labelling-Medication Guide: Zohydro.
6. Hayhurst CJ, Durieux ME. Differential Opioid Tolerance and Opioid-induced Hyperalgesia: A Clinical Reality. Anesthesiology. 2016;124(2):483-488.
7. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
8. U.S. National Library of Medicine—MedlinePlus. (2019). Hydrocodone.
9. National Institute on Drug Abuse. (2020). Commonly Used Drugs Charts—Prescription Opioids.