Hydrocodone is an opioid medication that is synthesized from codeine, a substance that is derived from the Asian poppy plant.
Hydrocodone is similar to other drugs in its class like heroin and morphine. All opioids have a special affinity for neural receptor sites in the brain that are specialized for neurotransmitters that are similar in structure to them (enkephalins and endorphins).
Therefore, opioids like hydrocodone have powerful analgesic properties. They also produce feelings of euphoria and well-being.
Hydrocodone is available in many different prescription medications that are used to control pain.
It is still readily prescribed in the United States. It may be prescribed alone or as a combination of medications, such as Vicodin (hydrocodone and acetaminophen).
Many of the drugs that contain hydrocodone are familiar drugs of abuse, such as Lortab, Norco, and Vicodin. Hydrocodone is at the highest level of control for any prescription medication.
Hydrocodone is classified in the Schedule II (C II) controlled substance category by the U.S. Drug Enforcement Administration (DEA). This classification indicates that the drug does have useful medical applications, but it is also a potentially dangerous drug of abuse that is likely to produce physical dependence in people who use it for extended periods.
The medication can only be obtained legally with a prescription from a physician, and it cannot be automatically refilled. A refill requires a new prescription.
Use & Misuse
Some of the most reliable data regarding drug use and misuse are released by the Substance Abuse and Mental Health Services Administration (SAMHSA). They release yearly figures that estimate the use and misuse of many different medications and illicit drugs. The estimates are based on survey data and statistically sound with acceptable margins of error. According to the latest data:
- In 2016, it was estimated that 54.8 million individuals used a product containing hydrocodone at least once. In 2017, this estimate was 52 million.
- In 2016, it was estimated that 91.8 million individuals used any form of prescription pain reliever at least once. In 2017, this figure was 90.8 million.
- In 2016, it was estimated that 6.9 million individuals misused a hydrocodone product at least once. In 2017, this estimate was 6.3 million.
- In 2016, it was estimated that 11.5 million people misused prescription pain medication at least once. In 2017, this figure was 11.1 million.
The above data reveal two alarming conclusions:
- More than half of the people in the United States who report using a prescription pain reliever use a hydrocodone product.
- Well over half of the individuals who reported misusing a prescription pain reliever misused a hydrocodone product.
Misuse vs. Abuse
It is important to distinguish between misuse and abuse.
The misuse of any medication or substance involves a person using the substance for reasons other than its intended or prescribed purpose. People admitting to at least one misuse of a hydrocodone product are admitting that they took the product for a reason other than attempting to control pain; they took more of the product than they were supposed to at least once; or they used the drug more often than they were supposed to use it (at least once).
Abuse of a drug implies a more consistent pattern of misuse where the person begins using the drug regularly for purposes other than it is intended for, such as to achieve psychoactive effects (euphoria) or attempting to avoid withdrawal symptoms.
The number of people who actually end up being diagnosed with an opioid use disorder as a result of hydrocodone abuse is significantly lower than the number of people who admit to at least one misuse of the drug. Misuse figures are important in understanding the potential a specific medication has for abuse.
When a powerful medication like hydrocodone is used as intended, the potential for the drug to be abused is quite low. In fact, organizations like SAMHSA report that a very low percentage — less than 10 percent — of individuals prescribed opioid medications are later diagnosed with an opioid use disorder.
However, as can be seen from the figures above, a large number of individuals who use hydrocodone products engage in misuse of the substance at least one time.
According to the U.S. Centers for Disease Control and Prevention (CDC), when people begin the use of prescription opioids for lengthy periods, they often begin taking more of the drug then they are prescribed. The potential to develop a substance use disorder (addiction) increases rapidly.
How Hydrocodone Misuse Leads to Abuse
The feelings of euphoria that are produced by hydrocodone will quickly decrease with multiple uses because tolerance rapidly develops to these psychoactive effects. People misusing the drug for its euphoric effects begin to take more and more of the drug to try to achieve these effects, but over time, the effects can never be fully replicated.
However, continually taking large doses of powerful drugs like opioids results in alterations in the brain, such that the individual is less likely to experience feelings of pleasure and well-being unless they are taking the drug. When they are not taking the drug, they feel irritable, on edge, and cranky.
They may even begin to develop withdrawal symptoms that are more intense. These individuals began using hydrocodone to feel “normal,” and they find they need more and more of the drug to feel functional.
When people develop a significant physical dependence on the drug (increased tolerance and withdrawal symptoms), the cycle of addiction rapidly intensifies. These people are taking the drug, so they don’t feel bad instead of taking it to relieve pain or feel good.
Developing physical dependence on a drug is not necessarily the same thing as having an addiction. A substance use disorder, or addiction, automatically implies that the person is using the drug for nonmedical reasons and experiencing significant issues with their ability to function normally as a result of their drug use.
Many people who need to use powerful opioid drugs for the control of chronic pain, such as arthritis, cancer pain, and other types of pain, often develop some level of physical dependence on these drugs. As long as they use them for their intended purpose, they would not be considered to be addicted to the drug
The development of physical dependence is simply a result of the drug’s mechanism of action. However, those who abuse drugs develop far more serious and intense withdrawal symptoms than individuals who use drugs for medical reasons and according to their prescribed directions.
In individuals who abuse drugs, signs of physical dependence are often considered to be symptoms of a substance use disorder.
There is no sure way to predict who will develop a substance use disorder and who will not. A risk factor is some type of condition that increases the potential or probability that someone might develop some specific disorder, disease, or other types of conditions. A risk factor is not a guarantee that someone will develop the condition.
Risk factors are additive, meaning that if an individual has more than one risk factor, the potential to develop the issue in question is increased further.
Who Develops an Addiction?
There are some identified risk factors associated with increasing the probability that one may develop a substance abuse issue. The more salient risk factors associated with developing substance use disorders include:
- Someone in the family, especially immediate family, who has a history of a substance use disorder.
- A diagnosis of some other type of mental health condition.
- Someone in the family, especially immediate family, who has a psychiatric disorder.
- A history of trauma or abuse, especially as a child.
- Parental separation as a child.
- Substance use at an early age.
- Peers who use drugs or alcohol recreationally.
Past Behavior Predicts Future Behavior
One of the best predictors of how someone will act in the future is how they acted in a similar situation in the past.
One of the most salient risk factors associated with the development of an opioid use disorder is a history of some other type of substance abuse, such as alcohol abuse or marijuana abuse. When individuals are prescribed opioids to treat post-surgical pain or chronic pain, it is extremely important that physicians are aware of any history of substance abuse, so these people can be monitored closely regarding their medicinal opioid use.
The more available hydrocodone products are — as a result of prescriptions for people who need them for medical reasons — the more abuse cases and diagnoses of opioid use disorders will occur. Data from SAMHSA and NIDA support this notion.
How Can Substance Abuse Be Stopped?
Responsible prescribing practices, an understanding of the characteristics of at-risk individuals, and tighter controls on the distribution of medications that have a high potential for abuse, like opioids, have already had some effect on lowering rates of abuse. For example, SAMHSA’s oversight of opioid treatment programs has been successful.
Making treatment more accessible to individuals with substance abuse issues can also help to reduce the severity of problems related to substance use disorders in the United States. Data produced by SAMHSA indicates that a surprisingly small proportion of individuals who have diagnosable substance use disorders actually receive treatment for them.
Concentrating on prevention and treatment can help to reduce the incidence of opioid use disorders that result from hydrocodone abuse.