The U.S. Centers for Disease Control and Prevention (CDC) has reported that U.S. life expectancy declined in 2017, due, in part, to the raging opioid drug crisis. Though the powerful, synthetic opioid fentanyl appears to be fueling overdose deaths that have affected American life, prescription medications like hydrocodone still play a significant role.
In fact, there were 14,495 overdose deaths attributed to hydrocodone and oxycodone in 2017, according to the Kaiser Family Foundation.
People turn to hydrocodone — the semisynthetic opioid marketed as Vicodin and Norco — to treat severe pain over a long period. In 2016, there were almost 6.6 million hydrocodone prescriptions written, making it the 113th most-prescribed drug in the U.S.
Widespread use brings about opportunities for abuse and addiction. And make no mistake, hydrocodone has played its part in ensnaring people from all walks of life and every ethnic, socioeconomic stripe — even physicians who have prescribed opioids. Such is the case of Lou Ortenzio, a former family medical doctor from West Virginia.
“I had to have hydrocodone. It was more important than oxygen,” said Ortenzio in a report by The Marshall Project. I was taking 40 pills a day — 25,000 milligrams of acetaminophen every day. A toxic dose.”
Before Ortenzio realized long-term sobriety, he tried to detox on his own, revealing just how awful being “dopesick” or going through withdrawal was for him.
However, his story isn’t unique. When people addicted to opioids like hydrocodone stop using and experience withdrawal, they reuse to alleviate the misery of those symptoms. This cycle solidifies addiction and leaves users open to the prospect of fatal overdose.
How Does Hydrocodone Work?
German scientists synthesized hydrocodone in 1920, and it was approved by the U.S. Food and Drug Administration (FDA) in 1943.
A formulation of hydrocodone and acetaminophen is sold under brand names such as Vicodin, Norco, and Lortab and is prescribed to treat moderate-to-severe pain and cough. Hydrocodone-acetaminophen medications are available as a tablet, elixir, and a solution and are the most prescribed hydrocodone product in the U.S.
Like other opioids, hydrocodone binds to receptors in the brain and spinal cord areas to effectively block pain signals. It also impacts areas that govern emotion (also in the brain), which further diminishes pain perception. However, the effect that leads to hydrocodone addiction is the way it activates the release of dopamine, the brain’s feel-good chemical that causes people to experience intense feelings of euphoria.
The effect is so profound that it is enough to compel people to take hydrocodone and other opioids again and again. Hydrocodone is classified as a Schedule II controlled substance by the U.S. Drug Enforcement Administration (DEA), which means it carries a high potential for abuse and leads to severe psychological or physical dependence.
The federal government has proposed policies to make it more difficult to procure hydrocodone and other opioids. Still, it is being abused recreationally.
Users have also unknowingly misused the product by not sticking to prescription guidelines. They make the mistake of assuming that hydrocodone is safe because it is doctor-prescribed. In the process, they develop a tolerance and become dependent, when their bodies become used to the presence of the drug.
Once they stop, they may begin to experience symptoms of withdrawal, which makes hydrocodone dangerous.
The Stages of Hydrocodone Withdrawal
Opioid addictions should be treated with the same vigilance as a terminal disease, in which early detection is necessary. Why? Because the cycle of addiction that opioids unleash makes quitting difficult.
A key indicator of a growing hydrocodone abuse issue or mounting addiction is when someone experiences withdrawal symptoms.
Also, while opioid withdrawal symptoms are not considered life-threatening, they are painful and uncomfortable to the point of compelling someone to reuse.
People who are addicted to hydrocodone are prone to overdose, as sensitivity for the drug’s effects increase, and tolerance decreases. Detoxing from hydrocodone, or any opioid, should not be done at home.
What’s more, hydrocodone produces three distinct stages of withdrawal symptoms, which can last seven to 10 days.
Hydrocodone withdrawal occurs in the following stages:
Beginning stage: In one to three days of withdrawal, the brain, and gastrointestinal system attempt to get used to being without hydrocodone. The brain has become dependent on the presence of the drug, especially in how it binds to opioid receptors and triggers feelings of reward. A cluster of nerves located in the gastrointestinal system has also become accustomed to the presence of hydrocodone. This loss impacts digestion and causes constipation and reduced appetite. Symptoms will also feel like a cold or flu. Additionally, intense drug cravings crop up at this stage, which can be difficult if users attempt to detox on their own.
The symptoms of withdrawal that arrive at the beginning stage include:
- Agitation, anxiety, and restlessness
- Muscle aches and pains
- Runny nose
- Watery eyes
- Insomnia or sleep disturbances
Peak stage: The worst feelings show up at this stage of withdrawal, which usually occurs three to five days after quitting hydrocodone. The flu-like feeling will be at its worst. Cravings for hydrocodone will also be at their strongest. When someone experiences peak symptoms, it is recommended that they seek medical and/or professional help.
Peak stage symptoms include:
- Joint aches
- Muscle pain
- Difficulty sleeping
- Stomach pain
- General malaise
Decline stage: At days five to seven, you may begin to feel better. However, you will likely experience physical and psychological symptoms. The physical symptoms that usually manifest are goosebumps, nausea, diarrhea, or muscle aches. Mood swings, agitation, insomnia, and cravings are the psychological symptoms that arrive at the decline stage. These psychological symptoms take longer to go away, especially if you do not have social or medical support of a physician, therapist, or addiction specialist.
Another point to consider: Without proper medical oversight or treatment, hydrocodone users in withdrawal are prone to getting post-acute withdrawal syndrome (PAWS). People who have abused hydrocodone for a long time, and try to quit cold turkey and relapse, are liable to develop this syndrome.
It is also not unusual for people who have not used it very long to experience PAWS. It all depends on the individual.
Post-Acute Withdrawal Syndrome (PAWS)
While there are three stages of hydrocodone withdrawal, they may only serve as precursors to the first true level: the acute stage.
For some users, PAWS can be the second full stage when symptoms linger for weeks or even months. While these symptoms may be more psychological than physical, a user will experience concerning effects, especially without medical supervision.
Longtime opioid abusers are more prone to developing PAWS, particularly if they have tried to quit before and relapsed after a few days.
During PAWS, they may experience a reemergence of pain or become more sensitive to pain. They could experience symptoms in which they feel like they are contracting a cold or flu again. Psychological effects such as depression, anxiety, and bouts of insomnia may crop up as well.
The lingering effects of PAWS are why a detox and rehabilitation program are absolutely critical. Relapsing during the PAWS phase puts you at risk for succumbing to a hydrocodone overdose.
An overdose can result in permanent brain damage and even death. The symptoms of hydrocodone and/or hydrocodone-acetaminophen overdose include:
- Nausea and vomiting
- Breathing problems, including slow and labored breathing, shallow breathing, or no breathing
- Liver failure (from acetaminophen overdose), causing yellow skin and eyes (jaundice)
- Bluish-colored fingernails and lips
- Cold, clammy skin
- Weak pulse
- Loss of consciousness
- Low blood pressure
- Muscle twitches
- Tiny pupils
- Spasms of the stomach and intestines
How Professional Treatment Helps
For people who are battling an opioid addiction, professional addiction treatment can offer evidence-based therapy and a medically supervised detox. During detox, the drug and other toxic substances are removed from the body, and withdrawal symptoms are alleviated.
A professional program begins with acute treatment. Doctors can administer medications to ease those withdrawal symptoms. With the guidance of clinicians, you are provided treatment options that best address your needs.
For hydrocodone addictions, treatment through clinical stabilization services is recommended. Clinical stabilization provides comprehensive therapy and counseling designed to help you get to the root causes of your addiction.
The services that are offered include:
- Nutritional assessments
- Emotional regulation
- Medical education
- Motivational enhancement
- Relapse prevention
- The 12 steps of recovery
- Wellness skills
- Cognitive behavioral therapy (CBT)
- Dialectical behavior therapy (DBT) skills
- Genetic testing
- Family-focused therapy
- Trauma-informed sessions
The next step is outpatient services, where you receive ongoing treatment and counseling while attending to the obligations of your life.
Upon completion of treatment, you can get connected to a recovery community that provides long-term support and counseling for your hydrocodone addiction.