Hydrocodone is an opioid pain medication prescribed to treat moderate to severe pain. It may be  combined with non-opioid pain relievers, such as Tylenol, in prescription medications such as Vicodin.

Hydrocodone is classified as Schedule II narcotic by the Drug Enforcement Administration (DEA) due to its high potential for misuse, which can lead to opioid use disorder (OUD).[1]

Side effects of hydrocodone can occur with both legitimate use and misuse. They include constipation and digestive issues, drowsiness, mood swings, body aches and breathing issues, among others.

What Is Hydrocodone Misuse?

Hydrocodone misuse involves taking the medication in ways your doctor didn’t prescribe. As the U.S. National Library of Medicine points out, prescription drug misuse can involve the following activities:[9]

• Taking pills prescribed for someone else
• Taking bigger doses than your doctor recommended
• Taking the medication in ways your doctor didn’t suggest (like crushing the tablets)
• Using the medication to get high, not to treat a medical condition

What Is Hydrocodone?

Hydrocodone is a semi-synthetic opioid drug. It works by binding to opioid receptors in the brain to block pain sensations.

Like other opioids, it also reduces the brain’s reflex to breathe, which can increase the risk of respiratory suppression and overdose. Hydrocodone comes in a variety of prescription medication formulations. It is one of the most commonly prescribed opioid drugs in the United States with over 80 million hydrocodone-containing products dispensed in 2018.[2]

Hydrocodone Types

Hydrocodone is prescribed both as a single medication and as a combination product that also contains a non-opioid pain reliever, such as ibuprofen or acetaminophen (Vicodin). Hydrocodone products are available in various forms, such as tablets, capsules, and oral solutions.

These are common brand names for hydrocodone:

• Zohydro ER (extended release): hydrocodone
• Hysingla ER: hydrocodone
• Vicodin: hydrocodone/acetaminophen
• Lortab: hydrocodone/acetaminophen
• Norco: hydrocodone/acetaminophen
• Lorcet: hydrocodone/acetaminophen
• Ibudone: hydrocodone/ibuprofen
• Hycotuss: hydrocodone/guaifenesin

Hydrocodone Dosages & Precautions

Hydrocodone dosing will depend on the type and strength of the medication.

For example, the tablet, solution, capsule, and syrup are generally designed to be taken every four to six hours as needed. The extended-release suspension and extended-release capsule are to be taken once every 12 hours as needed, while the extended-release tablet is designed to be taken once per day to control pain for longer periods of time.

Hydrocodone products can contain varying amounts of the opioid drug too. The Centers for Disease Control and Prevention (CDC) recommends that you do not exceed 20 mg of hydrocodone in a day.[3] For example, if you are taking Vicodin containing 5 mg of hydrocodone and 300 mg of acetaminophen, you should not exceed four doses per day.

When taking a hydrocodone product, be sure to tell your doctor about any other medications or supplements you are taking. Let your doctor know about possible allergies to this medication or if you are pregnant or breastfeeding.

Hydrocodone can make you drowsy. You should not operate a motor vehicle until you are aware of how the medication is going to impact you and your ability to drive.

Additionally, hydrocodone is an extremely addictive medication with a high potential for misuse. When taken regularly over time, even if taken exactly as directed, hydrocodone can still be habit-forming.

Side Effects of Misuse & Abuse

Hydrocodone and combination products can cause the following potential side effects:[4]

• Drowsiness
• Stomach pain
• Constipation
• Lightheadedness
• Dry mouth and throat
• Sleep difficulties
• Ear ringing
• Back pain
• Muscle tightness
• Foot or ankle swelling
• Headache
• Uncontrollable shaking
• Painful, difficult, or frequent urination
• Anxiety
• Mood changes

These can occur with both legitimate medical use and misuse, but they are more likely with misuse.

These are more serious possible side effects that may occur in some people:

• Itching
• Chest pain
• Nausea, vomiting, or loss of appetite
• Weakness
• Dizziness
• Heartbeat irregularities
• Agitation
• Hallucinations
• Decreased sex drive
• Inability to keep an erection for men
• Irregular menstruation in women
• Trouble breathing or swallowing

With continued misuse, the risk for overdose increases, and this can be fatal.

Many hydrocodone products also contain acetaminophen, and this ingredient can be toxic to the liver at high doses. Researchers say many cases of acute liver failure can be directly tied to misuse of hydrocodone/acetaminophen products.[13]

What Does Hydrocodone Misuse Look Like?

People struggling with hydrocodone misuse may do their best to hide the problem from people they love. Even so, they may have telltale signs that you can look for.

Symptoms of a substance use disorder can be placed into the following four categories:[10]

• Impaired control: The person may tell you they’re going to quit or even throw all hydrocodone products away. However, they always seem to return to drugs in time.
• Social issues: The person may lose their job, stop participating in activities they once loved, or reduce the time spent with family. Their relationship with you and others may become strained.
• Risky use: The person takes hydrocodone while driving, operating a boat, or in another situation that could cause harm.
• Drug effects: The person needs more hydrocodone to get the same effect or seems sick when they try to quit.

Can You Prevent Hydrocodone Misuse?

If you’re using hydrocodone products to ease pain, your medications could become a target of someone else’s misuse. It’s critical to protect your medications from those who might misuse them.

These five tips from the American Medical Association may help:[11]

1. Store your medications in a locked container, like a safe.
2. Keep all of your pills in their original packages, so they’re not mistaken for candy or something else.
3. Store all medications out of the reach of children.
4. Never share your medication with anyone else.
5. Safely dispose of pills you don’t need. Ask your doctor about drug take-back programs in your area. Your pharmacy may also have a drop site or collection program for unwanted medications.

Hydrocodone Overdose

Close to 50,000 people died from an opioid overdose in 2019 in the United States.[5] An opioid overdose is a serious and potentially life-threatening condition that requires immediate professional medical attention.

Signs of an overdose on hydrocodone include the following:

• Difficulty breathing
• Drowsiness and inability to stay awake
• Bluish tint to skin and lips
• Lack of coordination and balance
• Nausea and/or vomiting
• Dizziness
• Changes in blood pressure and heart rate
• Mental confusion
• Pinpoint pupils

An opioid overdose should promptly be treated with naloxone (Narcan). If you have Narcan on hand, use it immediately and call 911.

Withdrawal Symptoms

Stopping hydrocodone suddenly can lead to withdrawal symptoms in individuals who have developed dependence. Some individuals may be able to stop hydrocodone immediately without any withdrawal symptoms, while others may experience severe withdrawal.  

If you notice physical dependence or withdrawal symptoms, you should consult a medical professional to help with the withdrawal process. Withdrawal is more likely if you have been using hydrocodone for a prolonged period, but can occur as soon as even a few weeks of using the medication regularly in certain individuals.

Withdrawal symptoms can include the following:

• Nausea and vomiting
• Diarrhea
• Fatigue
• Chills and goosebumps
• Headache
• Sweating
• Dizziness
• Muscle aches
• Stomach cramps and pain
• Anxiety
• Irritability
• Restlessness
• Mental confusion and trouble concentrating
• Depression
• Sleep issues

Treatment for Hydrocodone Misuse

Opioid use disorder is a treatable condition. Your treatment program may include both behavioral and pharmacological therapies. Treatment should be personalized and tailored to fit the needs of each individual. Treatment options can range from inpatient (or residential) programs to outpatient models, depending on what is best for the individual.

Behavioral Therapies

Behavioral therapies, such as cognitive behavioral therapy (CBT), teach coping mechanisms and life skills for managing triggers and negative thoughts and emotions.

Support Groups

Peer support groups can help to provide a healthy outlet and understanding community in recovery for OUD.

Medication

Medication is often an important component of a complete treatment plan. Medication for Addiction Treatment (MAT) involves using prescription medications, such as Suboxone, to decrease cravings, minimize withdrawal symptoms and support a sustained recovery.[7] Medication is combined with therapy in this model, and it is considered the gold standard in treatment for hydrocodone addiction.[8]

In an MAT program, treatment teams will learn more about your hydrocodone use, including how much you take regularly and your attempts to quit in the past. They’ll develop a dose of medication that seems right for you.

Since medications like Suboxone can trigger uncomfortable withdrawal when given too close to a hydrocodone dose, your team may look for signs like shivering or goosebumps before providing your first dose. Within the next several days, that dose will be adjusted to a level that keeps symptoms under control while allowing you to focus on your sober life.

Researchers say up to 90% of people who use MAT stay sober at the two-year mark.[12]

If you or a loved one are interested in learning more about MAT for OUD, please reach out to Bicycle Health.