Table of Contents
Hydrocodone Addiction, Abuse, and Symptoms

TABLE OF CONTENTS

I. The Basics

This guide explains the effects, trends, and dangers of hydrocodone use, as well as an unbiased analysis of the medicinal and behavioral treatment methods for hydrocodone addiction based on current research and publicly available statistics. In some cases, usage statistics are derived from general prescription opioid use, which includes hydrocodone, oxycodone, morphine, hydromorphone, and tramadol.

Primary Hydrocodone Dangers

  • Addictiveness: In 2007, medical journal The Lancet published the results of a study conducted to determine the addictive potential of several substances. During the study, researchers assessed each substance based on factors such as risk of dependence and potential for social harm. Although hydrocodone was not included in the study, the researchers did test another opiate: heroin. Out of the 20 substances analyzed, heroin had the highest addictive potential, demonstrating the dangers of opioids.
  • Risk of overdose: In the United States, the number of overdose deaths involving opioids has increased drastically in the past two decades. Between 1999 and 2017, nearly 500,000 overdose deaths involved an opioid-like hydrocodone, according to the Centers for Disease Control and Prevention.
  • Unintended side effects: Long-term use of hydrocodone can cause serious physical and psychological consequences. Physical side effects include muscle twitching, slower breathing rate, irregular breathing, and chest tightness. Psychological side effects include hallucinations and confusion.
  • Legal risks: Hydrocodone is a Schedule II controlled substance in the United States, which means it’s a crime to possess it without a valid prescription. Possession is usually charged as a misdemeanor, which is less serious than a felony; however, the penalties for a misdemeanor conviction can still be harsh. If convicted, a user may have to pay a fine, spend up to one year in jail, or participate in inpatient or outpatient drug rehabilitation.

Hydrocodone Background Information

Derived From Synthesized from codeine
Ways Used Ingestion, injection, crushing/snorting
Scientific Name Hydrocodone bitartrate, hydrocodone bitartrate with acetaminophen
Slang/Street Names for Hydrocodone Lorris, Fluff, Vickies, Idiot Pills, Norco, Vico, Vikes, Watson-387, Scratch, Tabs, Hydro, 357s
How Long in Bodily System Half-life: 4 to 6 hours
Elimination in three to four days but up to a week in chronic users
Punitive Legal Measures: Using/Possession Due to its status as a Schedule II controlled substance, it’s illegal to possess hydrocodone without a prescription provided by a licensed medical professional. A first-time conviction usually results in a fine and up to one year in jail. An individual convicted of possession may also be required to complete a drug rehabilitation program.
Punitive Legal Measures: Selling/Distributing Selling or distributing hydrocodone without a prescription may be charged as a felony, as it’s considered more serious than simple possession. The penalties vary based on each state’s laws, but an individual convicted of selling or distributing this substance may be sentenced to more than 20 years in prison.
DEA Drug Rating Schedule II

II. Signs of Abuse

Behavioral Symptoms of Hydrocodone Usage and Abuse

How hydrocodone affects the brain

Like other opioids, hydrocodone increases the amount of dopamine in the brain, resulting in an enhanced sense of well-being. The rush of dopamine causes a euphoric effect in some users, increasing the risk of dependence. An increase in dopamine also activates the reward center of the brain. The brain perceives the rush of dopamine as a reward, causing some users to develop cravings for the drug. Over time, it takes more and more hydrocodone to experience the same effects, increasing the risk of overdose.

Behavioral signs of hydrocodone usage and abuse

When individuals can’t get hydrocodone from friends and family members, they may start buying it off the street. As a result, sudden changes in an individual’s financial circumstances could signal a problem with hydrocodone or another opioid. Borrowing large sums of money, taking out loans, opening up multiple credit accounts, and withdrawing large sums of cash are all possible signs of hydrocodone misuse.

Changes in how an adult behaves at work or how an adolescent behaves at school could also indicate that an individual has been misusing hydrocodone. In adults, these changes may include attendance problems, inability to meet deadlines, problems getting along with colleagues, and making serious mistakes on work assignments. For adolescents, any sudden decline in academic performance is cause for concern. Adolescents who misuse hydrocodone may also skip classes, start spending more time alone, and drop out of school activities that they used to enjoy.

Misusing hydrocodone may also cause an individual to engage in risky behavior, such as speeding, driving under the influence, or shoplifting. As a result, some individuals who are addicted to hydrocodone may suddenly start having trouble with the law, even if they previously had clean records.

In some cases, hydrocodone users engage in deceptive behavior to convince medical professionals to give them valid prescriptions. For example, someone who is addicted to hydrocodone may exaggerate their pain levels or claim that they’re in pain even when they’re not. Some users also ask multiple doctors to give them hydrocodone prescriptions, a practice known as doctor shopping. It’s also common for someone who engages in this type of behavior to claim that non-narcotic pain relievers aren’t effective.

Physical Symptoms of Hydrocodone Abuse

How hydrocodone affects the body

Hydrocodone works by attaching to opioid receptors in the brain, which slows down the nervous system and relieves pain. Within 30 to 60 minutes of taking hydrocodone, users may start to feel drowsy or dizzy. Some users also experience nausea and loss of coordination once the drug takes effect. If the user takes hydrocodone products containing acetaminophen, the acetaminophen is broken down into several compounds and excreted in the urine.

Early physical effects of hydrocodone

This table illustrates the possible short-term physical effects associated with hydrocodone.
Short-Term Physical Symptoms
Initial (direct effects of drug, 30 – 60 min.) Nausea
Dizziness
Drowsiness
Lingering (within an hour of taking the drug) Confusion
Itching
Slower breathing
Loss of appetite
Slow heart rate
Itchy skin
Post-Use (several hours to days after use) Constipation
Yellowing of the skin and whites of the eyes
Dark urine
Changes in stool color
Dependence (more likely with higher/more frequent doses)

Severe and long-term physical effects of hydrocodone

Hydrocodone has serious side effects involving the respiratory system. When an individual takes hydrocodone, the respiratory system slows down, resulting in a slower breathing rate. If an individual takes too much hydrocodone at one time, his or her breathing could get dangerously low. A slower breathing rate is also dangerous for users who have sleep apnea and other respiratory conditions.

Hydrocodone is especially risky when it’s combined with other substances. For example, combining hydrocodone with alcohol enhances the depressant effects of both substances, which may cause the user’s heart rate or breathing rate to get dangerously low.

When hydrocodone is combined with acetaminophen, it can be even more dangerous, as the liver is responsible for breaking down acetaminophen into several byproducts. The more acetaminophen an individual takes, the harder the liver has to work. Therefore, individuals who misuse hydrocodone products containing acetaminophen are at risk for liver damage.

This table illustrates the possible long-term physical effects associated with hydrocodone.
Long-Term Physical Symptoms
Casual Nausea
Vomiting
Constipation
Drowsiness
Dizziness
Chronic
Including all of the above effects for casual use
Changes in urine color or stool color
Lightheadedness
Confusion
Withdrawal Bone and muscle pain
Sweating
Chills
Yawning
Diarrhea
Nausea
Vomiting

Further Resources

Both the National Institute of Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) offer in-depth information on the symptoms and treatment of prescription opioid addiction.

III. Hydrocodone Usage

Misuse of hydrocodone is a serious public health concern all over the world

The hydrocodone supply has increased significantly since the 1990s, making more daily doses available to the inhabitants of many countries. For example, Germany had approximately 30,000 daily doses of opioids available for every one million inhabitants between 2013 and 2015. The United States has an even larger opioid supply, with the International Narcotics Control Board reporting that the country had more than 47,000 daily doses per one million Americans during the same period.

Due to serious concerns over increased opioid use, legislators, law-enforcement officials, and medical professionals have implemented several initiatives to reduce the availability of these substances. As a result, the hydrocodone supply has decreased since it reached its peak of 45,000 kilograms in 2012. As of 2016, the global supply of this substance was approximately 25,000 kilograms. Although the global supply of hydrocodone has decreased since 2012, hydrocodone is often used as a substitute for stronger narcotics with more serious side effects. Therefore, hydrocodone is still widely available, making it more accessible to individuals who have an elevated risk of developing an addiction.

The United States may have the largest number of hydrocodone users in the world, but opioid addiction is not a uniquely American problem. Approximately 1% of the population of Asia — approximately 44 million people — used opioids in 2017, according to the 2019 World Drug Report. In Australia and New Zealand, over 3% of the population used opioids like hydrocodone in 2017.

Prescription Opioid Use Throughout the World
Highest Second Third
Regions With the Highest Number of Prescription Opioid Users North America Oceania Middle East/South-West Asia
Regions With the Highest Number of Daily Doses of Opioids Available (per 1,000,000 inhabitants) North America Oceania South-Eastern Europe/Western Europe

Hydrocodone Usage Demographics in the U.S.

Misuse of hydrocodone and other opioids has caused a crisis in the United States

The United States has the highest number of hydrocodone users in the world, due in part to the large supply of hydrocodone available. As of 2016, 4.4% of the American population — 11.8 million people — had used an opioid-like hydrocodone within the previous year. The opioid epidemic is so serious that two million people were diagnosed with opioid use disorder in 2018; furthermore, more than 130 Americans die every day as the result of opioid overdoses, according to the U.S. Department of Health and Human Services.

Although the opioid crisis is concerning, it appears that recent policy changes have started to have their intended effect, as demonstrated by a decrease in the number of adolescents using narcotics. The Monitoring the Future Survey collects data regarding substance use among students in 8th, 10th, and 12th grades. In 2019, only 5.3% of the 12th graders surveyed reported that they had used a narcotic other than heroin at any point in their lives, a decrease from 6% in 2018. Past-year use also decreased from 3.4% to 2.7% of the 12th graders surveyed.

Demographics of Prescription Usage
Past Year (2018) Lifetime
8th grade (14-15 yo) No data collected No data collected
10th grade (15-16 yo) No data collected No data collected
12th grade (17-18 yo) 3.40% 6.0%

IV. How to Find Help

Once a user is dependent on hydrocodone, it’s difficult to stop using it due to the effects it has on the brain. Hydrocodone attaches to an individual’s opioid receptors, producing an enhanced sense of well-being and causing some users to experience a pleasant “high.” The drug also causes an increase in the amount of dopamine in the brain, which activates the brain’s reward circuit. As a result, the brain interprets the high produced by hydrocodone as a reward to be pursued. Then the user must take larger doses of hydrocodone to produce the same effects, increasing the risk for addiction.

Even if an individual doesn’t want to keep using hydrocodone, it’s difficult to stop because opioid withdrawal can cause severe physical and psychological side effects. Therefore, a multistep rehabilitation process is usually the most effective way for an individual to recover from hydrocodone addiction. This process usually begins with an initial detoxification period, which gives the user a chance to taper off hydrocodone gradually instead of stopping “cold turkey.”

 

For more information about rehab, read our guide on Hydrocodone Rehab.

Staging an Intervention

If you have a loved one who’s struggling with addiction, staging an intervention is often the first necessary step towards sobriety, but it’s important to be strategic and loving in your approach. Even the most well-meaning of interventions can have a negative effect if they aren’t handled correctly.

5 Tips for Staging an Intervention

1. Don’t Do It Alone. A professional interventionist is always the most qualified to guide a successful intervention. Also, rely on non-addict family and friends — especially those who have a close relationship with you or the addict.
2. Research Ahead of Time. It’s best to do plenty of research ahead of time to gather insight on the addiction and how it affects the addict. Also, be prepared with local resources for getting help.
3. Write Out Your Statement. During the actual intervention, emotions will likely be running high, so it’s best to have a statement of how the person’s addiction has impacted you and your relationship with him or her. These statements should be honest yet written from a place of love — no personal attacks.
4. Offer Help. It’s important for everyone attending the intervention to offer tangible help and support as the person works through detox and rehabilitation.
5. Set Boundaries. If the person refuses to seek help and take the next steps outlined, it’s important that they understand that everyone present will end codependent and enabling behaviors.

V. Sources