Hydrocodone Addiction: Signs, Symptoms, and Treatment

Hydrocodone is the most prescribed opioid in the United States; however, it is also misused for its opioid euphoric effects and has a high potential for hydrocodone addiction.¹

This article will cover what hydrocodone is, how it’s used, the effects it can cause, and how you or your loved one can get treatment for hydrocodone addiction.

What Is Hydrocodone?

Hydrocodone is a semi-synthetic opioid (man-made from the natural plant) medication that is used to treat moderate to severe pain.² It is known as a narcotic analgesic (pain reliever), which is prescribed to treat moderate to severe pain.¹ It can also be prescribed as a cough suppressant.¹ Numerous generic and brand name variations of hydrocodone exist, with the most common being a combination of hydrocodone and acetaminophen, known as Vicodin.¹

Hydrocodone is a Schedule II drug, meaning, it has a high potential for misuse that can lead to psychological and physical dependence.³ Other Schedule II drugs include cocaine, methamphetamine, oxycodone (OxyContin), Adderall, Ritalin, and fentanyl.³

Hydrocodone is available for oral use in the form of tablets, capsules, and oral solutions.² It is not meant to be dissolved, chewed, or crushed as that can initiate uncontrolled absorption and overdose.² Hydrocodone comes in immediate-release (IR) and extended-release (ER) formulations.²

In 2013 over 136 million prescriptions were written for hydrocodone-containing medications in the U.S. alone.¹ That number has been on the decline due to the strict regulations in response to the opioid crisis. However, as recently as 2018, there were still over 70 million hydrocodone-containing products prescribed in the U.S.¹ Learn more about hydrocodone addiction and recovery facts.

Is Hydrocodone Addictive?

Yes, hydrocodone can be addictive. Opioids, including hydrocodone act on the reward center of a person’s brain and can lead to feelings of euphoria (intense happiness), which may increase the potential for misuse or substance use disorder (the diagnostic term for addiction).⁴

Opioids like hydrocodone can be particularly addictive because they release large amounts of dopamine into the body, which can reinforce drug-taking behaviors.⁵ Opioids bind to opioid receptors in the brain, blocking pain receptors and producing feelings of intense pleasure.⁵

Even people who take prescription opioids as prescribed can develop dependence. Dependence occurs when the body becomes so used to the drug that it believes it needs it to function and as a result. If the individual reduces their dose or quits using hydrocodone, they are at high risk of withdrawals. Dependence is different than addiction and one does not always lead to the other.⁴

Addiction is regarded as a chronic, relapsing condition that’s characterized by compulsive drug-seeking behavior, despite negative consequences in a person’s life.⁶ The recurrent use of alcohol or drugs can cause psychological and physical health problems, which can lead people to neglect obligations at school, work, or home.⁷

Signs of Hydrocodone Addiction

Substance use disorders (the clinical term for addiction) can range in severity from mild to severe.^7,8 The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) also has a classification specifically for opioid use disorder (OUD), which includes 11 criteria. Only a medical professional can diagnose a hydrocodone addiction like OUD; however, these signs of hydrocodone addiction may help you or a loved one identify a potential problem and when to seek help.

If you or a loved one have experienced 2 or more of these criteria in the past 12 months, you may consider reaching out for support to address these signs of hydrocodone misuse and addiction:^8,9

• Hydrocodone is taken in larger amounts or over a longer period than was intended.
• There is a persistent desire or unsuccessful efforts to cut down or control hydrocodone use.
• A great deal of time is spent trying to get hydrocodone, use hydrocodone, or recover from its effects.
• The person experiences hydrocodone cravings or a strong desire or urges to use hydrocodone.
• Recurrent hydrocodone use results in a failure to fulfill major role obligations at work, school, or home.
• Continued hydrocodone use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
• Important social, occupational, or recreational activities are given up or reduced because of hydrocodone use.
• Recurrent hydrocodone use in situations in which it is physically hazardous.
• Continued hydrocodone use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
• The person exhibits tolerance (the body requires more of the drug to feel the same desired effects).
• The person exhibits hydrocodone withdrawal symptoms (associated with dependence).

Adverse Effects & Health Risks of Hydrocodone Misuse

Possible effects of prescription opioids, including hydrocodone, include:^{5, 10}

• Drowsiness.
• Confusion.
• Nausea.
• Constipation.
• Slowed breathing.
• Respiratory depression (a sign of overdose). ¹
• Cardiovascular issues like hypotension and slowed heart rate.¹
• Insomnia.¹¹
• Stomach cramping and constipation.¹¹
• Increased risk of overdose.¹⁰
• Risk of using other opioids like heroin.^{5, 11}

Hydrocodone Withdrawal Symptoms & Timeline

When a person is dependent on hydrocodone and suddenly stops using the drug, they can experience potentially severe withdrawal symptoms.⁵ It is important to remember that the timing of withdrawal symptoms will vary depending on a number of factors, such as:^12,13

• The severity of symptoms.
• The time of onset and duration of symptoms.
• The duration of hydrocodone use.
• How much was being consumed.

Hydrocodone withdrawal symptoms may occur within hours after a person’s last dose and can include:^5,10

• Muscle and bone pain.
• Restlessness.
• Insomnia.
• Diarrhea and vomiting.
• Sleep problems.
• Cold flashes with goosebumps.
• Uncontrollable leg movements.
• Severe cravings.

Older adults who use opioids are at a higher risk of misuse or developing an addiction because they often take multiple medications for chronic conditions. This could increase the risk of harmful drug interactions.⁵ Older adults also tend to have slower metabolisms, which can affect the body’s ability to break down drugs once ingested. Slower metabolism means that opioids can stay around longer in the body, which can increase the risk of overdose or withdrawal.⁵

Hydrocodone Overdose

If you or someone you know is experiencing an opioid overdose, call 9-1-1 immediately. A hydrocodone overdose occurs when a person takes enough of the drug to create potentially life-threatening effects or even death.⁵

Prescription opioid overdoses most commonly lead to breathing that slows or even stops.⁵ As a result, hypoxia can occur, a condition where an insufficient amount of oxygen reaches the brain.⁵ Hypoxia can lead to coma, permanent brain damage, and death.⁵

In 2019, over 70,000 people died of a drug overdose in the U.S., and 70% of those deaths involved opioids.¹⁴

If you are worried someone might be experiencing an opioid overdose, there are warning signs to be aware of including:¹⁵

• Constricted “pinpoint” pupils.
• Slow, shallow breathing.
• Loss of consciousness.
• Choking or gurgling sounds.
• Limp body.
• Pale, blue, or cold skin.

It’s important to seek medical attention immediately if you’re experiencing an opioid overdose as medical personnel can administer Naloxone, which blocks opioid effects to help stop an overdose.⁵

Risk Factors for Hydrocodone Overdose

Several factors may contribute to the risk of hydrocodone overdose:¹⁵

• Taking opioids with alcohol or certain other drugs.
• Taking larger doses or more hydrocodone than prescribed.
• Presence of medical conditions such as sleep apnea and poor liver, or kidney function.
• People over the age of 65 or those who take large, daily doses of opioids

Additionally, there are biological and environmental risk factors that can play a role in the development of a substance use disorder and overdose. Some of these include:⁶

• Gene expression: A family history of addiction or genetic predisposition to substance misuse.
• Environmental factors: A person’s family and home environment (emotional instability or neglect, parents who use drugs or alcohol, or children exposed to abuse), pressure from peer groups, and even stressors at school.
• Mental health disorders: Particularly mood disorders like depression and anxiety can lead to someone trying to “self-medicate” with drugs or alcohol to manage symptoms.
• Age of first use: The earlier someone begins using drugs, the greater the potential for serious problems developing as they get older.
• Route of administration: Injecting a drug directly into a vein increases addictive potential.

Treating a Hydrocodone Overdose

If you suspect someone is experiencing an opioid overdose, call 9-1-1 immediately. If a person ingests too much of an opioid drug, it can interrupt the body’s ability to breathe, leading to brain damage or death.¹⁶

Naloxone is a life-saving drug, approved by the U.S. Food and Drug Administration (FDA) to reverse an opioid overdose if administered quickly enough.¹⁴ It comes in the form of an injectable and a nasal spray.¹⁶

Naloxone only works in the body for approximately 30 to 90 minutes. If someone is experiencing an overdose and naloxone is given, they still need emergency medical care right away as the effects of opioids may still be felt after naloxone wears off.¹⁶

Most pharmacies carry naloxone, and in some states, you don’t even need a prescription.¹⁶ Anyone who has a loved one with an opioid use disorder should have this life-saving drug on hand; however, you should still call 9-1-1 so the person can continue receiving medical care after naloxone is administered.¹⁶ It will have no effect if administered to someone who does not have opioids in their system.¹⁶

If someone around you is experiencing a hydrocodone overdose, the following tips may be helpful:¹⁶

• Call 9-1-1.
• Administer naloxone if it is available.
• Try to keep the person awake and breathing.
• Lay the person on their side to prevent choking.
• Stay with them until emergency assistance arrives.

Hydrocodone Addiction Treatment Options

Addiction is a complex and chronic condition, but it is treatable.¹⁷ There are several treatment options available; however, no single approach to treatment is right for everyone.¹⁷ Effective treatment for hydrocodone addiction should address the individual needs of the person, including any associated medical, psychological, social, vocational, or legal issues a person might be struggling with.¹⁷

Medications can be an important element of opioid addiction treatment for people with severe opioid disorders. There are medications to help manage withdrawal and cravings in addition to those for an opioid overdose:^10,17

• Methadone is a long-acting opioid that is given during detoxification and long-term treatment to reduce opioid cravings and withdrawal symptoms.
• Buprenorphine is a partial opioid agonist that eases withdrawal symptoms and cravings.
• Naltrexone is an opioid receptor antagonist that blocks the euphoric effects of opioids and helps reduce cravings.

Behavioral therapies, including individual, group, and family therapy are commonly used in treating drug and alcohol addiction and have been proven highly effective, especially when used in conjunction with medication to manage cravings.¹⁷

One common therapy approach is cognitive-behavioral therapy (CBT), which helps people address negative patterns of thinking that are often associated with unhealthy behavior patterns. CBT also helps people learn healthier coping strategies, problem-solving skills, and communication tools.⁵

Treatment can take place at various levels of care and settings depending on the person’s needs and substance use. Treatment options can include one or more of the following:^{17, 18}

• allow people to maintain their daily routines and live at home while receiving treatment.
• Intensive outpatient treatment is more intensive than traditional outpatient, involving several hours a week of treatment, while still allowing a person to fulfill obligations at work and home.
• Residential/inpatient treatmentis when a person resides at a treatment facility for a period of time while receiving treatment. This is typically for people with more severe substance use disorders or those with co-occurring mental health conditions who need more supervision.

Get Help for Hydrocodone Addiction

If you or a loved one is struggling with hydrocodone misuse, it may be time to seek help. Contact a local rehab center for assistance.