Is Hydrocodone Addictive?

What is Hydrocodone?

Hydrocodone is a powerful painkiller and cough suppressant. It’s available in tablet, capsule, and oral solution forms.^{1, 2, 3}

It’s the most common prescription opioid in the U.S. Over 136.7 million products were dispensed in 2013 and 93.7 million in 2016.⁴

Opioids are drugs that can relieve pain and produce pleasurable feelings. One popular opioid is heroin, which is illegal in the U.S. 

Commonly prescribed opioids for moderate-to-severe pain include:^{5, 6, 7}

• Natural opioids like morphine and codeine
• Semi-synthetic opioids like hydrocodone, oxycodone, and oxymorphone
• Synthetic opioids like fentanyl and methadone

Side Effects of Hydrocodone 

Hydrocodone has a broad range of side effects, including:^{1, 2, 7, 8, 9, 10} 

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Is Hydrocodone Addictive?

People can misuse prescription opioids by taking:⁷

• The drug in a way that’s not prescribed
• Someone else’s prescription drugs
• The drug to get high

Opioids are usually safe and effective when taken as prescribed for short periods. However, they can easily lead to physical and psychological dependence when taken in increasing amounts for longer periods.

Since hydrocodone is an opioid, using it can lead to addiction and the abuse of more potent opioids. 

In 2009, hydrocodone was the second-ranked prescription opioid submitted to forensic labs as drug evidence.⁴

Two years later in 2011, hydrocodone combination products were involved in over 100,000 drug abuse-related emergency room visits in the U.S.¹¹

Hydrocodone’s classification went from Schedule III (moderate-to-low potential for abuse) to the more restrictive Schedule II (high potential for abuse) in 2014. This change aimed to control hydrocodone prescriptions.^{3, 4, 11, 12}

In the U.S., the number of people aged 12 and above who misused hydrocodone fluctuated over the years:⁴

• 6.9 million in 2016
• 7.2 million in 2015
• 6.9 million in 2017
• 5.5 million in 2018

Non-medical use of hydrocodone among school-aged children remains a concern, too. 

In 2018, these age groups varied:⁴

• 0.6% of 8th graders
• 1.10% of 10th graders
• 1.70% of 12th graders

What Causes Hydrocodone Addiction?

Like other opioids, hydrocodone binds to and activates opioid receptors within the central nervous system (CNS). 

This action blocks pain signals sent from the brain to the body. It also triggers the release of dopamine, a hormone that produces euphoria. 

People may want to use hydrocodone repeatedly because of this euphoric effect. They may take the drug in higher amounts than prescribed or for longer than recommended. 

People may develop tolerance over time by increasing the dose to get the same euphoric intensity they felt when they started taking hydrocodone. 

Opioids suppress the natural release of dopamine in the brain, decreasing the normal ‘good’ feelings that most people get on a regular basis.

Further, hydrocodone use may lead to physical dependence and addiction. People may experience withdrawal symptoms if they stop taking the drug.^{1, 6, 7}

Opioid addiction is complex. It’s influenced by various risk factors like:⁶

• Genetics
• History of substance abuse
• Depression or other mental illnesses
• Abuse or neglect during childhood
• Certain traits like being impulsive or seeking the euphoric sensation
• Poverty
• Mingling with other opioid users
• Having easy access to opioids

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How to Tell if Someone is Addicted to Hydrocodone

Hydrocodone’s side effects are a good starting point for spotting people with hydrocodone addiction. 

For a more accurate diagnosis, use the following 11 criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).

People are likely to be addicted if they:

1. Take hydrocodone in increasingly higher amounts or frequency, or over extended periods
2. Want to stop using hydrocodone but have no success
3. Spend lots of time obtaining or using hydrocodone, or recovering from its side effects
4. Continue to use hydrocodone even though it is causes problems
5. Avoid essential activities due to hydrocodone use
6. Neglect to fulfill obligations due to hydrocodone use
7. Get involved in dangerous situations, like driving under the influence or having unprotected sex
8. Continue to use hydrocodone even though it causes social or relationship problems
9. Experience intense cravings to use hydrocodone
10. Have developed tolerance to hydrocodone
11. Experience withdrawal symptoms if they stopped using hydrocodone

The severity of a person’s hydrocodone abuse can be classified based on the number of met criteria: 

• Mild: 2 to 3 criteria
• Moderate: 4 to 5 criteria
• Severe: 6 or more criteria

Other Risks of Hydrocodone Misuse

Hydrocodone is an opioid. The general risks of opioid misuse generally apply to hydrocodone as well. 

Aside from addiction, there are other risks of hydrocodone misuse, which include the following: 

Addiction to Stronger Drugs

It’s common for prescription opioid users to switch to more potent opioids like heroin and fentanyl. 

In 2011:⁷

• Four to 6 percent who misused prescription opioids switched to heroin
• Eighty percent who used heroin first began using prescription opioids

Heroin is similar to other opioids in terms of effects and chemical structure. People sometimes switch to heroin because it’s cheaper and easier to obtain than prescription narcotics. 

Drug Overdose

Opioids can lead to overdose when combined with other drugs or taken in high doses.

Some symptoms of opioid overdose include:^{1, 2, 6, 8, 9}

• Slow or difficulty breathing
• Slow heart rate
• Sleepiness
• Apnea (stopping breathing)
• Excessively dilated or constricted pupils 
• Clammy or bluish skin
• Low blood pressure
• Loss of consciousness

When breathing slows down or stops, it decreases the amount of oxygen to the brain. This can lead to coma, permanent brain damage, or death.⁷

Seek emergency help immediately if you suspect you or someone you know has overdosed. Administer naloxone, which reverses the harmful effects of opioid overdose, while waiting for help.^{1, 2, 7, 8}

Withdrawal Symptoms

People may experience withdrawal symptoms if they stop or significantly reduce their hydrocodone intake.

These symptoms include:^{2, 7, 8}

• Anxiety, irritability, or restlessness
• Dilated pupils
• Teary eyes
• Runny nose
• Yawning
• Unusual sweating
• Goosebumps
• Back, joint, or muscle aches
• Weakness
• Abdominal cramps
• Nausea
• Vomiting
• Diarrhea
• Fast breathing or heart rate
• Sleeping problems
• Uncontrolled leg movements
• Severe cravings

Symptoms typically begin at least 6 hours after the last intake. They may last for days, weeks, or months.  

Because withdrawal symptoms can be uncomfortable,many people find it hard to stop using opioids.

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Hydrocodone Addiction Treatment Options 

Treatment approaches for hydrocodone addiction do not differ from that of other opioid addictions. They include:

Medications and Gadgets

FDA-approved medications and gadgets for opioid addiction include:^{7, 10}

• Methadone and buprenorphine activate opioid receptors but don’t produce euphoria.
• Naltrexone blocks opioid receptors to prevent euphoria.
• Lofexidine reduces withdrawal symptoms.
• NSS-2 Bridge is a small electrical nerve stimulator that can be placed behind the ear during the acute withdrawal phase.

Behavioral Treatments

These approaches are proven to be effective, especially when combined with medications:^{7, 14}

• Cognitive behavioral therapy (CBT): This therapy helps change drug use expectations and learn how to manage triggers and stress. 
• Multidimensional family therapy: For adolescents with drug use problems, this therapy addresses personal and family influences on drug use patterns. 
• Mutual support groups: In these groups, members celebrate success, express frustrations, share resources and referrals, and exchange sobriety tips. 

How to Prevent Hydrocodone Addiction

Here are some tips to avoid hydrocodone addiction:^{1, 2, 8, 9}

• Only use hydrocodone for pain that other medications can’t treat.
• Take hydrocodone exactly how your doctor prescribes. Don’t change dosage or frequency without your doctor’s permission.
• Swallow hydrocodone tablets or capsules. Don’t crush, chew, or dissolve them. Doing so can lead to uncontrolled release and hydrocodone overdose. 
• Discuss treatment with your doctor if your body becomes used to hydrocodone. They may increase your dose or prescribe another medication.
• Tell your doctor if your pain decreases even though you still have some pills. They may reduce your dosage gradually.  
• Don’t stop taking the drug without consulting your doctor. You may develop hydrocodone withdrawal symptoms if you stop using abruptly.
• Talk to your doctor immediately if you’re starting to crave the drug even though you no longer feel pain. They will help you avoid developing a hydrocodone addiction.
• Don’t share your medication with others.

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