For countless people in severe pain, hydrocodone seems like a miracle drug. Surgeries, injuries, and chronic conditions can make life challenging, and significant relief is found by people who thought they would always have to live in agony. Hydrocodone is one of the most frequently prescribed medications in the United States, with over 140 million prescriptions written every year.
In October 2014, the Food and Drug Administration (FDA) enacted regulations changing the classification of hydrocodone from Schedule III to Schedule II. This change reflects the understanding that although hydrocodone is useful and commonly prescribed, it represents a danger to its users is terms of its potential for abuse and addiction.
What Is Hydrocodone?
Hydrocodone is a semi-synthetic medication that is used extensively for pain relief and to treat coughs. It is synthesized from the poppy plant, making it an opiate, and relieves pain by attaching to the brain’s opiate receptors.
Illegal opiates include heroin and cocaine, but many opiates are legal and highly regulated, including prescription drugs like hydrocodone, oxycodone, codeine, and morphine. Opiates are currently the most frequently used medications to treat moderate or severe pain.
What Is Hydrocodone Abuse?
Since hydrocodone is so effective at relieving pain, people sometimes take it in ways that the prescribing physician did not intend.
- Taking more than the prescribed amount
- Taking it more often than prescribed
- Taking someone else’s prescription
- Taking it in a way other than intended, such as crushing pills and then snorting or injecting the resulting powder
Doctors are careful to prescribe certain dosages for specific needs and situations, so any time someone takes hydrocodone in a way other than what a physician has directed, even if the person is treating pain, it is considered abuse.
Hydrocodone also has other effects in addition to pain relief. Some people find that it relaxes them, gives them a sense of wellbeing or euphoria, or makes them feel warm and content. Hydrocodone is not indicated for depression, anxiety, or unhappiness, and taking it to treat those states is considered abuse as well.
In short, any use of hydrocodone that was not prescribed by a physician is considered abuse.
Who Is Likely to Abuse Hydrocodone?
There are two categories of people who might abuse hydrocodone: those who are in pain and have prescriptions for hydrocodone, and those who take hydrocodone for its other effects. While some people abuse hydrocodone in an effort to adapt to an increasingly higher tolerance to the drug, others use it recreationally, in an effort to chase a “high.”
Hydrocodone is prescribed for many different types of pain, including chronic or long-term pain. Unfortunately, it is possible that after a while, the original prescription no longer alleviates the patient’s pain as well as it once did. Since physicians are very wary of increasing the dosage of hydrocodone, people experiencing pain might take more of it, or take it more often, than they are directed to by their doctors.
This category can include people of any age, gender, or socioeconomic level, because everyone experiences pain and its challenges at some point in their lives. The potential for hydrocodone abuse applies to everyone, and anyone who takes it, even for completely legitimate treatments, should be aware of the dangers.
The second category of people who could potentially abuse hydrocodone are those who have discovered that it can give them pleasant emotional or physical sensations, and wish to take it even when they are not in pain. Sometimes, this happens after a person has had a prescription for a true pain need, but then noticed the other pleasant effects and did not want to stop taking it for that reason, even after the pain had been managed.
Sometimes, however, a person with an authorized prescription will have friends or family members who wish to share or buy their hydrocodone pills. These are not people who need it for pain management; rather they use these prescription medications like recreational drugs, in order to feel a rush or a high. This is, of course, abuse of this potent medication, and it puts users in danger.
Dangers of Abuse
One of the reasons physicians are so careful about how much hydrocodone they prescribe is because hydrocodone can have many significant side effects. As a powerful medication, side effects can be physical, mental, and emotional.
When abused — someone taking too much or too often — the side effects of hydrocodone can be dangerously intensified. If a person takes too much hydrocodone, overdose can occur. This involves the body’s system slowing significantly, leading to coma and even death. Per the CDC, 44 people die due to overdose on prescription painkillers like hydrocodone every day in the US.
Some people use other substances, such as alcohol, marijuana, or other prescription drugs, along with hydrocodone. This practice is strongly advised against, whether the person is using hydrocodone legitimately or abusing the drug. Multiple substances can combine in unpredictable and harmful ways within the brain and body, compounding potential side effects and increasing the risk of overdose.
It’s Never Too Late to Get Help
Recognizing Hydrocodone Abuse
If you are worried that someone you love might be abusing hydrocodone, there are signs to look for.
- Is the person’s medications disappearing faster than usual?
- Has the person started getting prescriptions filled by another doctor or at another pharmacy?
- Does the person complain more about pain, despite taking more hydrocodone?
- Has the person experienced various life difficulties in a short period of time, such as failing grades, being fired from a job, or excessive fighting with a partner or spouse?
- Has the person asked you for help in getting medication to treat pain?
- Has the person taken hydrocodone in a manner that is not as intended, such as crushing and snorting the drug?
- Does the person have more hydrocodone despite not visiting a doctor recently?
- Does the person often need extra cash or spend significant time ordering things online?
If you suspect that someone you love is abusing hydrocodone, help is available. As a serious opiate drug, those who have been abusing the medication should not attempt to stop taking it on their own. Medical detox, followed by comprehensive addiction treatment, is needed. With proper care, complete recovery is possible.
Without medical assistance, withdrawing from hydrocodone takes about one week, but the process can be very uncomfortable. The severe discomfort could cause the individual to relapse in an effort to end their nausea or pain. Instead of attempting hydrocodone withdrawal alone, it is important to contact a doctor or other medical professional to get help. Medical detox programs involve supervising physicians and other medical professionals who oversee the withdrawal process.
There are two basic ways that a medical professional will help a person ending their hydrocodone addiction to withdraw from the drug. First, they may schedule a taper. This is the process of gradually taking less and less of the drug until the body is no longer dependent on it. Since hydrocodone is a prescription opioid painkiller, people who take the drug as prescribed may also need to taper the substance with their doctor’s oversight due to physical dependence; tapering low-dose painkillers is a normal process for many medical professionals. A taper may be a 10 percent reduction in dose size per day for several weeks; a reduction of 25 percent each week; or a more dramatic change, like a 50 percent reduction each day. A doctor will assess their patient individually to ensure the taper will suit their needs and help them end physical dependence on the drug.
In some instances, people who have struggled with opioid addiction for a long time need additional help. One of the reasons hydrocodone and similar opioid painkillers are addictive is that they induce a relaxing, pleasurable high when abused. The individual then craves the euphoria induced by hydrocodone, and these intense cravings make the withdrawal process incredibly difficult. As a result, medication replacement therapy is often used in medical detox.
Methadone was traditionally the go-to medication for opioid detox, but buprenorphine is increasingly being used to replace opioid drugs in medication management. As a partial opioid agonist, buprenorphine connects to the opioid receptors in the brain, reducing or preventing withdrawal symptoms without creating a high. Buprenorphine is combined with naloxone in Suboxone; the naloxone helps to discourage abuse of the medication since it can trigger intense withdrawal symptoms if abused.
Rarely, a person can simply stop taking opioid drugs cold turkey. However, a doctor may evaluate the person and decide that this process could work best. In that case, the person’s doctor will monitor their symptoms, using the Clinical Opioid Withdrawal Scale (COWS) or another scale measuring the severity of withdrawal symptoms. The doctor may offer over-the-counter painkillers, anti-nausea medications, or small doses of other drugs to ease the detox process.
The National Institute on Drug Abuse (NIDA) offers extensive information about drug addiction treatment and prevention. Their website includes a list of Principles of Effective Treatment. The list notes that while medications are very helpful during the detox process, counseling and behavioral therapy are the most common and effective treatments to overcome addiction. They address addiction, not just ending a person’s physical dependence on an intoxicating substance. Both group and individual therapy are vital aspects of a good rehabilitation program. More of these programs are beginning to offer family therapy, to help heal relationships between spouses, parents, children, and extended family, which may have been harmed during the person’s struggles with substance abuse.
The first step to a rehabilitation program that provides appropriate counseling and therapy is an evaluation with a case manager or social worker. This person will evaluate both physical and mental health to create a personalized treatment plan that will help the individual understand and overcome their addiction.
- Cognitive Behavioral Therapy: One of the most common forms of group and individual therapy available, this process helps people to recognize problematic situations and their responses; avoid stressful situations and people; and learn healthier behaviors in response to stress or triggers.
- Multidimensional Family Therapy: This form of therapy was specifically developed to help adolescents with substance abuse problems and their families. The process addresses patterns and influences within the family that may have contributed to the substance abuse and aims to change them for the betterment of the entire family.
- Motivational Interviewing: This starts with the individual entering treatment; when a person goes into rehabilitation willingly because they know they need to overcome their addiction, this type of therapy helps the person stay focused on their goal and how important it is.
- Motivational Incentives/Contingency Management: This therapy focuses on good choices and positive behaviors that a person is developing and rewards these actions. Positive reinforcement has been shown to work particularly well for specific types of substance abuse, such as meth addiction.
A person going into a rehabilitation program may encounter several of these types of therapy, along with other complementary therapies that may have a religious or spiritual basis, art therapy, movement therapy, and more.
Alternative Medications and Holistic Approaches to Pain Management
Often, those who struggle with hydrocodone addiction typically start out as people seeking straightforward relief from pain. They may have long-lasting pain from an injury or chronic condition, or temporary pain after a surgery. In an effort to alleviate that pain, they may have been prescribed hydrocodone or another prescription painkiller. As their tolerance rises, they may up the dosage without consulting their doctor, and this often begins a cycle of abuse that leads to addiction.
Those who go into a rehabilitation program for prescription painkiller abuse often need alternative forms of pain management, so they don’t have to live in pain once off opioids. A temporary solution may involve over-the-counter painkillers; however, if pain is too extreme for these medicines, non-medication forms of pain management may be able to help.
- Massage relaxes tense and sore muscles, relieving some discomfort around painful areas.
- Relaxation techniques like deep breathing, biofeedback, guided imagery, and mindfulness meditation help to focus the mind, accept current circumstances, and stabilize physical reactions like blood pressure and breath rate.
- Meditative movements like gentle yoga or tai chi can take the mind off pain; build physical endurance; tone muscles for better support; increase flexibility; and improve mood.
- Physical therapy helps the body recuperate from an injury, and it may incorporate movement practices, easy exercise, and massage to improve strength and flexibility into sessions.
- Pet therapy can bring relaxation, joy, laughter, and a different focus to treatment.
- Acupuncture and chiropractic adjustment are popular holistic approaches to treating pain.
Support Groups and Aftercare
Detox and rehabilitation programs are very important parts of overcoming addiction; however, recovery continues after both of these important steps are over. Taking care of oneself at home, and finding social support in the form of support groups, will help a person in recovery continue to stay sober and avoid relapse.
There are support groups for all kinds of addictions all over the country and online. WebMD offers a support group through a forum. The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a list of self-help, peer-support, and consumer groups to help people maintain abstinence from drugs or alcohol. Psychology Today also offers a search feature to find available support groups. Rehabilitation programs will also be able to recommend good, ongoing local support groups, and local hospitals, doctors’ offices, therapists, and social workers should be able to help people find these resources too.
Going to a support group is one form of aftercare – the process of continuing to maintain abstinence with help while also finding a job, continuing education, and adjusting social and living conditions to a drug-free life. Finding an individual therapist or counselor to help, especially in the case of a co-occurring mental health and substance abuse condition, is important too. Rehabilitation programs may offer ongoing case management to help clients manage resources for their recovery process after rehabilitation; this includes help finding a job, vocational training, other educational opportunities, housing services, and self-help programs.
While aftercare has traditionally involved going, in person, to meetings with a case manager or calling for more information, the digital age is changing how people interact with these services. One doctor, with the help of the University of California, Los Angeles (UCLA), created a text messaging aftercare service, specifically to help adolescents and young adults participate more fully in their recovery. As mentioned above, many websites offer help finding support groups; it is likely that case managers, social workers, therapists, and more will also provide information through email. Increasingly, subscription websites like TalkSpace offer access to all kinds of therapists through their website service, which can greatly benefit people in remote areas who need very specific help.
Without a doubt, aftercare is very important to recovery. People who fail to enter aftercare generally relapse at higher rates.