Hydrocodone Addiction Explained
Hydrocodone is one of the most commonly available medicinal opioids worldwide (though its availability in the UK is more limited); nevertheless, its use and abuse reaches far beyond medical confines, and it is responsible for countless cases of addiction around the world.
What is Hydrocodone?
Hydrocodone is an opioid (a drug acting on opioid receptors in the brain, producing morphine -like effects) with the chemical formula C18H21NO3, derived from codeine extracted from the opium poppy. Hydrocodone is primarily used medicinally, but is also a comparatively common recreational substance, typically brought into the UK via dark web purchases. It is considered to be roughly equivalent to morphine in terms of potency, and is known to be significantly habit-forming.
Hydrocodone is available by itself in a long-acting formulation, though it is more typically sold in combination with paracetamol or ibuprofen. Either alone or in combination, it is usually found in tablet form or oral suspension and less frequently is found as an ingredient in some nasal sprays and suppositories).
Legal Status (UK)
In the UK, hydrocodone is a class-A controlled drug (the most restrictive class) with serious penalties for illegal possession and supply. Although hydrocodone can be supplied on prescription, it is not available on the NHS, and some of the forms of hydrocodone which are most popular in other jurisdictions (for example, in combination with paracetamol) are not legally available in the UK.
Pharmacological Actions of Hydrocodone
Hydrocodone is an opioid, impacting upon opioid receptors (technically, it is a highly selective full agonist of the μ-opioid receptor)in the brain and central nervous system and gastrointestinal tract, where it has depressant effects with sedative and analgesic properties, possibly also producing a sense of euphoria in the user.
Hydrocodone Brand and Street Names
Hydrocodone is available – either by itself or in combination with paracetamol or ibuprofen – by a range of brand names around the world, including Hysingla, Vicodin,Vicodib, Anexsia, Lortab, Lorcet, Norco, Hycomine, Tussionex, Dicodid, Zohydro, Vicoprofen, Riboxen, Ibudone, Reprexain and Zydone.
It is also available on the street under names including hydro, narco, Vikes and Vickies.
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Hydrocodone Addiction and how it develops
Addiction is fundamentally a disorder of the brain’s reward system, whereby an individual is compelled to engage repeatedly in rewarding behaviour regardless of any negative consequences which may result from such behaviour. The more that individual engages in the consumption of hydrocodone – the more their brain’s reward centres grow accustomed to the experience of that behaviour, altering the production of chemicals including dopamine which create positive sensations and emotions when the behaviour is repeated. Additionally, this creates serious negative psychological responses when the levels in the system of such chemicals are lowered as a result of the behaviour not being engaged in.
As an opioid, the repeated consumption of hydrocodone over time can also cause dependence, which develops when a person’s system adapts to the presence of certain levels of a substance (in this case, hydrocodone) and comes to rely on those levels for normal functioning. Once someone has become dependent, a sudden absence of the substance in question – for example, if they stop taking hydrocodone – can trigger the abnormal functioning of the brain and body, and the manifestation of various unpleasant and potentially dangerous symptoms known as withdrawal syndrome.
Although addiction and dependence are closely related phenomena – and are frequently mistaken for each other – each can develop without the other.
Why is Hydrocodone addictive?
As with any opioid, there are two main reasons why hydrocodone is addictive. Firstly, taking hydrocodone can produce a euphoric “high” in the user which can be extremely enjoyable, and someone taking it may seek to replicate the experience of high over and over again, thus taking it repeatedly and regularly, with psychological addiction likely to manifest.
Secondly, hydrocodone has a very high dependence liability, meaning that consuming it repeatedly over time is very likely to lead to the development of physical dependence. As noted above, once dependence has developed, an individual will need to keep taking hydrocodone to stave off potentially distressing and debilitating withdrawal symptoms.
Causes & Risks factors in Hydrocodone Addiction
Why one individual may develop an addiction, and another in very similar circumstances may not, is not yet fully understood; however, it is known that both genetics and an individual’s environment have a part to play in the development of addiction of any kind.
The main causes of hydrocodone addiction are the regular consumption of the drug for medical reasons, and the repeated recreational use of hydrocodone. Someone who initially takes hydrocodone for medical purposes may go on to use and abuse the drug recreationally, possibly as a means of combating withdrawal after developing dependence.
The genetic causes of addiction are becoming increasingly well understood, and it is clear that genes play a substantial role in an individual susceptibility to addiction. A family history of substance abuse disorders is one of the leading risk factors for hydrocodone addiction; mental health disorders of genetic origin are also prominent indicators of the likelihood that someone will develop an addiction to hydrocodone.
Biology plays a significant role in addiction; people who metabolise hydrocodone slowly, or who experience a greater than average euphoria when taking it, are more likely to become addicted to it. Chronic pain, depression and anxiety, and other physical and mental health disorders are also significant risk factors.
Environmental and Social
A previous history of substance abuse; coming from a low socio-economic background; having comparatively easy access to hydrocodone; belonging to a peer group in which hydrocodone abuse is prevalent; and having a partner who abuses hydrocodone, are all prominent risk factors for hydrocodone addiction.
People who are more likely to engage in risky activity; are extroverted to the point of showing off; are extremely introverted; have difficulties regulating their behaviour; or have a strong desire to fit in, are all more likely than the average to develop an addiction to hydrocodone.
Co-Occurring Disorders with Hydrocodone Addiction
It is common for substance abuse to occur alongside other disorders. Individuals suffering from mental health issues may resort to substance abuse as a means of escapism or self-medication; meanwhile, substance abuse itself can cause a huge variety of mental health issues, especially if addiction results.
The co-occurrence of a substance abuse disorder alongside another mental health disorder is known as dual diagnosis, which is typically much harder to treat than cases of simple addiction. If dual diagnosis is present in someone presenting for addiction treatment, specialist care is likely to be required.
Relationship between prescription hydrocodone and other drugs
As with any opioid, someone who has become dependent to hydrocodone may switch between that drug and other opioids as a means of staving off withdrawal syndrome. Furthermore, it is not uncommon for an individual abusing opioids to engage in the abuse of other substances, commonly including cocaine (and crack), cannabis and alcohol.
Hydrocodone can interact dangerously with numerous other drugs, including other opioids, alcohol, some antihistamines, antipsychotics and other central nervous system depressants. They may also have problematic interactions with serotonergic medications.
Signs and Symptoms of Hydrocodone Addiction
Identifying an addiction in someone, even someone close to you, can be very difficult, as addicts typically go to great lengths to conceal their condition because of the stigma associated with addiction and substance abuse.
Nevertheless, some symptoms typically indicative of addiction include:
- frequent intoxication
- financial troubles
- engagement in criminal activity
- mental and physical health issues
- a preoccupation with obtaining substances of abuse
- a disinterest in previously enjoyed activities
- changes in sex drive and sexual preferences
- altered peer group
- decreased attention to appearance and hygiene
- altered sleep pattern
- altered eating pattern
- an abandonment of personal and professional responsibilities
- a decrease in professional and/or academic performance
- frequent tiredness
- mood swings
Someone addicted to hydrocodone or other opioids may also exhibit various withdrawal symptoms if they stop taking the drug. Typical withdrawal symptoms include:
- decreased appetite
- feeling lightheaded or dizzy
- increased sweating
- hyperalgesia, or worsening pain
- rash or hives
- new and unexplained swelling
- trouble breathing
- difficulty swallowing
- chest pain
- extreme drowsiness
The Social Impact of Hydrocodone Addiction
As with any form of addiction, hydrocodone addiction has serious social ramifications. Addiction is a leading cause of family break-ups, job losses, homelessness and suicides, all of which have an incalculable social cost. Many hydrocodone addicts resort to criminal behaviour to fund their habits, with drug-related crime costing billions of pounds annually. The cost to the NHS of treating hydrocodone addiction specifically is not available, but treating drug misuse generally costs the NHS at least £500 million a year.
The Dangers of Hydrocodone Addiction
Hydrocodone, like any opioid, is a dangerous drug; not only can addiction and dependence result from regular use, but there is also the risk of overdose, which can be fatal (see below). Hydrocodone use can also result in an increased risk of accident, risky sexual behaviour, criminal activity with potentially lifelong consequences, aggression resulting in violence, and a higher risk of contracting blood-borne diseases such as HIV/AIDS and hepatitis C.
Impact of Long-Term Hydrocodone Abuse on the Brain
Over the long term, the abuse of hydrocodone and any other opioid can cause frequent respiratory depression, which deprives the brain of oxygen; over a significant period, this can lead to permanent brain damage. Long-term opioid abuse is also linked with impaired decision-making, substandard behavioural regulation, and an inability to respond effectively to stressful situations.
Hydrocodone Overdose explained
Overdose is one of the biggest risks associated with the use of hydrocodone. Overdose occurs when someone takes more of a given substance than their body is able to process effectively. An overdose of hydrocodone usually results in respiratory depression (insufficient breathing) or respiratory arrest (stopping breathing altogether) which can cause the death of the overdosing individual; even in circumstances where the individual survives, they may sustain permanent brain damage.
The most common signs of a hydrocodone overdose are the “opioid overdose triad”: decreased consciousness or unconsciousness; pinpoint pupils; and respiratory depression. If you witness those symptoms, or seizures or muscle spasms, in anyone you know to have taken hydrocodone, call an ambulance immediately.
Other problematic symptoms of hydrocodone use include:
- generalized muscle weakness
- slowed breathing
- slowed heartbeat
- cold or clammy skin
- profound drowsiness
- loss of consciousness
Use in pregnancy
It is strongly advised that pregnant women do not take hydrocodone for any length of time, as dependence can manifest in the unborn child, leading to neonatal abstinence syndrome (NAS) which can cause a range of difficulties and can potentially be fatal.
Differentiating hydrocodone misuse from approved use
Hydrocodone should only ever be used strictly in accordance with a doctor’s instructions. Taking it for longer than advised, in greater quantities than prescribed, or by means other than intended all constitute abuse. Any recreational use of hydrocodone also constitutes misuse of the drug.
Signs and Symptoms of Hydrocodone Dependence
The most obvious sign that you have developed a dependence to hydrocodone is the manifestation of withdrawal symptoms (see above) if and when you stop taking the drug. Constant cravings and the development of tolerance (needing to take more of the drug to achieve the desired effect) are also prominent symptoms of hydrocodone dependence.
Dangers of Hydrocodone Dependence and Withdrawal
Once dependence has developed, an addict may be forced to go to great lengths to obtain hydrocodone in order to stave off withdrawal (and such behaviour may have serious ramifications including criminal consequences). While hydrocodone withdrawal itself is not usually considered potentially fatal, it can cause serious depression and suicidal ideation.
Hydrocodone Detox Process
Because of the dangers associated with detoxification (including the aforementioned risk of suicidal ideation, and the risk of relapse – which can lead to overdose) it is vital that you do not attempt to detoxify from hydrocodone independently. Speak with your GP and/or an addiction specialist about appropriate detoxification methods.
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Hydrocodone Addiction Medication
Although there is no “magic bullet” cure for a hydrocodone addiction, various medications are used in treatment.
Therapy for Hydrocodone Addiction
Therapy lies at the heart of all addiction treatment, as only therapy can both reveal and address the underlying psychological causes of addiction, as well as providing the addict with defence mechanisms against relapse. Therapy can be provided in a broad range of settings, including residential rehabilitation (rehab) and in a host of different models and structures, including group and one-to-one.
Other Kinds of Intervention
Interventions are popular ways of tackling an addiction, and can help an addict to see how their addiction is damaging loved ones and friends. However interventions can do more harm than good, so it is vital that you speak with an addiction specialist about how to carry out effective intervention before you embark on the process.
Hydrocodone Addiction Statistics
There are over 150,000 opioid users in the UK.
- Drug treatment on the part of the NHS yields a return to society of £4 for every £1 spent.
- UK government spending on drug and alcohol services has been cut by a quarter since 2013.
- Hydrocodone was patented in 1923.
- More than 6 million people receive prescriptions for hydrocodone each year globally.
- Upwards of 40% of opioid addicts also suffer from a co-occurring mental health issue.
Ready to get help for your addiction?
If you are suffering from an addiction to hydrocodone, or any other opioid, you are placing yourself in great danger. Your addiction could ruin – or even end – your life. However, do not despair: high-quality professional help is available if you are willing and able to ask for it.
Get help today
The sooner you can reach out for help, the sooner you can receive it – so speak with your GP and/or an addiction specialist today, and take the first step on the road back to happiness and health.
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