Hydrocodone Withdrawal Overview – Symptom Duration and Severity
Hydrocodone is semi-synthetic opiate derived from codeine. It is indicated for moderate to acute pain as well as severe coughs. Hydrocodone is almost always formulated with other analgesics such as acetaminophen or aspirin to help increase the effectiveness of the drug without increasing the narcotic effects.
Hydrocodone Withdrawal Treatment
- In-patient medical detox: Abrupt cessation of Hydrocodone with the assistance of a hospital or rehab center.
- Home detox: Decrease dose (taper) before total cessation of drug intake combined with the administration of home detox remedies like Withdrawal Ease.
- “Maintenance Therapy”: Methadone and Suboxone (Buprenorphine)
- Prescription drugs currently prescribed for Hydrocodone withdrawal symptoms include: Clonidine, benzodiazepines (Xanax, Klonopin etc.), Gabapentin and Seroquel.
- Over the counter remedies for Hydrocodone withdrawal symptoms include: Immodium AD (Loperamide), Advil, Tylenol, Ben Gay ( for leg cramps and RLS) and various nutritional supplements.
Hydrocodone withdrawal symptoms can take place if use of the drug is abruptly stopped after taking it consistently for a protracted amount of time. Opiate withdrawal is not typically life threatening; however, symptoms can be extraordinarily uncomfortable.
Symptoms may include:
- Runny Nose
- Muscle Cramping
- Stomach Cramps
- Loss of Appetite
- Acute Hydrocodone Withdrawal: 3-5 days
- Post Acute Hydrocodone Withdrawal: 1-2 Weeks
Symptoms Severity Scale Rating
Hydrocodone Fast Facts
- Other variants and names: Hydro, Vicodin, Lortab, Vicodin ES, Lorcet and Norco
- Common Strengths: 5mg/500mg (Hydrocodone/Acetaminophen), 7.5/750, 10/500, 10/325
- Usually taken: Orally in pill form
- Half Life of Hydrocodone: 4-6 hours
Hydrocodone and The FDA
99% of Hydrocodone prescribed in 2007 was consumed in The U.S. according to the International Narcotics Control Board. The increase in rates of abuse and accidental overdoses have skyrocketed over the past 10 years. According to The Centers For Disease Control, Hydrocodone and other opiates caused more accidental deaths than car crashes. This has finally gotten the full attention of The FDA. Hydrocodone was also widely used as an antitussive or cough suppressant for severe coughs. Recently this indication and the number of syrups available has dwindled due to increased reports of infant and child deaths as well as rampant abuse.
Most Hydrocodone is formulated with Acetaminophen which can help increase its efficacy. All pills have markings consisting of letters and/or numbers which help identify the manufacturer and the amount of Hydrocodone relative to the amount of Acetaminophen.
Up until late 2014, all forms of Hydrocodone with less than 15mg per dose were classified as a “Schedule III” drug which meant that it could be prescribed without a triplicate prescription pad. However, there was increasing pressure from health organizations to “re-schedule” Hydrocodone as a “Schedule II” drug regardless of the amount of hydrocodone in each pill. In October of 2014 all forms of Hydrocodone were officially classified as Schedule II by the DEA.
More on Schedule II v. Schedule III below…
What’s the difference between Schedule II and Schedule III drugs? Good question!
Under The Controlled Substances Act passed in 1970 all drugs must be classified in one of 5 “Schedules”. The Drug Enforcement Agency and FDA determine these classifications based on a variety of factors including safety, potential for abuse and/or potential for physical dependency.
Schedule II drugs are those that The DEA and FDA have determined as having high potential for abuse, addiction and overdose. These drugs include many of the stronger prescription painkillers such as Dilaudid, morphine sulphate, Oxycontin, Fentanyl, Oxycodone and a variety of other prescription painkillers and street drugs. The Schedule II prescription drugs require triplicate prescription forms (copies of which are submitted to the DEA) and tighter restrictions on refills. Your doctor cannot call in refills for schedule II drugs.
Schedule III drugs are those drugs that are considered less potent and less likely to cause physical dependence and/or abuse than Schedule II drugs. Prior to the re-scheduling of hydrocodone, this was ironic because Hydrocodone, Vicodin et. al. are some of the most widely prescribed and abused drugs in The U.S.
If you are prescribed Hydrocodone, you may notice that on the label you will see two different numbers next to the name. i.e. Hydrocodone 7.5/500. This means that the pills have 7.5mg of Hydrocodone and 500 mg of Acetaminophen. There are other combinations such as 10/325, 5/500 and so on.
What makes things even more complicated is the fact that there are a number of different manufacturers making Hydrocodone using different brand names. Norco for instance is Hydrocodone in various strengths made by Watson Pharmaceuticals. Lortab is the same thing made by UCB.
In 2013, due to the sharp rise in abuse and accidental overdoses, The FDA recommended that all Hydrocodone be re-classified as Schedule II starting in 2014. These votes are technically “recommendations” by The FDA but typically the DEA will re-schedule if the health benefits are obvious. It’s worth mentioning that in early 2015, the FDA approved the sale of a new, more powerful form of pure Hydrocodone called Zohydro which created quite a stir. Zohydro is time released but contains no abuse deterrents like Oxycontin so it was a puzzling move by the FDA especially in light of the rapidly increasing overdose deaths caused by opioid painkillers. The rationale for the approval was due to the fact that Zohydro does not contain any acetaminophen which can cause stress on liver function and potentially even death if an extremely high dose is consumed. This was a bit absurd since the last thing patients in the U.S. needed was another opiate painkiller; especially one which could be easily abused. What is even more bizarre about the FDA approval of Zohydro was the fact that the FDA’s medical advisory board voted almost unanimously to reject approval… yet it passed anyways.
Updated November 2015: I could say I told ya so but it was a pretty easy bet that tighter restrictions alone would create a sellers market for heroin. Due in part to the re-scheduling of Hydrocodone, heroin has made a comeback of epic proportions. To make matters worse, the people that really need these drugs for treatment-resistant acute pain now have to trudge into their doctors office and/or their pharmacy every time they need a refill.