Also called dihydrocodeinone, this semi-synthetic opioid is a narcotic analgesic famously a part of Vicodin, Lortab, Zohydro ER, and Norco. Why is hydrocodone an opiate? Because it’s indirectly made from opium poppy, as a byproduct of the extraction of codeine (alkaloid of opium).
Because of this, dihydrocodeinone is one of the most dangerous controlled substances. Not only does hydrocodone hold a high risk of addiction, its side effects are severe, and can become life-threatening in the case of hydrocodone overdose.
The bulk of this article will delve into the main types of available forms for dihydrocodeinone. We will analyze the typical dosage for it, as well as its legal status in the US and around the world. However, one must know its effects before treatment. The benefits, counterindications, and side effects of the opioid will follow.
In the latter part of the article, it remains that we review the widespread hydrocodone addiction crisis. Here we’ll see popular cases, along with the effects of OD and withdrawal. Leading up to the conclusion, there will also a be a short part on Oxycodone. The latter opioid is often in prescriptions as an alternative to dihydrocodeinone.
Hydrocodone is a medication useful against strong and medium-strong pain. Apart from pain outbursts, the drug is also available as cough medicine (often in syrups). Because of its side-effects, adverse effects, and counterindications, dihydrocodeinone is only purchasable with a prescription.
On the pharmaceutical market, hydrocodone is generally in mix with other, less potent painkillers. Because of its strong properties, physicians recommnd this painkiller only if the patient is in constant physical pain. Periodical medical controls are in need to avoid addiction.
Generally produced for oral intake. Though less common, dihydrocodeinone is also available in intranasal and rectal administration forms. Orally-administered dihydrocodeinone can be prescribed as immediate-release and controlled-release. The first class is good for patients that can self-administer the treatment, while the latter is mainly prescribed to more difficult cases.
The class of immediate-release hydrocodone painkillers includes:
- Hydrocodone/paracetamol: the most common pills for this drug. They include Vicodin, Zydone, Maxidone, Lorcet, Lortab, and Norco.
- Hydrocodone/ibuprofen: slightly less common, its main advantage is the low toxicity, thus being easier on the liver. It’s on the market as Vicoprofen, Ibudone, and Reprexain.
- Hydrocodone/aspirin: the last of the three ordinary painkillers, aspirin too pairs well with dihydrocodeinone. This combination is prescribed for chronic pain. Commercially, it’s known as Alor5/500, Demason-P, Panasal 5/500, Lortab ASA, Azdone.
The class of controlled-release hydrocodone painkillers includes:
- Hysingla ER: treatment for severe pain for long-term use, with extended release.
- Zohydro ER: also for extended release, yet with more counterindications. Side-effects include severe problems breathing.
Controlled-release dihydrocodeinone is best for people that have a history of addiction (especially to dihydrocodeinone). Because of its extended release, patients do not feel the urge to take more than the recommended dose.
The recommended dose for hydrocodone acetaminophen and the other immediate-release forms is 1 tablet orally at a 4 to 6-hour interval. For 5 mg tablets, one can take up to two over the same period. The maximum dose is 6 to 8 tablets per day. Pills over 5 mg should not be taken more than 6 times daily and on an ‘as-needed’ basis. Continue the treatment only if the pain returns.
In 2014, the US Government placed further restrictions on the drug. As such, it was moved from a Schedule III drug to a Schedule II one, according to the standards of the DEA. This was a response to the rise in emergencies related to dihydrocodeinone abuse three years earlier.
For a substance to fit Schedule II US drugs, it must meet a set of criteria:
- It’s approved for use as medical treatment/use in the United States with restrictions.
- It has a severe dependence liability.
- Its abuse leads to severe dependency, both psychological and physical.
Schedule II drugs in the US are not eligible for refills. This can be a great burden for both the patient and the physician. However, it can save many lives from the dark slope of addiction. However, prescriptions can be handed out for 90 days at a time. Furthermore, the government gives states the option to overrule the DEA refill ban (see the chart below).
The main difference between Schedule II and Schedule III is in the nature of the dependence. For the latter classification, psychological and physical addictions are moderate or low. Thus, we can conclude that hydrocodone can be the onset of severe psychological addiction, as well as physical.
Hydrocodone targets the mu-opioid receptors, yet can affect the kappa and delta opioid receptors. After ingesting the drug, it enters the gastrointestinal system where it can bind itself to the plasma proteins in a 20 to 50 percent proportion.
Dihydrocodeinone begins to act after approximately 20 minutes and can last for up to 8 hours depending on the amount one ingests. Some pharmaceutical companies hold that their dihydrocodeinone-based products produce relief after less than 10 minutes.
While this substance has just one-tenth the painkilling properties of morphine, it’s still more potent than codeine. However, due to the low concentration of morphine in morphine-based drugs, dihydrocodeinone and morphine pills are considered equally efficient in pain suppression.
The benefits of hydrocodone are few and particularly specific. As any typical painkiller dihydrocodeinone helps ease symptoms by acting upon the opiate receptors. Essentially it drugs the brain into thinking you are not in pain.
- Slight numbness.
- Sense of well-being.
- Pleasurable high.
Because of the high caused by dihydrocodeinone, the brain alters its reward circuitry. The dopamine trigger in one’s brain overloads. Thus the process of addiction starts.
Both the NIH and the DEA say that the number of people that use hydrocodone-based drugs (such as Vicodin) for recreational purposes has been rising. As of 2013, that number was up to 24 million. It’s also a safe assumption that a great number of these people have become addicted. Still, it becomes more alarming when we consider the side effects of dihydrocodeinone.
There are several counterindications to taking hydrocodone:
- Consuming alcohol is strictly prohibited.
- Consuming other opioids is not recommended.
- Antihistamines are completely prohibited.
- Anti-anxiety medication, antidepressants, and antipsychotics are not recommended.
Dihydrocodeinone has a potent effect on the nervous system. As such, any other types of substances that act upon the central nervous system are not recommended as well. Using such drugs alongside dihydrocodeinone can lead to severe complications.
Persons suffering from depression spectrum disorders can see their symptoms worsen if they combine their usual prescription drugs with this specific painkiller.
There are two types of possible side effects that come with dihydrocodeinone use: mild and severe. It is a proven fact that hydrocodone can cause situational depression, or worsen depression cases that already exist. Thus, many of these side effects have to do with how our bodies react (physically) to depression.
The mild side effects of hydrocodone use include:
- Muscle weakness;
- Nightmares and trouble sleeping;
- Dizziness and drowsiness;
- Anxiety and/or dysphoria.
The severe side effects include (but are not limited to);
- Severe breathing problems;
- Slowed heartbeat;
- Acute allergic reactions;
- Problems urinating;
- Bowel movement problems.
When you find you or a loved one exhibit one or more of these symptoms when taking dihydrocodeinone, contact a health care provider before continuing the treatment.
If you know someone who continues to take this drug while exhibiting the symptoms above, it could be that he or she is addicted. When this is the case, reach out to a healthcare expert as soon as possible.
Possibly the most dangerous long-term side effect of hydrocodone use is addiction. Addiction is a severe brain disorder that has people compulsively engaging in obtaining reward stimuli. Because of its fundamentally psychological nature, addiction can circumvent other brain processes such as logic or higher reasoning.
The result can be one’s inability to function socially. Addictive behavior can push a person to do close to anything to obtain the addictive drug. Of all the addictive drugs available, opioids are possibly the most popular. As an opioid itself, dihydrocodeinone possesses the same dependency level.
A worrisome fact for this specific addiction lies in its onset. Many of the people suffering addiction to this opioid began using it as a painkiller first. In some cases, per a study in the American Journal of Therapeutics, physicians could be also at fault. The study concluded that patients with a history of addiction are more likely to get addicted to dihydrocodeinone and other prescription meds.
The cough syrup made with this opiate is one of the more complicated cases. Firstly, because anyone pretending to have a cough problem can buy it. Others may purposefully seek to get a sore throat in order to obtain a prescription. Secondly, doctors often wrongly prescribe the cough syrup to people who have trouble sleeping.
Since cough syrup based on hydrocodone is much easier to come by than Vicodin (for instance), a lot of recreational users chose this option. Thus, the likelihood of addiction is greatly increased.
Vicodin is possibly one of the most famous Schedule II drugs in the US. There are references to it in in many song lyrics (from Eminem to Queens of the Stone Age). Yet most notoriously, we’ve seen Vicodin as the drug of choice for controversial Dr. Gregory House in the House M.D. series.
The show’s protagonist used Vicodin because of severe pain in his leg. As we learn over the eight seasons, a physical intervention on his leg muscle caused him to be in constant pain. We also learn that as time went on, House had become psychologically and physically addicted to Vicodin. As such, the side effects of Vicodin begin to set in, as he goes down the path of addiction.
Over the course of the whole show, we see Gregory House show all signs of dependency.
- The first obvious sign is that he takes too many pills.
- Secondly, he does not follow any doctor’s instructions.
- He mixes Vicodin with alcohol frequently. In a few instances, we see him resorting to morphine and ibuprofen as alternatives.
- House continues to take Vicodin even when the pain in his leg is no more.
- He repeatedly fakes injury to obtain pain medication, including Vicodin.
- He often sneaks into the hospital clinic to obtain Vicodin without a prescription.
The show has shown a very graphic and realistic depiction of addiction. Hydrocodone addiction, in particular, is as a very serious one. Who knows? Maybe the show influenced DEA authorities to move it to Schedule II.
Many people believe that since dihydrocodeinone is so common, it’s not possible to overdose on it. That is simply not true. Any type of medication can cause overdose. So is it with dihydrocodeinone.
In the case of an overdose, the side effects of dihydrocodeinone can become heightened. The most common one is difficulty breathing. This symptom is characterized by shallow breaths, possibly leading to complete loss of breath. We need not mention how dangerous this could be.
If you or a loved one purposefully or accidentally overdose on drugs containing hydrocodone, call 911 immediately.
Withdrawal from dihydrocodeinone can be a long and difficult process. Symptoms start within 6 to 12 hours, peaking at about 72 hours. To completely eliminate the addiction, it should take at least one mont. However, after this month, cravings will still exist. A person wishing to successfully get over their addiction should schedule regular appointments with a therapist dealing with addiction cases.
Oxycodone is an opioid painkiller very similar to hydrocodone. Some studies point out that oxycodone is more potent, yet a single dose of either market form of both drugs should have the same effects.
Both oxycodone and dihydrocodeinone are Schedule II drugs. Oxycodone is on the market in its pure form under the brand names OxyFast, OxyIR, OxyNorm, and Roxicodone. The controlled release version is Oxycontin, with a 12-hour duration and a 4-5 hours half-life. Another very common form of oxycodone is Percocet, a mix with paracetamol.
Hydrocodone vs oxycodone side effects are slightly different. Apart from the ones for dihydrocodeinone, there are a few extra adverse effects for oxycodone:
- Loss of appetite;
- Abdominal pain;
The following symptoms are signs one does not tolerate opioids and should interrupt treatment immediately:
- Shallow breathing;
- Cold skin;
Oxycodone withdrawal shows roughly the same process as dihydrocodeinone withdrawal.
Hydrocodone is a famous drug, extremely good as a painkiller, but with some dangerous side effects. Particularly, dihydrocodeinone is scary because of its opiate properties and their effects.
Addiction, psychological and physical dependency are both serious causes for concern. Remember to always check with your health care provider during the whole duration of your hydrocodone treatment.