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Hydrocodone Withdrawal and Detox

Although opioids are prescribed to control pain, diminish cough or relieve diarrhea, they also produce feelings of euphoria, tranquility and sedation. This can lead to problems including the need to escalate doses in order to achieve the initial effects. High levels of opioids can overwhelm the respiratory system and lead to death. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, an opioid use disorder is defined as the repeated occurrence within a 12-month period of two or more of 11 problems. These include withdrawal, giving up important life events in order to use opioids and excessive time spent using opioids. Having six or more of the 11 criteria indicates a severe addiction.1

Physical dependence underlies the physiological adaptations responsible for the emergence of withdrawal symptoms when opioids are abruptly stopped. Hydrocodone withdrawal symptoms vary in severity on the basis of the type, dose and duration of opioid prescribed. Symptoms can be barely noticeable to quite uncomfortable and last from one to 14 days. Many people have comorbid conditions including co-occurring drug use, significantly impacting withdrawal.2,3

Physical Withdrawal Symptoms

  • Fever
  • Body aches
  • Joint pain
  • Constant chills/shivering
  • Goosebumps
  • Intense sweating
  • Difficulty sleeping
  • Excessive fatigue
  • Restlessness
  • Dilated pupils
  • Dizziness
  • Headaches
  • Hot flashes
  • Itching
  • Runny nose
  • Reduced appetite
  • Abdominal cramping
  • Diarrhea
  • Nausea
  • Vomiting
  • Heart palpitations
  • Rapid or irregular heartbeat2

Psychological Symptoms

  • Depression
  • Anxiety
  • Irritability
  • Mood swings
  • Panic attacks
  • Depersonalization
  • Suicidal thoughts2

Hydrocodone Detox and Treatment

Medically supervised withdrawal or detox can improve an individual’s health and facilitate participation in a rehab program. Gradual tapering of opioids is administered on an inpatient basis in which individuals receive around-the-clock medical monitoring. Methadone and buprenorphine pharmacotherapy result in similar outcomes during opioid withdrawal. Buprenorphine is typically preferred because it results in less sedation and respiratory depression. To avoid more intense withdrawal symptoms, buprenorphine should be initiated 12 to 18 hours after the last administration of opioids in individuals who abused shorter-acting opioids. After the individual’s condition has stabilized for three to five days, the dose is usually decreased over a period of two or more weeks.1,3

By itself, medically supervised withdrawal is typically not sufficient to produce long-term recovery. It may increase the risk of overdose in people who lost their tolerance to opioids if drug use is resumed. The most efficacious approach includes a combination of education, motivational enhancement and self-help groups, incorporated into individual and group counseling sessions in inpatient and outpatient programs. A multifaceted behavioral approach helps people change their perception of opioids, recognize change is possible, work toward decreasing old behaviors associated with illicit drug use and replace them with healthier behaviors.1,3

  1. Schuckit MA. Treatment of Opioid-Use Disorders. N Engl J Med. 2016 Jul 28;375(4):357-68. doi: 10.1056/NEJMra1604339.
  2. Hydrocodone Withdrawal Symptoms + How Long Does It Last? Mental Health Daily website. http://mentalhealthdaily.com/2014/08/04/hydrocodone-withdrawal-symptoms-how-long-does-it-last/ Accessed January 18, 2017.
  3. Volkow ND, McLellan AT. Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies. N Engl J Med. 2016 Mar 31;374(13):1253-63. doi: 10.1056/NEJMra1507771.
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