Hydrocodone is a semi-synthetic opioid, synthesized from codeine, an opioid alkaloid compound found in the opium poppy plant. Although hydrocodone and oxycodone are the two most common recreational prescription drugs in the U.S., the latter has received more media attention. Many people think that because they are prescribed by a physician, opioid analgesics are safe. However, long-term use can lead to physical dependence and severe withdrawal symptoms when the dose is lowered or discontinued. Myths and misconceptions abound about prescription opioids despite recent increased public awareness. Below are a few hydrocodone facts that provide a better understanding of this powerful, potentially addictive pain reliever.
What Is Hydrocodone Used for and Is It Safe?
Hydrocodone is an orally active narcotic analgesic (pain reliever) and antitussive (cough suppressant) available in tablet, capsule and liquid forms. It is prescribed for the management of pain not well-controlled by nonsteroidal anti-inflammatory or other non-narcotic analgesic options. It is typically compounded with other, generally less effective non-opioid compounds such as acetaminophen, ibuprofen or aspirin. These are often added to discourage recreational use and to provide a possible synergy of analgesic effects between hydrocodone and other non-opioid compounds. When taken in high doses, acetaminophen can cause potentially fatal liver damage. Aspirin and ibuprofen also have side effects in high doses, but these are generally less serious. Hydrocodone itself can cause a wide array of physical and psychological effects when misused.1,2
How Long Does Hydrocodone Withdrawal Last?
Hydrocodone stays in one’s system less than 24 hours after the last dose. After the drug has cleared from the body, withdrawal begins. The initial or acute phase is the worst and lasts about one week to 10 days. During this period, a person typically experiences the most extreme physical and psychological symptoms. After this period, most people have made significant strides and feel better. For others, protracted withdrawal symptoms including fatigue, anhedonia (inability to feel pleasure), poor appetite and insomnia can endure for weeks to months.3
How Does Hydrocodone Impact the Brain?
All opioid medications exert pain-relieving effects predominantly by binding to mu-opioid receptors, densely concentrated brain regions regulating pain perception. They impart pain-induced emotional responses in the amygdala, and in brain reward regions called the ventral tegmental area and nucleus accumbens, regions involved in the perception of pleasure and well-being. This explains why opioid medications can produce both analgesia and euphoria. Opioids not only directly activate analgesia and reward regions, but also concurrently mediate a learned association between taking the drug and the physiological and perceptual effects of the drug. Taking opioids repeatedly strengthens these learned associations and after long-term use, can contribute to drug craving. For a patient in chronic pain, even mild levels of pain can trigger the learned associations between pain and drug relief, manifested as an urge for relief. This conditioned urge for relief from even mild pain can lead to quick onset of inappropriate use of opioids.4
Can Hydrocodone Cause Sensorineural Hearing Loss?
Sensorineural hearing loss (SNHL) is an infrequently recognized side effect of opioid medication abuse. SNHL occurs when there is damage to the inner ear or to the nerve pathways from the inner ear to the brain. Although research studies have been small, evidence points to a potential connection between prescription opioid abuse and loss of hearing. In a study involving five individuals, hydrocodone-related hearing loss was reported with daily use of 10-mg to 300-mg doses. The duration of use prior to hearing loss varied widely, ranging from months to years, and only one participant was using the drug under physician supervision. Except for a history of hydrocodone use, no clear etiology or predisposing factor for hearing loss was identified, although 60% were diagnosed with hepatitis C. Although researchers could not identify the exact cause of the hearing loss, they theorize genetic polymorphisms of drug metabolizing enzymes and associated comorbidities like hepatitis C infection may play a role in the development of hydrocodone/acetaminophen ototoxicity (drug or chemical-related damage to the inner ear).5,6
- Hydrocodone Facts. COPAC website. https://www.copacms.com/resources/addiction-fact-sheets/hydrocodone/ Accessed January 18, 2017.
- Hydrocodone. Drugs website. https://www.drugs.com/hydrocodone.html Accessed January 18, 2017.
- 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.
- 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.
- Novac A, Iosif AM, Groysman R, Bota RG. Implications of Sensorineural Hearing Loss With Hydrocodone/Acetaminophen Abuse. Prim Care Companion CNS Disord. 2015;17(5):10.4088/PCC.15br01809. doi:10.4088/PCC.15br01809.
- Ho T, Vrabec JT, Burton AW. Hydrocodone use and sensorineural hearing loss. Pain Physician. 2007 May;10(3):467-72.