Vicodin Addiction Treatment
Vicodin contains hydrocodone, an opiate drug that works as a pain reliever and has some efficacy as a cough suppressant. The second substance is acetaminophen, a mild pain reliever, fever reducer and the active ingredient in Tylenol. Of all the prescriptions containing hydrocodone, the most frequently prescribed are brands combining it with acetaminophen. Vicodin is prescribed for the management of pain not well-controlled by nonsteroidal anti-inflammatory or other non-narcotic analgesic options. It works by blocking pain receptors in the brain and can induce a sense of euphoria, which makes it highly addictive. Long-term use of Vicodin poses the potential for severe liver damage or failure due to the acetaminophen, as well as an array of other health risks. In 1978, Knoll Pharmaceuticals introduced Vicodin in the U.S. with 5 mg of hydrocodone and 500 mg of acetaminophen, with a generic available in 1983. While Vicodin was the first hydrocodone acetaminophen combo introduced in the U.S., and is still likely the most well-known, multiple generic and trade name formulations are available today including Lorcet, Lortab and Norco.1,2
In 1971, with passage of the Controlled Substances Act, pure hydrocodone became a Schedule II narcotic, along with opium and morphine. In combination with other drugs such as acetaminophen, it was classified as a less-stringently-regulated Schedule III drug. On Oct. 6, 2014, under a final ruling issued by the U.S. Drug Enforcement Administration, hydrocodone combination products (e.g. Vicodin) were designated Schedule II drugs, after the U.S. Food and Drug Administration (FDA) made this recommendation based on a thorough scientific review. Factors leading to this decision included the drug’s actual or relative potential for abuse, its liability for causing psychic or physiological dependence and potential public health dangers.2,3,4
Vicodin Addiction and Abuse
In the past 200 years, opium and heroin have enjoyed enormous popularity for their potent pain-relieving (analgesic) effects. The unfortunate downside of opium and heroin is that both drugs are powerfully addictive, in part because they are snorted, smoked or injected, thereby producing intense and immediate effects. Narcotic analgesics exert powerful effects on the brain, transmitting signals to the spinal cord to dull the transmission of pain and lessen the conscious perception of pain. The same properties that make Vicodin an excellent painkiller also make it and other drugs in the same class highly rewarding and addictive drugs.5 Medically-supervised detox is generally required for those addicted to this drug, followed by treatment through inpatient rehab or an intensive outpatient program.
All effective opioid analgesics produce euphoria and this effect is mediated almost exclusively by mu-receptors in the brain, just like pain. The synergy between the analgesic and euphoric effects of Vicodin is practically perfect. This explains why it is nearly impossible to develop an effective narcotic pain reliever without addictive properties, despite considerable efforts to do so. The brain adapts and develops tolerance to the presence of high concentrations of Vicodin and other prescription opioids. It takes more of the drug to elicit a response from opioid receptors and produce effective pain relief, or euphoric effects in the case of misuse. The end result is a brain under constant assault, continually adapting in destructive ways to keep up with the insult produced by ever-increasing drug doses. It remains elusive why Vicodin and other opioids are so rewarding, although it is theorized that some individuals are genetically predisposed to experience a far more pleasurable response than others.5
It is imperative that physicians consider the benefits and risks associated with long-term opioid therapy, whether immediate release (IR) or extended release (ER) formulations, to ensure safe use of these drugs and prevent addiction, liver toxicity and other serious health risks.6
Stats and Facts
- Of more than 130 million IR hydrocodone prescriptions dispensed in 2011 in the U.S., 98% were for IR hydrocodone/acetaminophen.6
- A review conducted by the FDA revealed that 1.6 million individuals used hydrocodone combination products for more than109 days.6
- Past-year misuse of Vicodin among 12th-graders dropped dramatically in the past five years from 7.5% in 2012 to 2.9% in 2016.7
- A study analyzed the efficacy of oxycodone/acetaminophen versus hydrocodone/ acetaminophen for short-term pain management following discharge from emergency departments. Nausea and dizziness were 10% more common in those who received oxycodone/acetaminophen. There were no clinical or statistical differences in analgesic effect, with both opioids reducing pain scores by an estimated 50%.8
- Sales of prescription opioids increased from $1 billion in sales in 1992 to nearly $10 billion in 2015, yet opioid prescriptions have fallen 12% to 18% since 2012, based on data from two different healthcare firms.9
The risk of relapse is reduced when clients are slowly weaned off Vicodin and other opioid painkillers. For people with chronic pain, treatments such as acupuncture, medical massage, water/pool therapy and yoga can reduce pain.10 Exercise and other forms of therapy are also helpful for people in recovery for other prescription drug abuse. Long-term management by a team of multidisciplinary providers is key to addressing ongoing pain and preventing relapse.
- The Effects of Vicodin Use. Drug Abuse website. http://drugabuse.com/library/the-effects-of-vicodin-use/ Accessed January 22, 2017.
- Life Without Vicodin? New York Magazine website. http://nymag.com/news/intelligencer/topic/57770/ Published July 2, 2009. Accessed January 22, 2017.
- Rules – 2014. https://www.deadiversion.usdoj.gov/fed_regs/rules/2014/fr0822.htm United States Drug Enforcement Administration website. Published August 22, 2014. Accessed January 22, 2017.
- Re-scheduling prescription hydrocodone combination drug products: An important step toward controlling misuse and abuse. U.S. Food and Drug Administration. http://blogs.fda.gov/fdavoice/index.php/2014/10/re-scheduling-prescription-hydrocodone-combination-drug-products-an-important-step-toward-controlling-misuse-and-abuse/ Published October 6, 2014. Accessed January 22, 2017.
- Cicero TJ. No End in Sight: The Abuse of Prescription Narcotics. Cerebrum. 2015;2015:cer-11-15.
- DeVeaugh-Geiss A, Kadakia A, Chilcoat H, Alexander L, Coplan P. A retrospective cohort study of long-term immediate-release hydrocodone/acetaminophen use and acetaminophen dosing above the Food and Drug Administration recommended maximum daily limit among commercially insured individuals in the United States (2008-2013). J Pain. 2015 Jun;16(6):569-79.e1. doi: 10.1016/j.jpain.2015.03.004.
- Monitoring the Future 2016 Survey Results. National Institute on Drug Abuse website. https://www.drugabuse.gov/related-topics/trends-statistics/infographics/monitoring-future-2016-survey-results Updated December 2016. Accessed January 22, 2017.
- Chang AK, Bijur PE, Holden L, Gallagher EJ. Comparative Analgesic Efficacy of Oxycodone/Acetaminophen Versus Hydrocodone/Acetaminophen for Short-term Pain Management in Adults Following ED Discharge. Acad Emerg Med. 2015 Nov;22(11):1254-60. doi: 10.1111/acem.12813.
- Abby Goodnough and Sabrina Tavernise. Opioid Prescriptions Drop for First Time in Two Decades. The New York Times. May 20, 2016. https://www.nytimes.com/2016/05/21/health/opioid-prescriptions-drop-for-first-time-in-two-decades.html?_r=0 Accessed January 22, 2017.
- Lisa Esposito. Silent Epidemic: Seniors and Addiction. US News and World Report. December 2, 2015. http://health.usnews.com/health-news/patient-advice/articles/2015/12/02/silent-epidemic-seniors-and-addiction. Accessed January 22, 2017.