Hydrocodone, or dihydrocodeinone, was first synthesized in Germany in 1920 by Carl Mannich and Helene Lowenheim, approved by the Food and Drug Administration on March 23rd for distribution in the United States and approved by Health Canada for sale in Canada under the brand name Hycodan, the drug’s original trade name. Hydrocodone and its various compounds are marketed under a number of trademarks, including Vicodin, Hydrococet, Symtan; Anexsia, Biocodone, Damason-P; Dicodid, Hycodan, Hycomine; Hycet, Lorcet, Lortab; Norco, Novahistex, Hydrovo; Duodin, Kolikodol, Orthoxycol; Panacet, Zydone, Mercodinone; Synkonin, Norgan, Xodol and Hydrokon. Hydrocodone is currently the most widely prescribed drug in the USA. In 2010, 131.2 million prescriptions of Hydrocodone (combined with acetaminophen) were issued.
Hydrocodone is a semi-synthetic opioid derived from either of two naturally occurring opiates: codeine and thebaine. It is a narcotic analgesic (pain reliever) and antitussive (cough suppressant).
Hydrocodone is highly regulated worldwide. In the United States, Hydrocodone is listed as a Schedule II and Schedule III substance under the Controlled Substances Act, outlawing sale, distribution, possession, and consumption by anyone who has not obtained a medical license or a doctor’s prescription.
Hydrocodone is used to treat moderate to severe pain and as a cough suppressant. Until recently, Hydrocodone was the active antitussive in more than two hundred formulations of cough syrups and tablets sold in the United States. In late 2006, the FDA began recalling many of these formulations due to reports of deaths in infants and children under the age of six.
Hydrocodone is commonly available in tablet, capsule, and syrup form, and is often compounded with other, generally less effective non-opioid compounds such as acetaminophen or ibuprofen, added both to discourage recreational use because acetaminophen can cause potentially fatal liver toxicity at high doses.
Hydrocodone formulations containing more than 15 mg per dosage unit are considered Schedule II drugs, and those containing less than or equal to 15 mg per dosage unit in combination with paracetamol or another non-controlled drug are called Hydrocodone compounds and are considered Schedule III drugs.
Hydrocodone is one of the most common recreational prescription drugs in America, along with oxycodone and is particularly prevalent among teenagers and young adults because of the drug’s widespread availability. One of the major problems today with the illicit use of hydrocodone, especially in younger populations, is that users may not be aware that hydrocodone pills contain paracetamol, which can cause fatal liver toxicity at high doses.
As a narcotic, Hydrocodone relieves pain by binding to opioid receptors in the brain and spinal cord. Some effects of Hydrocodone come from the fact that a fraction of it is changed to Hydromorphone in the liver, as is the case with all codeine-based analgesics.
Hydrocodone presents much of the same side effects as other opioids, including euphoria, sedation, and somnolence. Many Hydrocodone users report a sense of satisfaction, especially at higher doses, as well as a warm or pleasant numbing sensation throughout the body, one of the most well known effects of narcotics.
Hydrocodone side effects include dizziness, itching, lightheadedness; nausea, sweating, drowsiness; constipation, vomiting, and euphoria. Less common adverse effects include allergic reactions, blood disorders, changes in mood; racing heartbeat, mental fogginess, anxiety; lethargy, difficulty urinating, spasm of the ureter; irregular or depressed respiration and rash. Long term Hydrocodone use may cause hearing loss in some cases.
Hydrocodone, along with most other opioids, may also severely decrease testosterone levels in men and may cause menstrual irregularities in women.
Opiate drugs similar to Hydrocodone include:
- Anileridine Pethidine
- Diacetylmorphine (Herion)
Hydrocodone can be habit-forming, which can lead to physical and psychological dependence, but the potential for addiction varies from person to person, depending on biological differences.
The federal Drug Enforcement Administration believes Hydrocodone may be the most abused prescription drug in the country. In the US, its use has quadrupled in the last ten years, and emergency room visits attributed to Hydrocodone abuse increased 500 percent. Many medical experts believe dependence or addiction can occur within one to four weeks at higher doses of Hydrocodone.
There are many signs of Hydrocodone addiction, including going through a Hydrocodone prescription too quickly and needing refills before they are due, “doctor shopping” in order to obtain multiple prescriptions, seclusion; stealing, lying, and other dishonest behavior; quickly decreasing funds, changes is social circles, abandoning old friends and replacing them with new ones, and unexplained changes in mood or behavior.
As Hydrocodone has a high risk of abuse and addiction, withdrawal from the drug after cessation is likely. Withdrawal effects may include severe pain, pins and needles sensation throughout body, sweating; extreme anxiety and restlessness, sneezing, watery eyes; fever, depression, and extreme drug cravings. Additionally, a newborn of a mother taking Hydrocodone may exhibit breathing problems or withdrawal symptoms.
Some studies have shown that Hydrocodone is stronger than Codeine, but only one-tenth as potent as Morphine.
Symptoms of Hydrocodone overdose include:
- Respiratory depression
- Extreme somnolence
- Blue, clammy, or cold skin
- Narrowed or widened pupils
- Heart attack
Combining Hydrocodone with alcohol, cocaine, amphetamines; methylphenidate, benzodiazepines, and barbiturates can have severe adverse reactions including heart failure, heart attack, respiratory distress; pulmonary failure, liver or kidney failure, jaundice; amnesia, seizures, blackouts, and coma.
The most common medication compounded with Hydrocodone is paracetamol (acetaminophen), which is metabolized exclusively by the liver. Therefore, the risk of fatal overdose due to hepatotoxicity can occur with significantly lower levels of paracetamol when mixed with ethanol. Additionally, the mixture has the potential to cause serious damage to the liver, kidneys, and stomach wall. Paracetamol may increase the potential for coma, respiratory problems, and can damage the central nervous system.
Daily consumption of Hydrocodone should not exceed 40 milligrams in user who are not tolerant to opiates. Consuming 10,000 to 15,000mg (10 to 15 grams) of paracetamol in a period of 24 hours typically results in paracetamol overdose and severe hepatotoxicity; doses in the range of 15,000 to 20,000mg a day have been reported as fatal.