Hydrocodone Withdrawal

Definition

Rehabilitation specialists define hydrocodone withdrawal as a normal, predictable consequence of a sudden drop in the level of hydrocodone in the body of a person who is physically dependent on hydrocodone. Withdrawal manifests itself in a variety of overpowering physical symptoms that can last five or more days; psychological symptoms of withdrawal may last much longer.

Causes

The human body adjusts to the presence of certain substances in the body, including hydrocodone. It can become tolerant of certain chemicals, which means it takes an ever-increasing amount of hydrocodone to cause a euphoric or pain-relieving effect. With prolonged use, the body may become dependent on the chemical; this means the individual must maintain a certain level of hydrocodone for the body to feel normal. If the level of hydrocodone drops rapidly, the body struggles to maintain its chemical balance. This struggle manifests itself through withdrawal symptoms.

Facts

Hydrocodone is an opioid pain reliever, derived from the poppy plant and provides pain relief and other effects similar to morphine. Hydrocodone is the most frequently prescribed opioid in the United States with over 139 million prescriptions filled in 2010 - enough hydrocodone to medicate every adult in the United States around the clock for one month. The U.S. Drug Enforcement Agency, or DEA, states that hydrocodone is associated with more drug abuse than any other opioid. Hydrocodone is the second most frequently found substance in police evidence lockers.

In the United States, there are currently more than 200 products containing hydrocodone available. By federal law, hydrocodone is only available by prescription and always in combination with other pain relievers, such as acetaminophen or aspirin. Dependence on hydrocodone increases the risk for side effects associated with hydrocodone, as well as raising the chances for adverse reactions and medical conditions caused by the added pain relievers.

Hydrocodone, like other opioids, produces a pleasant euphoria that makes it a target for abuse. Because of this effect and its wide availability, hydrocodone is associated with more drug abuse than any other opioid. The DEA says most illegal doses of hydrocodone started out as legally prescribed medication before being stolen or sold, a process known as diversion. According to the DEA, hydrocodone is the most widely diverted drug in the United States. Illicit users frequently combine hydrocodone with alcohol, increasing the individual's buzz but also his risk for side effects such as toxicity, overdose and liver disease.

Other side effects associated with hydrocodone abuse include the potential for abuse, physical dependence and addiction. The U.S. Drug Enforcement Agency, or DEA, classifies substances according to their associated potential for abuse. The DEA classifies hydrocodone as a Schedule II narcotic, which means it carries a high potential for abuse and mental or physical dependence that leads to withdrawal once the individual quits taking hydrocodone.

According to the Centers for Disease Control and Prevention, or CDC, one in 20 Americans over the age of 12 years had used a prescription opioid in 2010 such as hydrocodone non-medically, which means they used the drug without a prescription or to get high. Repeated abuse on such a wide scale may eventually cause an epidemic of hydrocodone withdrawal syndrome as millions of Americans attempt to quit hydrocodone.

The severity of these withdrawal symptoms depends upon how much hydrocodone the individual has been taking, the length and the route of administration. Hydrocodone is available as syrup or pill intended to be taken orally; some individuals crush hydrocodone tablets and inject the drug intravenously.

While withdrawal symptoms are extremely unpleasant, they are typically not life threatening. Nonetheless, opiate withdrawal can exacerbate other conditions and it is always best to undergo withdrawal under a doctor's supervision.

Symptoms

Withdrawal from hydrocodone is typically associated with physical symptoms similar to the flu, but withdrawal also causes psychological symptoms whose demoralizing affects can be just as overpowering as the physical symptoms of withdrawal.

Physical

The physical symptoms of hydrocodone withdrawal can last five or more days, with the worst symptoms appearing on or about the fourth day. These physical symptoms are debilitating, preventing the individual from participating in the activities of his daily life. Overpowering physical symptoms force many people back to hydrocodone abuse, especially those who try to quit without the help of a medical professional.

Physical symptoms of withdrawal include:

  • Abdominal Cramping
  • Diarrhea
  • Fever, Runny Nose or Sneezing
  • Goose Bumps and Abnormal Skin Sensations
  • Hot Sweats and Cold Sweats
  • Insomnia
  • Low Energy Level
  • Muscle Aches or Pains
  • Nausea or Vomiting
  • Pain
  • Rapid Heartbeat
  • Rigid Muscles
  • Runny Nose
  • Shivering, Tremors
  • Teary Eyes
  • Yawning

Psychological

Frequently overshadowed by physical symptoms of hydrocodone withdrawal, the psychological symptoms can be equally as devastating. The withdrawal process is emotionally exhausting and demoralizing, which increases the chance the individual will lose hope and return to drug use. Without the help of rehabilitation professionals, the psychological aspects of hydrocodone withdrawal go unaddressed.

Psychological symptoms of withdrawal include:

  • Agitation
  • Anxiety
  • Depression
  • Hallucinations
  • Irritability
  • Poor concentration
  • Restlessness
  • Social isolation

Possible Complications

Complications of hydrocodone withdrawal include vomiting and then breathing the stomach contents into the lungs, known as aspiration. Aspiration is a serious medical emergency and may result in infection. Extreme vomiting and diarrhea may result in dangerous dehydration if not treated with intravenous fluids and medications to halt withdrawal symptoms.

Relapse to hydrocodone abuse is the greatest complication associated with opioid withdrawal. There is a greater potential for overdose in people who have recently gone through detoxification because detox reduces tolerance to hydrocodone; a person who has just completed detox can overdose on a much smaller dose of hydrocodone than they used to take before detoxification.

Treatment options

Hydrocodone abuse and physical dependence is a growing epidemic among American adults and youth. According to the National Institute on Drug Abuse, more than 23 million people in the United States over the age of 12-years needed treatment for alcohol or substance abuse in 2010; of these, only about 11 percent received treatment at a specialty facility. Just over 5 percent of admissions to publicly funded substance abuse programs were for treatment of opioid abuse. These treatment facilities assist individuals in overcoming physical dependence, withdrawal symptoms during detoxification and rehabilitation.

Many individuals try to quit hydrocodone alone, without the help of medicine to reduce withdrawal symptoms. This is self-detoxification, or "going cold turkey," referring to the cold, clammy, pale and bumpy appearance the skin takes on during the withdrawal process. Uncomfortable withdrawal symptoms, such as diarrhea, abdominal pain, cold sweats and muscle pain can last for several days to two weeks.

Without proper medical assistance, the addicted individual may face complications. For example, he may vomit and inhale stomach contents, a complication known as aspiration. He also faces dangerous dehydration from excessive vomiting and diarrhea. Complications and overpowering symptoms of withdrawal cause many people who attempt self-detox to go back to hydrocodone abuse.

Other people reduce the withdrawal symptoms during self-detoxification by using a variety of products. Once such remedy is The Thomas Recipe, in which a person takes Xanax or some other medication to alleviate anxiety and induce sleep, anti-diarrhea medication, plus vitamins and supplements to ease muscle aches and fatigue

While this may reduce withdrawal symptoms, the individual may suffer dangerous complications. Furthermore, self-detoxification addresses only the physical dependency of hydrocodone abuse; self-detox does not address the behavioral aspects of hydrocodone addiction, increasing the risk that the individual will return to substance abuse.

Relapse is the largest complication associated with quitting hydrocodone. An individual who has recently gone through detoxification is at a greater risk for overdose, as detoxification lowers the body's tolerance to hydrocodone. He can accidently overdose on a lower dose than he used to take before detoxification.

Overdose requires emergency, sometimes lifesaving treatment. Doctors administer naloxone and other medications to reduce hydrocodone to safe levels quickly. Once the patient has completed the withdrawal process, she may participate in behavioral therapy as an inpatient or outpatient.

Some individuals participate in outpatient drug replacement therapy, or DRT. During DRT, physicians prescribe drugs such as methadone, Suboxone or buprenorphine to reduce withdrawal symptoms. These drugs bind to the same opioid receptors within the body as hydrocodone does. The replacement drugs are longer lasting than hydrocodone and do not produce the euphoric effects, allowing the individual to skip the hospital stay. After the individual changes the behaviors associated with addiction with the help of counselors, he weans himself from the replacement drug. Supporters of DRT recognize the flexibility of outpatient treatment while opponents say it is merely trading one addiction for another.

Medication-Assisted Treatment, or MAT, refers to any substance abuse treatment plan that includes pharmacological intervention to reduce the severity and duration of withdrawal symptoms. According to the Substance Abuse and Mental Health Services Administration, or SAMSA, this medical intervention:

  • Improves Survival
  • Increase Retention in Treatment
  • Decreases Illicit Opiate Use
  • Decreases The Risk for Hepatitis and HIV
  • Decreases Criminal Activities
  • Increases Employment
  • Improves Birth Outcomes for Pregnant Women Battling Addiction

Inpatient MAT programs focus on using medicine to alleviate hydrocodone withdrawal symptoms and facilitate detoxification. During detoxification, physicians administer some medications to decrease the level of hydrocodone and other drugs to address the resulting symptoms of withdrawal. Nurses observe the patient for dangerous complications, such as dehydration or aspiration, and respond appropriately. While detox eases the physical aspects of addiction, individuals must still endure the demoralizing process of detoxification.

Rapid detox is the most humane method of detoxification. During rapid detox, board-certified anesthesiologists administer standard detoxification and anti-withdrawal medications alongside anesthesia and sedatives so that the patient rests in a comfortable "twilight sleep." When the patient awakens, he will have no recollection of the grueling and demoralizing detoxification and withdrawal period and can move onto the rehabilitation process.

Rehabilitation

Although medical treatment and behavioral modification are independently useful in the treatment of hydrocodone withdrawal, addressing both the physical and behavioral aspects of physical dependence to hydrocodone offer the best hope for recovery. Behavioral therapy may take place at an inpatient or outpatient facility. To offer the best chance of success, it is important to match the type of facility to the individual's personal needs. Both pharmacological and behavioral treatments work to restore normalcy to those brain function and behavior related to hydrocodone withdrawal and dependence. These treatments also aim at improving employment rates, reducing relapse and lessening side effects associated with physical dependence to hydrocodone.

After successful detoxification or drug replacement therapy, patients may participate in drug rehabilitation treatments offering behavior modification techniques designed to change the behaviors that caused physical dependence or improve the environmental factors that led to the initial dependence on drugs and reduce the risk for relapse. Rehabilitation may be inpatient or outpatient, and programs can be as short as 28 days or as long as 6 months or a year.

New behavioral therapies show particular promise in the treatment of hydrocodone addiction. Contingency management therapy is a voucher system in which a patient earns points for negative drug tests. He may redeem these points for items that enhance a healthy lifestyle.

Cognitive-behavioral interventions modify a patient's expectations and behaviors related to hydrocodone addiction and give him new tools to deal with stresses that may cause relapse.

Long-term recovery from hydrocodone withdrawal depends on success during both the detoxification and rehabilitation phases. A significant number of individuals suffer relapse, especially those who engage in self-detoxification or do not participate in rehabilitation.