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Hydrocodone Withdrawal, Addiction, Side Effects, Alternatives, and Tapering

Medically Reviewed Fact Checked
Alternative to Meds Editorial Team
Medically Reviewed by Dr Michael Loes MD
Hydrocodone is an opioid analgesic narcotic used in many painkillers. FDA approved for the treatment of moderate to severe pain, hydrocodone was reclassified as a Schedule II drug in 2014 due to its high risk of abuse and addiction. Hydrocodone withdrawal is similar to heroin withdrawal in severity.

Many painkillers contain hydrocodone compounded with other medications. More than 11,000 deaths by overdose from products containing hydrocodone have been reported in the US each year from 2009 to 2019.3

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Hydrocodone Withdrawal Symptoms

Hydrocodone withdrawal symptoms can present even after a short period of use, but certainly occurs after long-term use, where the condition can become potentially life-threatening.5,6 The withdrawal symptoms from hydrocodone products are notoriously intolerable without preparation, guidance, and care, and can be best managed in a medically supervised facility that supports patients throughout a gradual withdrawal process.

Withdrawal symptoms present within hours of the last dose taken, and can include:

  • Tachycardia (racing heart rate at rest)
  • Suicidal thoughts
  • Increased sensitivity to pain, rebound pain
  • Diarrhea
  • Nausea, vomiting
  • Insomnia, unusual dreams, interrupted sleep
  • Mood swings, irritability, depression
  • Anxiety, agitation, restlessness, can be severe
  • Cognitive impairment, lack of focus
  • Profuse sweating
  • Dilated pupils
  • Photophobia (extreme sensitivity to light)
  • Hot or cold flushes, “goose-flesh”
  • Aches in muscles, joints, bone pain, headache
  • Runny nose, cough, watering eyes, hoarseness
  • High blood pressure
  • Excessive yawning
  • Restless leg syndrome, uncontrolled leg movements, or kicking motions

Discontinuing/Quitting Hydrocodone

Hydrocodone is a semi-synthetic opioid. And like all opioids, mimics natural endorphins which inhibits the body’s ability to produce endorphins for natural pain control. This natural endorphin deficiency, once created, results in withdrawals such as physical pain and heightened emotional distress and sensitivity. This state will last until the body can normalize its natural production of endorphins and enkephalins.7

The pain levels, both physical and emotional, can be severe and difficult to endure. To help offset some of the challenges, the use of short-term bridge medications can ease the withdrawal process and can be provided and administered in a clinical setting.12

Hydrocodone Addiction

Opioid compound painkillers such as Vicoden, Anexsia®, Hycet®, and similar compounds all carry elevated risk for addiction, because when you stop taking them, significant hydrocodone withdrawal symptoms occur, including pain and drug cravings. These are powerful drivers to continue using the drug. The following will provide answers to some of the most frequently asked questions about hydrocodone, why the side effects and withdrawals are often harsh, vital information about recovery after addiction to hydrocodone, and many other topics.

Hydrocodone is a member of the opiate drug class made from the same opium that heroin and all semi-synthetic opiates are made from. Opioids obstruct the way neurotransmitters perceive and respond to pain. Currently, hydrocodone bitartrate is only sold in a time-release version. Hydrocodone is used in many painkillers such as Vicoden®, Vicoprofen®, Norco®, and similar products on the market. In these compounds, hydrocodone is combined with acetaminophen, or ibuprofen, which are non-opioid analgesic drugs with inflammatory and fever-reducing properties.9,10

Two primary neurotransmitters1,7,8 that control pain:

  • Endorphins
  • Enkephalins

endorphins enkephalinsEndorphins and enkephalins are created by the body and these hormones or peptides are powerful natural painkillers. For example, in the unfortunate happenstance of a severe injury, the victim could feel no pain due to the increase in the levels of endorphins and enkephalins released. These natural chemicals are extremely effective at blocking pain. However, the synthesized versions of hormones can also produce the sensation of being “high,” especially when used in substantial amounts, which creates a powerful driver of addiction. It is concerning that a study found 18% of patients suffering from depression or anxiety are prescribed opioids as treatment for these mood disorders. That seems a short-sighted view of treatment, to say the least.2,14

Opiate drugs mimic these chemicals, though the exact mechanisms appear complex and are not completely understood.

When the body is exposed to these synthetic opiates, such as hydrocodone or other synthetic drugs, the production of some natural chemicals is inhibited. This suppresses the body’s natural response to pain and can result in super-sensitivity to pain when the synthetic drug is withdrawn, and also when the effectiveness of the drug wanes. Tolerance and attenuated dopamine release are two factors that are important to understand about hydrocodone withdrawal. And at least in part, explain why chronic opioid use whether for pain management or for mood disorders or for pleasure has the paradoxical effect of increasing pain levels, despite higher and higher doses of the drug.15,16

What Is Hydrocodone Used For?

Hydrocodone is prescribed to control physical pain that is moderate to severe. Many compound drugs contain hydrocodone compounded with other analgesics, such as ibuprofen and acetaminophen for reducing inflammation and fever. Hycodan® is a prescribed cough suppressant.21 Uses for these various medications “off-label” reportedly include treating RLS (restless legs syndrome), treatment for depression, anxiety, and for other mood disorders.14,15,17

Hydrocodone Alternative Names and Slang

Hydrocodone and drugs containing hydrocodone have developed a significant street presence due to their addictive, euphoric effects. Some of the street or slang names according to the DEA 13 include:

  • Vikes
  • Viko
  • Hydro
  • Watson-387
  • Vickies
  • Idiot Pills
  • 357s (sic)
  • Tabs
  • Scratch
  • Lorris
  • Fluff
  • Dro
  • Bananas

Hydrocodone Side Effects

Hydrocodone produces pain relief and temporary euphoria. These effects make the drugs high risk for abuse, whether prescribed or used recreationally. Other adverse side effects17,18 include:

  • False or unusual joy or euphoria, mood swings, crying, despondency, irritation
  • Drug cravings
  • Dizziness, syncope, lightheaded feeling
  • Loss of hearing
  • Sexual dysfunction
  • Inhibited antibody response
  • Inhibited cellular immune response
  • Hormonal dysfunction
  • Difficulty or labored breathing, tightness across the chest
  • Lowered heart rate
  • Mental fog, confusion, impaired thinking
  • Decreased energy levels
  • Hyperalgesia
  • Muscle rigidity
  • Ringing in the ears
  • Pain in abdomen, chest, back, painful urination, headache, muscles
  • Swollen feet, legs, or ankles 
  • Numbness or tingling, rashes, hives, itching
  • Dry mouth, inability to swallow
  • Tachycardia
  • Nausea, vomiting, heartburn, sour stomach, hiccups
  • Constipation (can be severe requiring medical intervention)
  • Increased thirst
  • Weight loss or weight gain
  • Sunken eyes or facial features
  • Tender painful lymph glands (neck, armpit, groin)
  • Extreme fatigue, drowsiness, tiredness


Hydrocodone FAQs

Below are some other frequently searched topics of information relating to hydrocodone and how it is thought to work in the body, specific organs, and the central nervous system and brain.

Is Hydrocodone an Opioid?

Yes. Hydrocodone is a drug that is synthesized from opium poppies. All drugs derived from opium are opiates or opioids. These terms are interchangeable. These drugs bind to the various opioid receptors in the brain and elsewhere in the body.

How Does Hydrocodone Work?

There is much that is still not understood about the mechanisms of action of opioid drugs. It is thought that hydrocodone provides a synthetic version of certain natural chemicals normally produced in the body and brain. There is a phenomenon called neuroplasticity that has been of great interest in the field of addiction and mental health for over half a century.19,20 The presence of hydrocodone is thought to override and shut down the body’s own production of pain-dampening natural chemicals called endorphins and enkephalins. In response, synaptic plasticity allows the regeneration of new pain receptors.

The body is ready-made with this rugged survival mechanism, similar to enhanced radar, so there is a heightened awareness of threats such as incoming pain signals. When the drug is withdrawn, the challenge is a general deficit of endorphins being naturally produced. However, because of neuroplasticity, a magnification of pain levels can occur due to the extra pain receptors that were generated. These extra pain receptors will atrophy after a period of time, especially with precisely targeted nutritive support, allowing the body a chance to rebalance itself.

Treatment for Hydrocodone Abuse and Addiction

Alternative to Meds Center employs protocols that can ease hydrocodone withdrawals gently, in a health-restorative context.

Understanding how opiates affect both physical and emotional aspects can greatly assist the recovery process.

hydrocodone withdrawalWhere natural endorphins need to be restored, a person may almost feel “too emotional,” much like a tuning fork, now open to the uncomfortable onslaught of every emotion in the room. We understand the vulnerable disposition in low-endorphin individuals that can draw them toward long-term opiate use, in an attempt to blanket these uncomfortable emotional sensitivities. That is why we use an orthomolecular, nutritional approach to recovery from opiate addiction at Alternative to Meds Center. Our focus is on neurotransmitter rehabilitation through holistic protocols. 

Quite apart from emotional pain, physical pain can take a similar grip, especially in a low endorphin person. Diet and supplementation can counter these problems and benefit a person who wishes to restore neurochemical deficiencies.

A correct diet provides the necessary precursors for healthy neurochemistry.

For example, the peptides mentioned earlier, such as endorphins, are constructed from amino acids. These can be made amply available through food-grade supplements as well as a diet rich in proteins from meats or vegan-friendly proteins and nutrient-dense vegetables.

getting off hydrocodoneIn addition to natural endorphin support, and a wealth of adjunctive therapies for comfort, short-term use of bridge medications such as Suboxone provides a popular option that ensures the withdrawal process is as mild and tolerable as possible. Clients discuss all options with their physician and their care team so that the client’s needs and wishes are primary, and the client is consulted at every step.

More information on the treatments at Alternative to Meds Center for inpatient opiate recovery is given in the opiate alternatives section of this website and we encourage you to become acquainted with all the information provided there. If you would like to receive more information about the program, insurance coverage, length of stay, and what is waiting for you at our retreat-style facility, please contact Alternative to Meds Center. We are happy to answer all your questions about how our protocols may help you or a loved one overcome the challenges of hydrocodone withdrawal and become free from opiate dependence.


1. Enkephalins Encyclopedia Britannica

2. Zagorsky N “Many Prescription Opioids Go to Adults With Depression, Anxiety” Psychiatry Online, 2017 Aug 17.

3. Kaiser Family Foundation Report “Opioid Overdose Deaths” [online] 2021 [cited 2021 Aug 31]

4. FDA drug label Hydrocodone bitartrate and Acetaminophen tablets [revised Aug 2014] [cited 2021 Aug 31]

5. Shah M, Huecker MR. Opioid Withdrawal. [Updated 2021 May 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526012/[cited 2021 Aug 31]

6. Tompkins DA, Bigelow GE, Harrison JA, Johnson RE, Fudala PJ, Strain EC. Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) opioid withdrawal instrument. Drug Alcohol Depend. 2009 Nov 1;105(1-2):154-9. doi: 10.1016/j.drugalcdep.2009.07.001. Epub 2009 Aug 3. PMID: 19647958; PMCID: PMC2774236. [cited 2021 Sept 1]

7. Sprouse-Blum AS, Smith G, Sugai D, Parsa FD. Understanding endorphins and their importance in pain management. Hawaii Med J. 2010;69(3):70-71. [cited 2021 ASept 1]

8. Chaudhry SR, Gossman W. Biochemistry, Endorphin. [Updated 2021 Apr 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470306/  [cited 2021 Sept 1]

9. FDA drug label Vicoprofen [online[ [cited 2021 Sept 1]

10. FDA drug label Norco  [online] [cited 2021 Sept 1]

11. Silber MH, Becker PM, Buchfuhrer MJ, Earley CJ, Ondo WG, Walters AS, Winkelman JW; Scientific and Medical Advisory Board, Restless Legs Syndrome Foundation. The Appropriate Use of Opioids in the Treatment of Refractory Restless Legs Syndrome. Mayo Clin Proc. 2018 Jan;93(1):59-67. doi: 10.1016/j.mayocp.2017.11.007. PMID: 29304922. [cited 2021 Sept 1]

12. Salehi M, Kheirabadi GR, Maracy MR, Ranjkesh M. Importance of gabapentin dose in treatment of opioid withdrawal. J Clin Psychopharmacol. 2011 Oct;31(5):593-6. doi: 10.1097/JCP.0b013e31822bb378. PMID: 21869694. [cited 2021 Aept 1]

13. DEA Drug Slang Code Words [online] [cited 2021 Aept 1]

14. Davis M, et al., “Prescription Opioid Use among Adults with Mental Health Disorders in the United States.” JABFM July 2017 (4) 407-417 [online] [cited 2021 Sept 1]

15. Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011 Mar-Apr;14(2):145-61. PMID: 21412369. [cited 2021 Sept 1]

16. Volkow ND, Michaelides M, Baler R. The Neuroscience of Drug Reward and Addiction. Physiol Rev. 2019 Oct 1;99(4):2115-2140. doi: 10.1152/physrev.00014.2018. PMID: 31507244; PMCID: PMC6890985. [cited 2021 Sept 1]

17. Habibi M, Kim PY. Hydrocodone and Acetaminophen. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538530/ [cited 2021 Sept 1]

18. Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, Glaser SE, Vallejo R. Opioid complications and side effects. Pain Physician. 2008 Mar;11(2 Suppl):S105-20. PMID: 18443635. [cited 2021 Sept 1]

19. Puderbaugh M, Emmady PD. Neuroplasticity. 2021 Jul 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 32491743. [cited 2021 Sept 1]

20. Solinas M, Belujon P, Fernagut PO, Jaber M, Thiriet N. Dopamine and addiction: what have we learned from 40 years of research. J Neural Transm (Vienna). 2019 Apr;126(4):481-516. doi: 10.1007/s00702-018-1957-2. Epub 2018 Dec 19. PMID: 30569209. [cited 2021 Sept 1]

21. FDA Label “Hycodan” [online] approved 2017 [cited 2021 Sept 1]


Originally Published Sep 13, 2018 by Diane Ridaeus


This content has been reviewed and approved by a licensed physician.

Dr. Michael Loes, M.D.

 

Dr. Michael Loes is board-certified in Internal Medicine, Pain Management and Addiction Medicine. He holds a dual license in Homeopathic and Integrative Medicine. He obtained his medical doctorate at the University of Minnesota, Minneapolis, MN, 1978. Dr. Loes performed an externship at the National Institute of Health for Psychopharmacology. Additionally, he is a well-published author including Arthritis: The Doctor’s Cure, The Aspirin Alternative, The Healing Response, and Spirit Driven Health: The Psalmist’s Guide for Recovery. He has been awarded the Minnesota Medical Foundation’s “Excellence in Research” Award.

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