Hydrocodone Withdrawal: Timeline, Symptoms, Detox

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Those living in the United States have become almost desensitized to the opioid crisis because of its prevalence nationwide. It has been at the forefront of public health issues that face this country. Unfortunately, it shows no signs of slowing down. Drugs like hydrocodone have contributed significantly to opioid addiction as a whole, and the drug is the most commonly prescribed drug in the country.

According to the National Institute on Drug Abuse (NIDA), close to 50,000 people died from opioid-involved drug overdoses in the United States in 2019. The misuse of and addiction to opioids, including heroin, prescription pain relievers like hydrocodone, and other synthetic opioids like fentanyl threaten public health. It’s hard to put a price on lives, but opioid addiction costs the country $78.5 billion annually due to addiction treatment, healthcare costs, lost productivity, and criminal justice involvement. 

The fact that hydrocodone and other opioids are addictive is widely recognized, but what makes these drugs so challenging to stop? For starters, hydrocodone and other opioid withdrawal symptoms are incredibly challenging to overcome. The severity of the symptoms is a significant barrier to stopping. Without seeking professional help, it’s nearly impossible to stop using hydrocodone. With that said, many people reluctantly seek professional help for various reasons. 

If you’ve been taking hydrocodone or hydrocodone with acetaminophen, which is found in Norco or Vicodin, understanding the withdrawal symptoms and what you’re potentially facing can hopefully help you make a decision and get the help you need. Below, we’ll discuss hydrocodone withdrawal and some options for professional guidance.

What Are Hydrocodone Withdrawal Symptoms?

As an opioid, hydrocodone falls under a broad category of substances known as central nervous system (CNS) depressants, shared only by alcohol, benzodiazepines, and barbiturates. Specific factors will affect the timeline of withdrawal and the severity of symptoms a person will encounter. Hydrocodone withdrawal symptoms will happen in two distinct phases. The initial onset of hydrocodone withdrawal is similar to a cold. In contrast, the next phase will be akin to a severe flu. Both are awful, but the second stage is much worse.

Physical symptoms are the most common and known for opioid withdrawal, but they might also include psychological or emotional symptoms. Depression, as well as agitation and anxiety, may accompany the person in the initial onset of symptoms, while feelings of hopelessness and despair follow in the second. 

It’s not uncommon for individuals to struggle with suicidal thoughts as they battle severe depression caused by hydrocodone withdrawal. If you have suicidal thoughts, seek emergency medical help. Reaching out for help can be the difference between life or death. 

The initial phase that consists of cold-like symptoms include the following:

  • Runny nose
  • Body aches
  • Fever
  • Anxiety
  • Agitation
  • Insomnia
  • Dehydration
  • Sweating
  • Increased tearing
  • Fatigue
  • Restlessness
  • Lethargy

The next stage in hydrocodone withdrawal that shares characteristics of the flu include the following:

  • Nausea
  • Vomiting
  • Cramping
  • Diarrhea
  • Goosebumps
  • Pupil dilation
  • Extreme drowsiness

As you’d expect with drugs, intense cravings are some of the most common symptoms of withdrawal. When this occurs alongside other severe symptoms, cravings are enough to push someone to get more hydrocodone. Achieving abstinence alone is that much harder, and seeking professional help during this time can provide relief. 

Hydrocodone withdrawal isn’t deadly, and you won’t experience the same level of risks that come with alcohol or benzodiazepines. However, they’re uncomfortable enough to provide additional challenges to get through it by yourself. Hydrocodone withdrawal is tough to deal with alone, and relapse is common when the process moves forward without medical help. As mentioned above, medical detox is the most reliable and safe way to overcome an addiction to drugs like hydrocodone. 

What Are the Stages of the Hydrocodone Withdrawal Timeline?

The symptoms directly related to hydrocodone withdrawal are determined by a person’s level of dependence on the drug. Symptoms will vary from mild to severe and be based on specific factors, including:

  • How much hydrocodone is taken
  • How long hydrocodone has been taken; and the
  • Dosage someone’s body adjusted to using 
hydrocodone-withdrawal

The size of the last dose will also play a role. 

The most common symptom associated with hydrocodone withdrawal is an overwhelming craving for the substance. Unfortunately, these cravings can lead to drug-seeking behavior, which is when a person looks for an alternative to soothe their cravings. 

In some cases, a person might settle for a more potent opioid like heroin. This can be extremely dangerous because as your tolerance decreases and you use an illicit opioid like heroin, it’s possible that you’ll overdose.

Cravings will follow you through the duration of withdrawals and beyond. Hydrocodone withdrawal symptoms can start as soon as six hours after the last dose, meaning you’ll want to use more shortly after cessation. 

The first sign that will indicate you’re withdrawing is feeling like you’re developing a cold. Around the 72-hour point, the symptoms will peak. People report that it feels like the worst flu they’ve ever had. Fortunately, the longer you stay off hydrocodone, the symptoms will gradually become easier to tolerate. Although you can expect most symptoms to disappear after a week, fatigue, depression, and anxiety will persist for a month or longer. 

Symptoms that drag on for longer than a month require attention from an addiction specialist. It’s common for long-term opioid users to develop a condition called post-acute withdrawal syndrome (PAWS). These symptoms can lead a person to relapse, and discussing how you feel with a specialist will help you learn how to cope with the symptoms. The length of PAWS can vary from weeks to months, and in severe cases, a year or more. 

Medications for Hydrocodone Dependence Treatment

Abrupt cessation from hydrocodone, also referred to as “cold turkey,” may lead to the most severe withdrawal symptoms that last the longest. If an individual develops dependence caused by chronic prescription use, their doctor will likely stop them with a slow taper of their dose, which minimizes the severity associated with hydrocodone withdrawal. 

Fortunately, various FDA-approved medications exist to manage opioid dependence. These include:

  • Buprenorphine (Subutex): Buprenorphine is a partial opioid agonist. It works by activating opioid receptors and reduces the intensity of withdrawal symptoms. It’s considered a longer-acting partial agonist drug, meaning it has a lower abuse potential than most of the abused opioids it’s used to treat dependence on. There is a “ceiling” on the effects of buprenorphine, so if someone tries to take more or abuse the drug, it won’t cause the effects they’re seeking. 
  • Buprenorphine & Naloxone (Suboxone): In addition to buprenorphine, Suboxone contains naloxone, which is an opioid antagonist. Opioid antagonists are responsible for blocking other opioids from binding to and activating opioid receptors found in our brain. By doing so, it renders them ineffective. If someone takes hydrocodone while using Suboxone, they won’t experience its effects. Naloxone may also cause rapid withdrawal symptoms when triggered and works as a deterrent for abuse. This is why naloxone is used in opioid overdose incidents. 
  • Methadone: Methadone is a long-acting opioid drug that can be used as a substitute for hydrocodone during detox. The medication is dispensed in federally regulated clinics once a day and can remain in a person’s system for up to 30 hours. It can also keep drug cravings and withdrawal symptoms to a minimum, making it an ideal option. However, it has a higher potential for abuse than other drugs and should only be used under close monitoring. 
  • Naltrexone (Vivitrol): Similar to naloxone, naltrexone is an opioid antagonist that blocks opioid receptor sites. However, one of the issues with naltrexone is that it cannot be administered until the abused drug(s) have left a person’s system. It’s not an ideal choice for acute withdrawals but has a promising future for helping a person remain sober in the long-term. Naltrexone is typically administered in the form of a shot once a month. 

Only a licensed professional can determine which medication will work best for you–if any. If you’ve been using hydrocodone for a prolonged period, even if you’ve followed your doctor’s instructions, withdrawal will occur. By checking into a professional detox facility and having access to professionals who can administer medication, you’re setting yourself up for success in the long-term.

Sources

Consumer Reports (January 2014) 5 Surprising Facts on Prescription Painkillers. from https://www.consumerreports.org/cro/2014/01/5-surprising-things-you-need-to-know-about-prescription-painkillers/index.htm

NIDA (March 2021) Opioid Overdose Crisis. from https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis

MedlinePlus (March 2021) Opiate and Opioid Withdrawal. from https://medlineplus.gov/ency/article/000949.htm

MedlinePlus (March 2021) Hydrocodone Combination Products. from https://medlineplus.gov/druginfo/meds/a601006.html

UCLA (March 2021) Post-Acute Withdrawal Syndrome (PAWS). from https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS

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