Hydrocodone
Hydrocodone, also known as dihydrocodeinone, Lortab, or Vicodin, is a widely prescribed opioid medication in the United States, primarily used for pain relief and as a cough suppressant. Classified as a Schedule II controlled substance, it is derived from natural opiates such as codeine and thebaine and is available in various forms, including tablets, capsules, and syrups. While it effectively alleviates pain by binding to opioid receptors in the brain, hydrocodone carries significant risks, including the potential for abuse, dependence, and overdose.
The drug has a complex history, having been synthesized in Germany in 1920 and later approved for use in the U.S. in 1943. Its misuse often occurs through prescription fraud or illicit online purchases, contributing to a growing opioid crisis. Short-term effects may include euphoria and sedation, while side effects can range from nausea to respiratory depression. Serious concerns have arisen with mixing hydrocodone with alcohol or other substances, which can lead to severe health complications or fatal outcomes. Despite a decline in prescriptions due to increased awareness of its dangers, the ongoing struggle with opioid addiction continues to pose significant public health challenges.
Subject Terms
Hydrocodone
ALSO KNOWN AS: Dihydrocodeinone; Lortab; Vicodin
DEFINITION: Hydrocodone is the most frequently prescribed opiate (narcotic) in the United States (US). It is an antitussive (cough suppressant) and analgesic (pain relief) agent.
STATUS: Legal
CLASSIFICATION: Schedule II controlled substances
SOURCE: Semisynthetic with either of two naturally occurring opiates: codeine and thebaine
TRANSMISSION ROUTE: Hydrocodone comes as a tablet, a capsule, a syrup, a solution (clear liquid), an extended-release (long-acting) capsule, and an extended-release (long-acting) suspension (liquid) to take by mouth. It is generally abused orally, often in combination with alcohol, but hydrocodone tablets can also be crushed and inhaled.
History of Use
Hydrocodone was first synthesized in Germany in 1920 by Carl Mannich and Helene Löwenheim. The first report of euphoria and habituation was published in 1923, and the first report of dependence and addiction was published in 1961. Hydrocodone was approved by the US Food and Drug Administration in 1943 for sale in the US.
Hydrocodone relieves pain by changing the way the brain and nervous system respond to pain, that is, by binding to the opioid receptor sites in the brain and spinal cord.
Hydrocodone is not usually produced illegally; diverted pharmaceuticals are the primary source for misuse. Misuse comes in the form of from call-in prescriptions, altered prescriptions, theft, and illicit purchases online. Diversion and abuse have been increasing, an issue which was highlighted by the well-publicized opioid crisis in the twenty-first century.
Effects and Potential Risks
Short-term effects are improved mood, reduced pain, euphoria, sedation, light-headedness, and changes in focus and attention. Side effects include nausea, vomiting, constipation, anxiety, dry throat, rash, difficulty urinating, irregular breathing, and chest tightness. When inhaled, burning in the nose and sinuses usually occurs. A newborn of a woman who was taking the medication during pregnancy may exhibit breathing problems or withdrawal symptoms.
Symptoms of overdose include cold and clammy skin, circulatory collapse, stupor, coma, depression, respiratory depression, cardiac arrest, and death. Mixing hydrocodone with other substances, including alcohol, can cause severe physical problems or death.
Abuse of hydrocodone is associated with tolerance, dependence, and addiction. There is no ceiling dose for hydrocodone in users who are tolerant to its effects. Acetaminophen carries the risk of liver toxicity with high, acute doses (of around 4,000 mg per day).
The dangers of painkillers entered the national consciousness during the opioid crisis of the twenty-first century, and since that time, there has been a decline in hydrocodone prescriptions. This decline was part of a more significant effort to combat opioid misuse and its potential for life-altering addiction or overdose. However, this awareness of the dangers of hydrocodone and the subsequent denial of health professionals who continued prescribing hydrocodone at the same rate led many to turn to illegal means of obtaining opiate drugs. This was a dangerous trend as it coincided with the proliferation of a synthetic opiate drug called fentanyl, which was often substituted and marketed in illegal hydrocodone pills, which itself caused a public health crisis.
Bibliography
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"Hydrocodone." MedlinePlus, 15 Mar. 2024, medlineplus.gov/druginfo/meds/a614045.html. Accessed 21 Aug. 2024.
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Parker, Phillip M., and James N. Parker. Hydrocodone: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego: Icon Health, 2003.
Seppala, Marvin. Prescription Painkillers: History, Pharmacology, and Treatment. Center City: Hazelden, 2010.