Vicodin
Vicodin is a prescription painkiller that combines hydrocodone bitartrate and acetaminophen, primarily used to alleviate moderate to moderately severe pain. Approved by the FDA in 1983, it is classified as a Schedule II controlled substance due to its potential for dependence and abuse. The drug acts on the central nervous system and can lead to side effects such as drowsiness, mood changes, and impairment of mental and physical abilities. Despite its effectiveness, nonmedical use of Vicodin remains a significant concern, with reports indicating millions of individuals misuse prescription painkillers annually.
The rise of the opiate crisis has prompted a decline in prescriptions, with figures dropping from over 68 million in 2014 to around 30 million in the early 2020s. Vicodin can be habit-forming, and users are cautioned against combining it with alcohol or other CNS depressants due to heightened risks of severe side effects. Special considerations apply to pregnant or breastfeeding women and geriatric patients, as the safety of Vicodin in these groups has not been firmly established. The ongoing challenge of managing its use highlights the need for careful prescription practices and awareness of its potential risks.
Vicodin
ALSO KNOWN AS: Hydrocodone bitartrate/acetaminophen; Lortab; Norco
DEFINITION: Vicodin is a prescription painkiller with a significant risk for dependence. The drug affects the central nervous system and smooth muscle through multiple actions to relieve moderate to moderately severe pain. The drug may prompt drowsiness, changes in mood, and mental clouding.
STATUS: Legal with a prescription
CLASSIFICATION: Schedule II controlled substance
SOURCE: Semisynthetic combination of hydrocodone and acetaminophen
TRANSMISSION ROUTE: Oral ingestion, sniffed as a powder form, injected intravenously when mixed with water
History of Use
The combination of hydrocodone and acetaminophen as Vicodin was approved by the United States (US) Food and Drug Administration for use as a brand-name oral prescription marketed by Abbott in 1983. The US Drug Enforcement Administration reported in October 2018 that hydrocodone was the most frequently prescribed opiate in the US and that the most frequently prescribed hydrocodone combination was with acetaminophen, such as in Vicodin. In the mid-2020s, Vicodin remained one of the most frequently prescribed opiates, despite declining instances of doctors prescribing the drug due to the opiate crisis. In 2014, a record 68.76 million hydrocodone prescriptions were dispensed. By the early 2020s, that number had fallen to 30.1 million. Nonmedical Vicodin use remains a great concern to the medical, public health, drug abuse prevention, and law enforcement fields. Many people unintentionally become addicted to the drug after they receive a prescription for the drug to address specific pain.
Users without prescriptions buy painkillers illegally on the street; steal from pharmacies, doctors, or dentists; or steal from family or friends who may be taking the drug as prescribed. Increasingly, users may turn to the dark web to purchase painkillers. This has become increasingly dangerous with the rise of fentanyl in black market drugs. According to the 2016 National Survey on Drug Use and Health, an estimated 11.5 million persons aged twelve years and older had taken a prescription painkiller for a nonmedical reason during the past year; 3.3 million were misusing prescription pain relievers at the time of the survey. In the mid-2020s, the number of persons aged twelve years and older who had taken a prescription painkiller for a nonmedical reason had fallen to between 9.7 and 10.7 million.
Effects and Potential Risks
In addition to providing temporary pain relief, Vicodin has the potential to produce many adverse reactions. It may prompt drowsiness, mood changes, impairment of mental and physical abilities, itchiness, light-headedness, dizziness, sedation, nausea, vomiting, anxiety, and fear. Vicodin may be habit-forming and can lead to abuse, addiction, physical dependence, and tolerance. At high doses, Vicodin can affect the respiratory, dermatological, and gastrointestinal systems.
Vicodin should not be taken concomitantly with alcohol and other central nervous system (CNS) depressants, such as antihistamines, antipsychotics, or antianxiety agents. The combination may produce an additive CNS depression.
The safety and effectiveness of Vicodin in children has yet to be determined. Pregnant women should not take Vicodin unless the potential benefit justifies the potential risk to the fetus. Regular use of opioids by pregnant women could cause the fetus to be born physically dependent on the drug. For mothers who are breastfeeding, both acetaminophen and hydrocodone are excreted in small amounts in breast milk. Use of Vicodin should be avoided in these cases because of the potential for serious adverse reactions in infants, although in deciding, one should consider the importance of the drug to the mother. Dosing of Vicodin in geriatric patients should be moderated as well.
Bibliography
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