Withdrawal From Hydrocodone

Hydrocodone is a semi-synthetic opioid that works like codeine to relieve moderate pain. It is often prescribed in combination with other compounds in products like Vicodin or Lortab, which contain hydrocodone and acetaminophen. It is the most widely available opioid in the United States, which means that it is inexpensive and easy to come by. Many victims of the current opioid epidemic got their start with hydrocodone.

Hydrocodone prescriptions have decreased in recent years, from 136.7 million prescriptions in 2013 to 83.6 million in 2017, but it is still the most commonly prescribed opioid in the United States. It is also one of the most widely abused prescription pain killers.  

Overview

Data from 2017 shows that roughly 6.3 million people age 12 or older had misused hydrocodone in the past year in the United States—amazingly, that is 2.3 percent of the population. Most of these people acquired the drug from someone they trusted, such as a doctor or family member. Unfortunately, hydrocodone misuse can quickly develop to dependence and addiction. 

Anyone who is physically dependent on opioids will experience withdrawal if they abruptly discontinue their dose.

Symptoms can range from mild to severe, depending on how much you’ve been taking and for how long. If you are currently taking a high dose of hydrocodone, or a mix of hydrocodone and other opioids, then suddenly quitting “cold turkey” without tapering down is going to be really difficult.

Even if you are on a lower, therapeutic dose of hydrocodone, the withdrawal is challenging—expect a feeling similar to having the flu (the severity will vary), plus psychological distress. Without treatment, most people experience chills, cramps, and diarrhea, along with nausea, sweating, and agitation.

You might feel like your heart is pounding out of your chest or like you will never sleep again. Runny noses and teary eyes are common. Some people feel extremely anxious, and others feel intense despair and hopelessness. 

Opioid withdrawal isn’t easy, but it is quick. Symptoms typically subside within one week. Fortunately, there are medications that can get you through this period with minimal discomfort. 

Signs and Symptoms

Like all forms of opioid withdrawal, hydrocodone withdrawal is not simple. Experiences vary from person to person, but typically include some combination of physical and psychological symptoms. Your personal experience will be shaped by a number of factors, including:

  • your current dose and how often you take it
  • how long you have been using opioids or other drugs
  • whether or not you are mixing hydrocodone with other drugs, such as heroin, Oxycontin, alcohol, or benzodiazepines
  • your willingness to seek treatment and support 
  • your past experiences with substance abuse
  • your physical and mental health

If you have been taking low doses of hydrocodone as directed by your doctor, then your withdrawal symptoms should be relatively mild. However, if you are a long-time poly-drug abuser, untreated withdrawal can be extremely uncomfortable. For most people, hydrocodone withdrawal symptoms start about eight to 24 hours after their last dose.

Withdrawal will come on slower if you are also using extended release opioids, like methadone or Oxycontin. 

Common hydrocodone withdrawal symptoms include any of the following:

  • Muscle, bone, and joint aches and pain
  • Flu-like feeling
  • Sweating
  • Runny nose
  • Headache
  • Chills
  • Nausea or vomiting
  • Cramping or diarrhea 
  • Insomnia or disturbed sleep
  • Teary eyes
  • Tremors
  • Anxiety or restlessness 
  • Gooseflesh
  • Heart pounding
  • Agitation
  • Skin-crawling 

Opioid withdrawal symptoms typically peak on the second or third day after your last dose, then start getting better. Most people feel better after five to seven days. 

Unfortunately, this isn’t always the end of it. Once acute withdrawal passes, some people experience something called protracted withdrawal, also known as post-acute-withdrawal syndrome (PAWS). Protracted withdrawal symptoms are much less severe and are mostly psychological in nature—meaning that you won’t be physically ill.

Instead, you may experience waves of depression that come and go or bouts of insomnia. Not everyone experiences protracted withdrawal, but those who do can expect symptoms to appear on and off for around six months. 

Coping and Relief

There are a number of steps you can take to ensure a smoother and less uncomfortable withdrawal experience. The best strategy for you will depend on your hydrocodone use patterns. 

Tapering

If you have been using hydrocodone as directed for the treatment of pain, then your doctor can help you develop a tapering schedule. Tapering your medication means taking progressively smaller doses over a period of several weeks. By incrementally decreasing your dose, you give your body time to adjust. While you may experience some withdrawal symptoms each time the dose is reduced, they should be relatively mild. 

There is no standard tapering schedule, so it is important to work with your doctor to develop a schedule that fits your needs. As you reduce your dose, you may find that your pain returns. If so, talk to your doctor about alternatives.

In addition to tapering your dose, there are other evidence-based treatments for opioid detox include medication-assisted treatment and symptom management.

Medications

Medications like buprenorphine (Suboxone/Subutex) can help prevent the symptoms of withdrawal and make it easier to get clean. These drugs are made with long-acting opioids that prevent withdrawal without getting you high. Suboxone contains a mix of buprenorphine and naltrexone, an opioid antagonist.

This means that it’s more or less impossible to abuse Suboxone to get high if injected. Suboxone can also prevent other opioids from getting you high, which reduces your chance of relapse.  

Over-the-counter (OTC) medications that may make you more comfortable during withdrawal include:

  • OTC pain relievers (Tylenol, Advil, Aleve)
  • anti-diarrhea medications (Imodium, loperamide)
  • antihistamines to help you sleep (Benadryl) 
  • anti-nausea medications (Pepto-Bismol, Kaopectate)
  • nutritional supplements for anxiety (valerian root, chamomile) 

Warnings

Although scientific evidence shows that medication-assisted treatment is the most effective way of treating opioid dependence, it is often surprisingly difficult to find. In fact, most people have trouble finding any substance use treatment at all.

Lack of Treatment

In 2017, it was estimated that 20.7 million people in the United States needed substance use treatment, but only 4 million received it. Only a small number of those who did receive help got it at a facility offering medication-assisted treatment. Treatment providers offering buprenorphine can definitely be difficult to find, but they do exist.

It’s not an inability to find treatment that prevents people from getting help, rather it’s the belief that they don’t need help.

Among the 20.7 million people who needed treatment for a substance use in 2017, only one million actually believed that they needed treatment. People typically underestimate the seriousness of their substance use disorder and overestimate their ability to “quit when they’re ready.” 

At-Home Withdrawal

Today, it is possible to detox from hydrocodone at home without help. Unlike alcohol or benzodiazepine withdrawal, opioid withdrawal isn’t dangerous, though it can be extremely uncomfortable. Many people relapse within days or weeks of quitting. When you detox from hydrocodone, your tolerance level drops fast. If you were to relapse with your pre-detox dose, it could kill you. 

There are some people in the recovery community who believe that “abstinence-only” is the best way to go. They believe that medication-assisted treatment is just “replacing one drug with another.” Although this is technically true, it’s not so simple. Medications that prevent withdrawal have been shown to reduce relapse and give you the opportunity to participate in therapy.

Without taking the time to address the issues that led to your substance abuse, your chance of relapse will remain high.  

Long-Term Treatment

Your long-term treatment requirements will depend on the nature of your hydrocodone dependence. If you became dependent on opioids while taking them as prescribed by a doctor, you may not need any treatment after you get off the pills. If you are struggling with a substance use disorder, however, detox is only the first step on a long road. 

If your goal is long-term sobriety, then you will need to put a lot of effort into relapse prevention. If you have tried to quit opioids before, then you know how easy it is to relapse after detox. Research shows that the best way to prevent relapse is a combination of medication and psychotherapy.

Preventing Relapse With Medication

Your long-term treatment plan may involve a maintenance dose of buprenorphine. Naltrexone is only useful after you detox, once your body is free of opioids.

This discourages opioid use, because if you use, you will be wasting time and money for nothing. Naltrexone can also help ease opioid cravings and may help prevent a lethal overdose. 

Preventative Psychotherapy

Medication paves the way for the second leg of long-term treatment, psychotherapy. During talk therapy, you will learn to identify the thoughts, feelings, and actions that trigger your cravings. You will also develop the skills you need to handle those triggers in a healthy way.

Many people choose to continue taking their medication indefinitely, but you can also tapper off after a few months or years. Therapy can prepare you for that transition. 

There are many different types of treatment with varying levels of intensity. Places you can find help include: 

  • addiction treatment centers
  • residential programs 
  • community health clinics
  • your primary care physician
  • a psychiatrist 
  • a therapist in private practice
  • methadone clinics
  • doctors certified to prescribe buprenorphine (Suboxone) 

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