Hydrocodone

General Information

Hydrocodone is a chemical derivative of both codeine and thebaine. The drug is used as an analgesic and antitussive. The brand name formulation of hydrocodone called Vicodin, which includes the NSAID analgesic acetaminophen, is often quoted as being a big part of popular culture. In Generation X, a book by Greg Critser, the author talks about a friend who works as an executive in a major studio partaking in "Vicodin Fridays." Each Friday, one executive would go door-to-door handing out Vicodin tablets, whose purpose was to round out the rough edges of the week. In the popular medical drama television series, House, M.D., fictional character Dr. Gregory House reveals he is addicted to unprescribed Vicodin, though the pain stems from a legitimate condition called thrombosis.

Pharmacology & Pharmacokinetics

Orally administered hydrocodone is well-absorbed via the gastrointestinal tract. Hydrocodone, metabolized hepatically, "exhibits a complex pattern of metabolism including O-demethylation, N-demethylation and 6-keto reduction to the corresponding 6-a- and 6-b-hydroxymetabolites."1 Some hydrocodone is converted to hydromorphone via cytochrome P450-2D6 (CYP2D6; however, the amount is clinically insignificant. Following oral administration, onset occurs after 10-30 minutes and peak plasma levels of hydrocodone occur after about an hour. The average plasma half-life is 3.8 hours.

Legal Status

Under United States law, hydrocodone can appear as both a Schedule II or Schedule III substance depending on the formulation. Here are the differences between the two:

• Schedule II — Includes pure hydrocodone & formulations containing more than 15 mg hydrocodone per dosage unit. Written prescription required for refills.
• Schedule III — Includes hydrocodone products containing less than 15 mg per dosage unit. May be refilled using phoned prescription.

In the United States, this drug is sometimes considered a Schedule II substance, making it illegal to use or possess without a prescription. Schedule II substances, such as dextroamphetamine, morphine, oxycodone, and cocaine, meet the following criteria according to the Controlled Substances Act:

1. The drug or other substance has a high potential for abuse.
2. The drug or other substance has a currently accepted medical use in treatment in the United States (or) a currently accepted medical use with severe restrictions.
3. Abuse of the drug may lead to severe psychological or physical dependence.

In the United States, this drug is sometimes considered a Schedule III substance, making it illegal to use or possess without a prescription. Schedule III substances, such as codeine, hydrocodone (when combined with a non-narcotic active ingredient), and Marinol (synthetic THC), meet the following criteria according to the Controlled Substances Act:

1. The drug or other substance has a potential for abuse less than the drugs or other substances in Schedules I and II.
2. The drug or other substance has a currently accepted medical use in treatment in the United States of America.
3. Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.

Side Effects

• Pain relief
• Euphoria or dysphoria
• Mood changes
• Reduced anxiety
• Sedation
• Itching
• Nausea and vomiting
• Decreased libido (sex drive)
• Constipation
• Facial flushing
• Vertigo

Withdrawal

Withdrawal from hydrocodone typically begins within 12-24 hours after last administration. The time it takes for withdrawal to start depends on frequency of use, dosage, as well as body chemistry. Acute withdrawal symptoms peak between 48 and 72 hours and are generally gone within one week; however, post-acute withdrawal syndrome (PAWS) may persist for weeks or even months afterward. Withdrawal from opiates and opioids is rarely fatal, though this factor is largely dependent upon the health of the user. Complications from other drugs, such as alcohol and benzodiazepines can easily result in death. Symptoms of hydrocodone withdrawal are listed below:

• Cravings
• Muscle & bone pain
• Restlessness
• Goose bumps
• Involuntary leg and arm movements
• Sweating
• Insomnia
• Nausea and vomiting
• Depression
• Anxiety

Sources