What Is Hydrocodone?
The History of Hydrocodone
The drug was first synthesized in Germany in 1920. It was approved for use in the United States of 1943. It was manufactured in Germany by Knoll pharmaceuticals that came out as a product known as Dicodid. Fortunately for them, it didn't really catch on and, as a matter of fact, they do not even use the hydrocodone in Germany and Europe anymore.
The first cases of habituation and euphoria with the drug were reported as early as 1923. The dependence and addiction were reported as long ago as 1961. Other hundreds of brand name and generic forms of hydrocodone typically mixed with acetaminophen (Tylenol).
The most commonly used drug or commonly known drugs are Vicodin and Lortab. They are basically the same thing.
How do you rate the strengths of the drug? Most people do it on the ability of the hydrocodone to constrict the pupil that is false measure. We know that it would take you about fifty percent more hydrocodone compared to oxycodone to get the same amount of people get rid of construction. On the other hand, if you happen to break your leg and you go to the emergency room, the drugs appear to be equivalent if you compare it to an injection of morphine. For everyone milligram of injected morphine, you would need about two and a half milligrams of oral hydrocodone. But if you look at oral morphine versus oral hydrocodone, they seem to be equivalent. And if you compare it to codeine you need about 30 milligrams of codeine to give you the same amount of pain relief that you would get with five milligrams of hydrocodone.
Now, most of the drug is used as an immediate release. You take the drug, it dissolves and gets into your system right away. It is not an extended-release product that you can take once or twice a day. Most of the hydrocodone is either combined with ibuprofen, but more often with acetaminophen. It is combined with it anywhere between 325 milligrams and a thousand milligrams of acetaminophen.
However, the acetaminophen is not really there to provide extra pain relief. It so that you don't break the pill down and inject it. The old idea was that if you did not have pain, you could not become addicted to the products. But that is absolutely false! As a matter of fact, if you combine the hydrocodone/acetaminophen with a depressant of the central nervous system, you are much more likely to have a side effect and overdose or die. Yet in spite of this, it appears that one person in three taking the drug also takes a sedative. One person in eight consumes at least two drinks of alcohol within two hours of the pill. One in 32 deaths come from a combination of the hydrocodone added to a muscle relaxant or alcohol, or a benzodiazepine. Benzodiazepine the drug that would be like Xanax. It's habit-forming and can lead to physical psychological dependence.
That is why Food and Drug Administration in 2014 said were not classifying this like we have for the longest period of time is class 3 drug, we are going to consider it the class 2 drug. In a class 2 drug, you have to a doctor write the prescription. You can't just call it into the pharmacy and you can only get a 90-day supply. One month supply of x two refills. You cannot get a five-month refill. That is a major difference far as how often you have to go see the doctor with costs are. But it's worth it because, unfortunately, people were abusing this drug.
In fact, the overwhelming majority of people who take the drug abuse the drug. They do not take them some legitimate medical reasons, everybody has the potential to become addicted to this drug once they start to take it but there are special risk factors. So, for instance, if you have a psychological or psychiatric disease, if you suffer from anxiety or depression you are more likely to become addicted to this drug if you start taking it. If you have a history of substance abuse, you smoke cigarettes you consume alcohol you are more likely to be at risk. And the longer you take the drug, the more tolerance you get. The more tolerance you get, the more quantity you need either a higher dose of the pill, or you need to take the bill more frequently.
When we are talking about the immediate release form, once you take it, it starts to dissolve and get into the system within 20 to 30 minutes and peaks at about 30 to 60 minutes. It lasts for about four to eight hours and then you have to take another dose. Now it's the most potentially deadly of all prescription medicines. By the year 2011, there were more people who died of overdoses of either oxycodone or hydrocodone than there were who died in automobile accidents each year in the United States.
Somewhere between 50,000 and 55,000 people died of drug overdoses. Some of those are legal drugs, some of those are illegal drugs. It seems that about 25,000 to 30,000 people are going to die of narcotics. The significant number of 500,000 people are going to go to the emergency room every year because of toxic reactions to this kind of drugs. People who take them get a feeling of euphoria, they feel better so they start off at one or two bills and then pretty soon they're on 10 or 20 bills or even more.
Hydrocodone Side Effects
The pills can have some side effects associated with them. We all know that they can cause you to have nausea or vomiting, the colossal case of constipation so you go to the bathroom only once or twice a week. They can cause dizziness and drowsiness, lightheadedness and anxiety. They can lead to either an elevated mood or a depressed mood. Hydrocodone can cause rashes, itches. It can narrow your pupils, lead to irregular breathing and sometimes chest tightness, shortness of breath. In men, it can interfere with the production of testosterone. It means infrequently it can cause progressive hearing loss.
There is also a special problem for women who are pregnant who take the pill. We know that the unborn child may become addicted and then cause problems after delivery with the neonatal withdrawal syndrome. We also know that it can lead to respiratory depression in a fetus. It can also lead to an increased incidence of birth defects.
The pill is especially problematic for people who have sleep apnea or bad bronchitis.
The hydrocodone by itself is not really toxic to the liver. Small benefit doesn't increase your liver blood tests, but when you combine it with acetaminophen, then you open the door for a significant problem. There is no evidence that taking more than 325 milligrams of acetaminophen combined with hydrocodone provides any extra relief, but it does lead to an increased incidence of liver failure need for liver transplant and death from liver toxicity.
There is especially a problem with your liver if you drink alcohol or maybe have muscle ache or pain or maybe you have a cough and you go over to the drugstore, and you get one of the commonly used over-the-counter drugs. They frequently contain additional acetaminophen. There is a limit to about 4,000 milligrams of acetaminophen that you can take per day without increasing your risk of liver toxicity or cirrhosis, or some other kind of severe problems.
The acetaminophen was added to hydrocodone in 1998 in order to prevent people from crushing the pills, snorting it or injecting the pill. Interestingly, the Food and Drug Administration informed the drug companies in 2011 that manufacture hydrocodone that they are putting too much acetaminophen in the pill. Let's limit it to no more than 325 milligrams and do that by 2014. It's voluntary, but if you do not do it, we are going to make a rule that says all drugs that have more than 300 milligrams or 325 milligrams have to come off the market.
There is a problem with hydrocodone if you combine it with other drugs that are going to affect the central nervous system. So, if you combine it with alcohol, you are at a higher risk of respiratory failure and death. Or if you take it with another opioid, antihistamine, antipsychotic, anti-anxiety drug like Xanax or maybe even if you take Prozac or Zoloft. Any of the central nervous system depressants can increase the likelihood of the toxicity.
Hydrocodone Withdrawal Symptoms
Withdrawal reactions can occur as early as 6 to 12 hours after your last dose. It means if you take a pill before you go to bed or by the time you wake up, you can start to have withdrawal reactions. Withdrawal reactions peak about 72 hours after you stop taking the pills. They last for about five to seven days, but can last for weeks or even months. The cravings and the emotional changes can last for years.
The symptoms of withdrawal include restlessness, sweating, chills, muscle and bone aches and pains. You can have some insomnia, diarrhea, vomiting, mood swings, headaches. Some people have depression, fatigue, some people even consider suicides.
You can also take too much of the drug and overdose on the Hydrocodone. In this case, we have other kinds of problems. The pupils become narrow, but as there is less oxygen going to your brain, your respirations can become shallow and short or ultimately stop. Your heart rate goes down, your skin gets to be cold and clammy, sometimes turns blue. You are getting excessively sleepy and can lose consciousness. You can have seizures and even die. The maximum you should take is 60 milligrams of hydrocodone a day and 4,000 milligrams of acetaminophen a day. It means you should take no more than 12 pills of the standard 5-milligram hydrocodone 325 milligrams acetaminophen a day.
Additionally, there are about 200 million prescriptions written for these drugs each year in the United States. It is estimated that there are 5 million addicts, 5 million people taking the drugs for inappropriate reasons here in the United States. Unfortunately, you take the pill you feel well so you overuse it and eventually this going to lead to addiction.
We have a lot of drugs mills here in the United States. Some prescribe what is known as the Trinity. It is hydrocodone combined with a muscle relaxant and the benzodiazepine like Xanax. Or the Holy Trinity, which is oxycodone instead again combined with the muscle relaxants and a benzodiazepine.
Every day in the United States somewhere between 45 and 50 people die of an overdose. 45 to 50 people per day die of an overdose of oxycodone or hydrocodone. It is a major number that adds up to more than 16,000 up to 20,000 people per year die of this medicine. For each person who dies 30 more going to go to the emergency room.
How Does Hydrocodone Work?
It simple binds to some opioid receptors in the brain and probably some other areas in the body. That is the way you get the benefits. Supposedly, that is the way you get the toxicity. Once you take the drug, its metabolized by a liver enzyme to another product called hydromorphone. Hydromorphone is even more potent than the hydrocodone.
Now interestingly, we have all these problems everyone knows you have a problem with hydrocodone when it's combined with another pain medicine like either Aspirin or ibuprofen. However, the Food and Drug Administration in 2014 allowed marketing of the drug known as Hydro ER. The ER stands for extended release. This release is over a period of about 12 hours, so you only have to take two pills a day. Supposedly, it's only for people who have severe pain who have prolonged pain round-the-clock necessity for taking some kind of a pain medication. But there's no evidence it is less addictive, no evidence it's any better and, unfortunately, with these extended release pills, we have a higher incidence of toxicity. It is the scheduled drug, just like immediate release hydrocodone.
The FDA has an advisory panel. Thirty states protested in the advisory panel that they don't market this drug, do not allow it to be marketed. The FDA said, okay, there was the tendency for the drug to be abused and potentially snorted or injected. Because it was a pure hydrocodone, it didn't have any of that acetaminophen in it. However, it was very quickly approved in 2014. By 2015 it had to be reformulated we have a problem with diversion. People go to doctors offices and they alter prescriptions, they steal the prescriptions, has a doctor shop and get lots of different prescriptions from lots of different doctors or they get an excessive number of prescriptions.
Most of the drug abuse in the United States is thought to be blue-collar type sort of rural areas, but hydrocodone is a white collar type pill. Now heroin costs about fifteen dollars a bag and when you compare that to a single black market hydrocodone for about five to seven dollars a pill for oxycodone that can go for up to eighty dollars until you can see that now these drugs are fueling a heroin epidemic. A horrible heroin epidemic that's occurring in the United States and, unfortunately, heroin is being added to fentanyl and now we have another major cause of death.
Well, hydrocodone is for short-term pain relief. It is for the pain that you would have after an operation or a fracture It is for people who have a terminal illness, who are going to die in a relatively short period of time.
On the other hand, more than ninety percent 90 percent of hydrocodone that is used in the United States, is used for chronic pain. But guess what? It does not work the people who have chronic pain. They still have chronic pain when they're taking the drug. So that means the drug is ineffective for the purposes that it's prescribed and the drug is often prescribed for people who have arthritis or people who have low back pain, people who have nerve pain. It is not to be used for those particular kinds of problems and, as a matter of fact, it can cause a paradoxical problem. So you take the pill and you actually have more pain now.
There is an another issue. What about the cost? Well, if were talking about going to a legitimate pharmacy, if you get months worth of hydrocodone combined with acetaminophen, the cost is usually somewhere around 350 – 450 dollars for the generic. It may be up to 500 dollars for the brand name product. So what do we say about the overall cost, it is reasonable if you buy a generic product.
Speaking about effectiveness, it is used mostly for chronic pain. And it does not work for this kind of problem. The drug is great to get rid of acute pain after you have your surgery or in case you break a leg. On the other hand, the way it's used in the United States right now is inappropriate.