Vicodin is a combination of the opioid painkiller hydrocodone and acetaminophen, commonly known by the brand name Tylenol. It’s used to treat moderate to severe pain and is typically prescribed in pill form. It was first introduced in 1978 by the German pharmaceutical company Knoll, and soon became an incredibly popular prescription. In 2006, 130 million prescriptions for Vicodin were given out in the US alone.
As an opioid, hydrocodone can produce a pleasurable high and has a high addiction potential. Once it was discovered that Vicodin could be obtained quite easily from doctors, people started taking it recreationally. Many became addicted and found themselves suffering from health issues, especially due to the harsh effect of the high dose of acetaminophen on the liver.
Reports of recreational use, health problems, addiction, and overdose became so common that the US government began investigating the substance. In 2009, the Food and Drug Administration (FDA) advisory panel voted to recommend to the agency that Vicodin be removed from the market entirely due to the high likelihood of overdose and death. Instead, the FDA asked manufacturers to limit the amount of acetaminophen in Vicodin to 325 milligrams rather than the standard 500 and required warning labels explaining the potential for liver damage and allergic reactions.
In 2014, the U.S. Drug Enforcement Administration (DEA) recategorized all hydrocodone products from Schedule III controlled substances to Schedule II, making it significantly more difficult to obtain from doctors and limiting the amount of medications like Vicodin that doctors are allowed to prescribe. Abuse of Vicodin continues in spite of these efforts, but may be on the decline.
Signs of Abuse
Technically, when it comes to prescription medications, abuse is defined as any intentional use beyond a doctor’s instructions. This includes taking it without a prescription and taking more than prescribed. Recreational use of a medication like Vicodin typically involves or leads to taking more than is recommended. Taking it in combination with other drugs or alcohol is also considered abuse. This can cause compounded and sometimes unpredictable effects and significantly increases the risk of overdose.
Many individuals who abuse Vicodin and other prescription medications don’t have a prescription, and instead obtain the drug from a friend or family member who doesn’t want it or is willing to share. Others may steal it from older family members or people who suffer from chronic pain or back problems. It’s one of the top drugs abused by high school students, with 4.8 percent of these young individuals having used it in 2014, according to the National Institute on Drug Abuse.
Opioid abuse tends to produce a calming effect, often making users feel sleepy and happy. As a central nervous system depressant, it slows down the heart, respiratory system, and other essential functions.
People are also likely to develop a tolerance to Vicodin over time. This means that the body and brain is adjusting to the frequent presence of the drug and higher doses are required to achieve the same effect, whether the individual is looking for a high or pain relief. Tolerance created by drug abuse is often the first step to addiction.
Addiction is typically thought of in two distinct categories: physical and psychological. Psychological addiction is characterized by serious cravings for the drug and the feeling as though one can’t get through the day without it. Physical addiction is defined by the appearance of severe withdrawal symptoms when a person stops taking the substance. These symptoms are often so unpleasant that the prospect of having to get through them can in and of itself be a deterrent to quitting.
Signs that abuse has progressed into addiction include:
- Unease when the drug is not available
- Lying to doctors to get a prescription
- Change in social circles
- Avoiding situations where there will be no access to the drug
Withdrawal symptoms include:
- Runny nose
- Muscle aches
Other signs of Vicodin abuse and addiction can be found in the effects that long-term, excessive use has on the body. Both hydrocodone and acetaminophen will wear on the body after a time, producing chronic and sometimes severe health problems.
Hydrocodone, the opioid aspect of Vicodin, slows the respiratory and gastrointestinal systems. This can cause chronic problems with both, including frequent respiratory infections and constipation. Over time, damage from these issues can cause more serious effects.
The greater concern with Vicodin is its high acetaminophen content. Taken in lower doses like that found in Tylenol, acetaminophen isn’t generally considered to be dangerous. However, at high doses, especially if taken frequently for an extended period of time, this drug can cause severe liver injury. The risk of this increases if taken with alcohol. The greatest risk comes from acetaminophen overdose. This can lead to acute liver failure, a potentially deadly medical condition that often requires a liver transplant if the person survives. According to the U.S. National Library of Medicine, even with early treatment, acute liver failure only has a 66 percent recovery rate.
It’s not recommended to take more than 4000 mg of acetaminophen in a day, and over 7000 mg can cause overdose symptoms, including liver damage.
Treatment and Recovery
Recovery from Vicodin addiction is absolutely possible. Researchers and addiction specialists have been working on the best way to combat opioid addiction for decades, as other opioids like heroin and morphine have caused addiction epidemics before Vicodin was even on the scene.
Once an addiction has been identified, it’s important to get into treatment as soon as possible to avoid a worsening dependency, liver damage, and overdose. Treatment can begin with a simple visit to a primary care doctor, who may refer patients to addiction specialists, especially if the problem appears to be severe. From there, a number of treatment options are available.
For opioid addiction, there are a couple of medications available that can help individuals wean themselves off their drug of choice. Perhaps the most well known of these is methadone, a medication first developed as an opioid painkiller and later used to treat heroin addiction. Methadone, as an opioid, satisfies physical cravings and prevents withdrawal symptoms but does not produce the same euphoric high as drugs like heroin and Vicodin. It also stays in the body longer, making it less addictive. Patients can be switched from Vicodin to methadone and then gradually weaned from the new medication. This reduces the chances of relapse.
Methadone is not effective or practical for everyone, however. It has a high potential for overdose, especially since the painkilling effects tend to wear off in a couple hours even though the substance stays in the body for 12 hours or more.
Unaware of this, people will take extra doses – and even a single extra dose of methadone can be deadly. This means that addiction treatment with methadone is highly controlled, often requiring clients to come to the treatment center or hospital on a daily basis to receive a dose directly from a medical professional.
To combat this issue, alternatives to methadone were developed. The most common is buprenorphine, another non-euphoric and less addictive opioid that’s considered to be safer than methadone. Individuals can take doses of this medication home with them to self-administer. It’s typically combined with naloxone, a substance that blocks opioid receptors, that is only activated when the film or tablet the medication comes in is crushed or dissolved for abuse purposes, such as for snorting or injection.
It’s highly recommended to combine medicated treatment with some type of supportive therapy or the attendance of addiction support group meetings. Treatment with methadone or buprenorphine is not generally meant to last forever, yet studies have shown that when addiction treatment stops, the “severity” of the condition almost triples, indicating a high rate of relapse. Ongoing therapy, support group participation, and general social support tend to make staying in recovery much easier.
Addiction is classified as a mental illness or disease, and relapse is very common, but it does not indicate a failure of treatment or of character. In fact, many addiction experts consider relapse to be a part of the recovery process. The important thing is to focus on healing and doing the best you can for yourself. Cravings for the drug tend to decrease as life satisfaction increases.