Vicodin is the brand name for the drug hydrocodone bitartrate, an opioid narcotic combined with Tylenol. Hydrocodone bitartrate, or hydrocodone for short, is the active ingredient in Vicodin. This combination of both medicines is used to treat moderate to severe pain and is usually prescribed after surgeries or dental procedures. It has high abuse potential and has been proven to be extremely addictive, so it is available by prescription-only in the United States due to its status as a controlled substance. Acetaminophen, also known as Tylenol, is added to increase hydrocodone's analgesic potential and incidentally discourages abuse by acting as a buffer. Since acetaminophen is non-narcotic and challenging to separate from similarly water-soluble opioids, the sheer amount of it in the pill makes injection and snorting both ineffective and dangerous. But this doesn't make Vicodin safe. Oral ingestion is the primary route of abuse, which causes a whole host of problems for the body in addition to the dangers of addiction. Vicodin is manufactured by Abbott Laboratories, a pharmaceutical company based out of Chicago. But Vicodin is not the only form of the drug hydrocodone available, as it can be found in various pill forms and cough syrups. The drug is also sometimes prescribed to treat persistent cough, being an antitussive in addition to a pain reliever.
The following list comprises the available prescription drugs, in addition to Vicodin, which contain hydrocodone:
- Lorcet Plus
- Vicodin ES
- Vicodin HP
Slang names for the drug vary by region and age group and are continually evolving with cultures, ethnicities, and time. The following are a few of the common slang names for Vicodin:
- Idiot Pills
- School Busses
- Yellow Jackets
The history of Vicodin
Vicodin didn't exist before 1978 when it was introduced by Knoll Pharmaceuticals, a company that became Abbott Laboratories in 2002. Its key ingredient, hydrocodone, was first synthesized by the same company over fifty years earlier in 1920. It was quickly recognized as dangerous as reports began to accumulate regarding tolerance and addiction. But it wasn't until 1971 that it was restricted under the Controlled Substances Act, and only in its pure form was it scheduled tightly. Other preparations that combined non-narcotic medications like acetaminophen were given flexible scheduling, allowing abuse to occur much more easily.
But Vicodin wasn't utilized heavily for around two decades, at which point it became suddenly popular, along with virtually every other prescription opioid in the early 2000s. As pharmaceutical companies began a battle to keep up with the atmosphere of a newly monopolized pain management market, thanks to Purdue and Oxycontin, opioid sales skyrocketed. The longstanding belief that these drugs were dangerous and addictive was undone within a decade by big pharma, physicians, pharmacies, hospitals, and anyone profiting from opioid narcotics. The medical community changed its tune and collectively began to backpedal, downplaying how dangerous drugs like Vicodin genuinely are.
The American Pain Society had its role in the opioid epidemic, introducing the "pain as the 5th vital sign" campaign, which began around the same time as the FDA's approval of Oxycontin. The Veterans Health Administration soon adopted the same campaign as part of its national pain management strategy. This declaration was not accompanied by the release of any method or device for objectively measuring pain, as was done with all previous vital signs. These include blood pressure, pulse, respiratory rate, and temperature. This exception made "pain" the first and only subjective vital sign.
The Joint Commission also bought into this in 2001 when they issued standards requiring the use of a pain scale and stressing the safety of opioids. The Joint Commission even went so far as to publish a guide sponsored by Purdue Pharma on pain management. This guide reportedly stated that some clinicians have inaccurate and exaggerated concerns about addiction, tolerance, and death risk. They also stated that this attitude prevails despite the fact there is no evidence that addiction is a significant issue when persons are given opioids for pain control. A statement of this nature would never be given today, knowing what we now know.
By framing pain management as a patient's rights issue, it allowed pharmaceutical companies to prey on the ignorant, naïve, and criminal as well as the innocent bystander, the American citizen. Even the Center for Medicare and Medicaid Services fueled the problem by restructuring its reimbursement structure for hospitals and physicians. To make a complicated matter relatively simple, the majority of healthcare providers' income is from Medicaid. Many patients cannot afford private insurance, and so they have Medicaid instead. That means that healthcare practices rely on getting paid back by Medicare for the patients they saw and treated, who are generally low income and have no other coverage.
The CMS made a significant change in how it paid out to practitioners and medical groups when introducing a new system that incentivized customer satisfaction. Instead of focusing on results or objective measures, the CMS pays more money to hospitals and doctors who receive good ratings from patients on post-treatment surveys. These surveys include questions about their satisfaction with how their pain was controlled. Since these hospitals and offices are businesses, they've been forced to play this game and cater to the surveys or go bankrupt. This means making sure that patients are happy and giving them opioids when they are in pain or state that they are. Remember, pain is not observable.
All of these factors have resulted in an explosion of opioid prescribing and subsequent abuse and addiction.
For many years, hydrocodone was the most prescribed drug in the United States. This was overall, not just among controlled substances. Combination drugs like this, which included a narcotic and a drug like Tylenol, were the vast majority of what was offered for pain management. Under the Controlled Substance Act, they were Schedule 3 opioids. However, in its pure form, hydrocodone was always a Schedule 2 substance.
Hydrocodone also was arguably the most abused pharmaceutical, partly because it was prescribed in such large numbers. Approximately 8.09 million Medicare beneficiaries were prescribed hydrocodone and acetaminophen, or generic Vicodin. In 2013 this made it the most prescribed drug among Medicare recipients in America.
In October 2014, hydrocodone combination products were rescheduled as Schedule 2, making refills impossible and requiring a trip to the prescriber for a new prescription. The reason for the rescheduling is hard to argue. Vicodin's abuse history and potential likely warranted a move to the most restrictive class long ago. After rescheduling, prescriptions dropped significantly from 120 million in 2014 to 93.5 million in 2015. But this drug is still highly overused and dangerous.
Effects of Vicodin
Vicodin acts on the mind and body in the same way that all opioids do. As a central nervous system (CNS) depressant, Vicodin acts to slow down the body's critical functions, such as heart rate, breathing, blood pressure, and digestion, to name a few. This is also why the drug produces sedation and causes the user to feel relaxed. Opioids block pain signals at receptors sights by mimicking natural endorphins, the body's own mood and pain management "chemicals." But in the extreme concentration provided by drugs like Vicodin, the user gets a "high" or intense euphoria and pleasure unrivaled naturally. The most noticeable signs and symptoms of Vicodin abuse are:
- A fixation on getting more of the drug
- An inability to focus on a given task
- Severe mood swings
- Nausea and vomiting
- Pinpoint pupils
- Excessive energy followed by "nodding off" or falling asleep quickly when stationary for periods
- Extreme talkative periods when on the drug and withdrawn when not.
Long term use of Vicodin can cause serious issues:
- Addiction and dependence
- Weight loss
- Gastrointestinal conditions
- Liver damage
- Overdose and acetaminophen toxicity
- Escalation of addiction to stronger opioids like Heroin and Fentanyl
From 1999 to 2018, more than 232,000 people died in the United States from overdoses involving prescription opioids. Overdose deaths involving prescription opioids were more than four times higher in 2018 than in 1999.
Overdose can occur when you take too large of a dose or combine it with another type of central nervous system depressant, such as alcohol, another opiate, or a barbiturate. The dose required to cause an overdose is different for everyone and is dependent on several factors, including body weight, tolerance to the drug, and underlying health conditions.
As with any opioid, death can occur and is caused by respiratory failure. Other Vicodin overdose symptoms include:
- Nausea, vomiting
- Constricted/pinpoint pupils (unresponsive to light change)
- Hypotension (low blood pressure)
- Weak/no pulse
- Slowed/shallow/difficult or no breathing
- Cyanosis (blue tint to lips and fingernails)
Even if an overdose is survived, there's no guarantee as to the quality of life. Brain damage can occur from a lack of oxygen. Tissue damage frequently occurs, including nerve damage and eventual atrophy due to the person being immobile for periods during an overdose, often in unnatural positions. This can cause muscles, tendons, nerves, and other tissue to become harmed under the body's weight while unconscious and from the immobility and lack of fluid exchange. People have lost the use of limbs and suffered atrophy or shrinking of the surrounding tissues, resulting from the disuse associated with paralysis. In severe cases, amputation or surgical removal of the now dead tissue may be needed.
Because of the severity of the opioid epidemic, much effort has been put into treating overdose. Thankfully, this has resulted in the increased accessibility of the drug naloxone. Also referred to by the brand name Narcan, Naloxone is a medication designed to reverse opioid overdose rapidly. It is an opioid antagonist, meaning that it binds to opioid receptors and can reverse and block other opioids' effects. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped from opioids. Previously, naloxone was only available to hospitals and other healthcare professionals who would be expected to treat opioid overdose. But when overdosing fatally, time is of the essence. The person loses consciousness before death and so can do nothing to save themselves or alert anyone. Since their breathing will become severely depressed and stop, they can incur brain damage the longer they are without help. People who survive what would otherwise be a deadly overdose do so because they were found quickly enough and gotten immediate assistance. As the opioid epidemic grew, substantial efforts resulted in Narcan being made available in many states as a take-home rescue medication. Those who struggle with addiction can keep it on their person or in their home, or more regularly, loved ones can obtain the drug and keep in just in case. Many schools, businesses, and organizations have chosen to keep Narcan on-premises for unexpected opioid overdose. Countless lives have been saved this way.
Because Vicodin is such a potent and effective opioid, addiction can occur rapidly and often unsuspectingly.
- Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.
- Between 8 and 12 percent develop an opioid use disorder.
- An estimated 4 to 6 percent who misuse prescription opioids transition to heroin.
- About 80 percent of people who use heroin first misused prescription opioids.
Addiction occurs where a person is struggling in some way in life. They are experiencing problems, or a significant issue, which they discover that drugs alleviate. This problem could be anything from physical pain, as is often the case in opioid addiction. Or, it could be mental and emotional anguish. Often, pain comes in grief, loss, rejection, and a variety of other unwanted feelings.
Opioids are excellent at numbing feelings since this is their primary function as painkillers. But the escape and reward provided from any drug have consequences. Addictive narcotics severely disrupt the functioning of the body's systems, causing the body to "adapt" to the drug when it is continually present. This act of getting used to the foreign chemical is accomplished by adjusting its own chemistry.
Now, the person is dependent on the drug. If they run out or stop taking it, the body must go back through a similar readjustment period to get back to normal functioning without it. But rather than being a pleasurable experience, the body is "starved" of these chemicals before it begins to produce its own again. This readjustment period is known as drug withdrawal.
Opioids are so addictive in part because of the profound effect they have on the body's chemistry. Withdrawal from drugs like Vicodin is perhaps the most excruciating form of detoxification. Symptoms are the exact opposite of the effects that the drug produced. For Vicodin, the means that the person will struggle with pain, insomnia, restlessness, chills, upset stomach, and muscle cramping, to name just a portion of the nightmare. This is accompanied by an intense craving for the drug and will last for several days, with some symptoms persisting for weeks or even months in severe cases.
Many people who become addicted to prescription pills began taking them for legitimate reasons. With opioids, this usually means pain. In the case of an injury or surgery, Vicodin is often prescribed to treat pain for short periods afterward.
Addiction can happen insidiously. For instance, a person could be struggling with shoulder pain for months. It begins to affect their daily life, preventing them from picking up their child easily or performing all of their duties at work. Worried that they'll be demoted or fired, they push through the pain, further injuring their shoulder.
They can no longer ignore the pain or function, so one night, when they can't sleep from it, they go to the Emergency Room. At the ER, their pain is treated with opioids, and they are referred to a specialist since nothing is detectable from X-ray or examination. They are sent home with a prescription for Vicodin as well, to last them until the specialist can see them.
The opioids work, and for once, the person feels good. They feel great. Not only is their shoulder not bothering them for the first time in months, but they feel happy and relaxed. The stress of their job and home-life melt away, and they find themselves feeling strangely optimistic about the future. This is the best they've felt in a long time. They don't tell their work because they don't want to be laid off or tied up in the workman's comp system.
Besides, it feels better. Work is now a breeze, and time flies. The Vicodin really help. And the specialist will cost more money and want to do fancy imaging and probably recommend surgery. No way. So, they go on figuring that it was just a flare-up, and it will get better with time. But soon, the shoulder is hurting again, and the warm and fuzzy feeling doesn't come when they take the pill. So, they take two of them, which works.
Soon, the prescription is gone, and the person has an empty pit in their stomach. The pain returns but is worse than before. They have been overusing the shoulder while "numb" on the pills. They begin to feel like they are coming down with the flu and cannot sleep that night. They cannot eat and have severe diarrhea, and the only thing that sounds good is more Vicodin. As you can see, the above example illustrates how addiction can occur quite easily to anyone. If the person continues to obtain opioids to feel better, it will only get worse.
How to help a loved one addicted to Vicodin
Vicodin addiction is not something to underestimate. If someone you know is addicted to Vicodin, it would be wise to act now.
Vicodin can develop tolerance rapidly, meaning that the person needs more and more of the drug to get high. But the problem with Vicodin is that it contains acetaminophen, which is toxic in high quantities. And taking more than the recommended dosage of Vicodin can easily put one into the dangerous range of toxicity, another major concern aside from overdose itself.
So, if a loved one is addicted to Vicodin, their life is in jeopardy each day. Even worse, as the Vicodin stop working so well, they may graduate to stronger prescription pain pills or illicit opioids like heroin and Fentanyl. This will dramatically increase the risk of overdose and death. As you can see, acting before it is too late is vital. Every day that addiction progresses, the person is that much less receptive and able to be helped.
If they openly use the drug, it becomes a matter of getting them into treatment. Assuming they don’t want to, otherwise, they’d probably already be in treatment, you will need to convince them to try. The wrong approach is to buy into the mentality that “you can’t help someone that doesn’t want to help themselves.” This is an excuse people use when they have failed to help someone in the past. It’s untrue. Intervention works and saves lives every day.
Intervention can take two forms, professional and non-professional. For cases of severe addiction, or when the person is likely to become violent or a danger to themselves, professional intervention is recommended. These services require much thought and planning by people who are trained to deal with these exact scenarios and help people make that decision to get help. A good interventionist will not simply force the person into treatment. They will help them arrive at their own decision to try it. And even if they go grudgingly, they have a better chance than continuing to use drugs while their loved ones stand by helplessly and watch them slowly kill themselves. As the drugs wear off and they return to rationality, they may just decide that they want to get better for themselves.
In the case of a person who may be receptive, or should you not be able to hire a professional interventionist, the next best thing is to try yourself. Regardless of what happens, you must never become angry or upset with them. This will nearly always cause a bad result. Instead, stay calm and be patient. Do not ask them questions they can easily lie about. Instead, tell them what you think or are concerned about. This opens the dialogue with an assumption that may be easier for them to accept.
Before starting this discussion, it is best to be prepared and have options for treatment. You can always call the number on this page to get assistance with this. Once you have a place or some places in mind, you can confront them. This way, if they agree, you can swiftly get them help before they change their mind or tragedy occurs.
Addiction to Vicodin usually requires treatment to achieve full recovery. Treatment options are abundant since much has been done to improve accessibility since the early 2000s. Additionally, opioids are one of the only substances that have treatment methods specific to it.
Medication-Assisted Treatment, or MAT, originated specifically as a harm-reduction approach. It has now morphed into a controversial method of treatment for opioid use disorder, specifically. It consists primarily of providing patients with Buprenorphine or Methadone, two potent opioids. Patients are often kept on these medications for life. This is often called "maintenance," a now derogatory term because of the connotation that it maintains the person's addiction. This is where the debate's essence lies since proponents of the method state that the claim of MAT "replacing one addiction for another" is utterly false.
Detractors argue that it is replacing one opioid with another opioid.
The key facts to know are that these medications are themselves addictive and minimally continue the cycle of physical dependence on opioids. If a dose is missed or they run out, they will suffer withdrawal symptoms of comparable magnitude to heroin withdrawal, but often lasting much longer.
The benefit of harm reduction measures is that they save lives. For those who refuse to go through the withdrawal process, which is extremely uncomfortable but not necessarily life-threatening, this may be their only route to betterment. They can regain some semblance of a normal life and avoid participating in criminal activities to acquire their drug of choice. This may also discourage riskier practices like IV drug use and needle sharing or curb it if the person was previously doing such.
Ideally, however, narcotics would only be continued for the minimal amount of time needed. The ideal result of rehabilitation is that the person no longer uses drugs or depends on them, so we must not be forced to accept less. Sometimes all a person needs is some help with getting off opioids and through the withdrawal process. This is where drugs like Suboxone and Methadone can shine. When used at a medical detoxification facility under the care of specialists, they can alleviate withdrawal symptoms. Still, dosing is tapered down to get the person off all opioids for good, smoothly and gradually.
This can make withdrawal tolerable and offer a route to rehabilitation. But any detox service must be followed immediately by treatment. Medical detox is not a treatment or a substitute for rehab.
The majority of people seeking help for addiction in the US end up in one of the country's many twelve-step programs. These have been the industry standard for decades, so most treatment programs incorporate the core concepts of Alcoholics Anonymous into their methodology. Another form of treatment available, but sometimes harder to find, are non-traditional programs. These usually consist of holistic approaches that avoid using drugs to treat drug addiction and focus on physical and mental health as core principles rather than sidenotes. These tend to be much more effective at giving a person their complete life back without remaining on any drugs or unnecessary medications. But they can also be more expensive due to nonrecognition from insurance providers and Medicaid.
All types of treatment fall into one of two categories, being either inpatient or outpatient.
Inpatient treatment is the most common form of treatment for opioid addiction. It merely means that the person lives at the facility and stays there throughout their completion before returning home. This approach's advantages include a high level of support around the clock and a lack of temptation to relapse due to the restrictions imposed by such facilities.
Outpatient treatment consists of the person living and staying at home but traveling to the facility for scheduled treatment sessions. These may be daily at first, becoming less frequent as a person progresses. Advantages of this include the ability to attend treatment when obligations that simply cannot be altered may prevent someone from enrolling in inpatient rehab. It may also be the right choice for some after completing inpatient treatment for continued support.
1 in 12
In 2017, more than 47,000 Americans died due to an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid. That same year, an estimated 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, and 652,000 suffered from a heroin use disorder. The 2018 data shows that 128 people in the United States die every day after overdosing on opioids.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including healthcare costs, lost productivity, addiction treatment, and criminal justice involvement.
America's largest drug companies saturated the country with 76 billion oxycodone and hydrocodone pain pills from 2006 to 2012.
From 1999–2018, almost 450,000 people died from an overdose involving any opioid, including prescription and illicit opioids. The number of drug overdose deaths decreased by 4% from 2017 to 2018, but the number of drug overdose deaths was still four times higher in 2018 than in 1999. Nearly 70% of the 67,367 deaths in 2018 involved an opioid.
Over 136 million prescriptions were dispensed in 2013. This number continues the streak of hydrocodone being the most prescribed medication in the US, with 20 million more yearly prescriptions since 2006. 24.4 million people over the age of 12 have used hydrocodone for nonmedical reasons. More than 99% of hydrocodone abused is abused in the US. Many other countries do not allow hydrocodone to be prescribed for any medical purposes on any level. While these countries have been banning the drug, the US prescriptions remain high, as the DEA raises production quotas to keep with perceived demand. Production quotas have increased by nearly two and a half times in the last decade. More dramatic increases were seen from 2011 to 2012 and 2012 to 2013, increasing by 20,000 units each year.
People using hydrocodone for nonmedical reasons can obtain it from several sources, including:
- Prescriptions intended for them. Some will obtain multiple prescriptions from multiple doctors in a process called "doctor shopping"
- Prescriptions intended for others then sold
- Altered or fake prescriptions
- Pills stolen by physicians or pharmaceutical workers
- Theft from homes, offices, and pharmacies
In 2017, an estimated 18 million people misused such medications at least once in the past year. According to results from the 2017 National Survey on Drug Use and Health, an estimated 2 million Americans misused prescription pain relievers for the first time within the past year, which averages approximately 5,480 initiates per day. Additionally, more than one million misused prescription stimulants, 1.5 million misused tranquilizers, and 271,000 misused sedatives for the first time. The reasons for the high prevalence of prescription drug misuse vary by age, gender, and other factors but likely include ease of access. Misuse of prescription drugs is highest among young adults ages 18 to 25, with 14.4 percent reporting nonmedical use in the past year. Among youth ages 12 to 17, 4.9 percent reported past-year nonmedical use of prescription medications.
Common Terminology Related to Vicodin
|Analgesics||Pain-relieving medications, including over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil®) and prescription opioids.|
|Chronic pain||Pain that lasts 3 months or more and can be caused by a disease or condition, injury, medical treatment, inflammation, or an unknown reason.|
|Drug misuse||The use of illegal drugs, or the use of prescription drugs in a manner other than as directed by a doctor, such as use in more significant amounts, more often, or longer than told to take a drug or using someone else's prescription.|
|Fentanyl||Pharmaceutical fentanyl is a synthetic opioid, approved for treating severe pain, typically advanced cancer pain. It is 50 to 100 times more potent than morphine. However, illegally made fentanyl is sold through illicit drug markets for its heroin-like effect. It is often mixed with heroin or other drugs, such as cocaine, or pressed into counterfeit prescription pills.|
|Heroin||An illegal, highly addictive opioid drug processed from morphine and extracted from certain poppy plants.|
|Illicit drugs||The nonmedical use of a variety of drugs that are prohibited by law. These drugs can include amphetamine-type stimulants, marijuana/cannabis, cocaine, heroin, other opioids, and synthetic drugs, such as illicitly manufactured fentanyl (IMF) and ecstasy (MDMA).|
|Naloxone||A drug that can reverse the effects of opioid overdose and can be life-saving if administered in time. The drug is sold under the brand name Narcan or Evzio.|
|Narcotic drugs||Originally referred to as any substance that dulled the senses and relieved pain. Some people use the term to refer to all illegal drugs, but technically, it refers only to opioids. Opioid is now the preferred term to avoid confusion.|
|Opioid||Natural, synthetic, or semi-synthetic chemicals that interact with opioid receptors on nerve cells in the body and brain and reduce the intensity of pain signals and feelings of pain. Opioids refer to all forms of the drug, including opiates.|
|Opiates||refer to natural opioids such as heroin, morphine, and codeine.|
|Antitussive||used as an adjective, it refers to the kind of drug used to prevent or relieve a cough.|