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Understanding hydrocodone addiction

Mina Draskovic, B.Psy., reviewed this content for accuracy on May 14, 2024

Hydrocodone is a powerful prescription opioid medication with a high potential for abuse. It is one of the most highly prescribed pain medications by clinicians for moderate to severe pain, and also one of the most highly abused by patients.

According to the Drug Enforcement Administration, nearly 7 million Americans over the age of 12 misused hydrocodone in 2016. That number decreased to 5.5 million in 2018, but hydrocodone addiction is still all too common.

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If you or someone you know is struggling with hydrocodone addiction, seek professional help to overcome this dangerous and potentially life-threatening condition. Our drug addiction rehab center in Provo, Utah is here to support you on your journey to break free from opioid use disorder and achieving lasting sobriety. 

What is hydrocodone?

Hydrocodone is a semi-synthetic opioid medication derived from codeine, a natural opioid alkaloid found in the opium poppy. It is synthesized by modifying the chemical structure of codeine to increase potency and effectiveness in treating pain.

According to research published in Frontiers in Pharmacology, “hydrocodone is the second drug of abuse in the United States but the first preferred by women.” Most women mistakenly believe that hydrocodone has a better safety profile because of the perceived lower overdose rate. Reports show an increase in hydrocodone-related deaths with a higher prevalence among female victims, resulting in approximately 97,000 drug-related emergency room visits caused by abuse or misuse in 2011.

Hydrocodone is primarily used as a prescription for: 

  1. Management of moderate to severe pain
  2. Treatment of pain resulting from injuries or surgical procedures
  3. Chronic pain associated with cancer or arthritis
  4. Severe cough (in some formulations combined with other medications)
  5. Short-term treatment of acute pain
  6. Management of pain in palliative or end-of-life care
  7. Combination with other medications to provide more effective pain relief

Types of hydrocodone

Hydrocodone is available in different formulations and combinations to cater to patient needs, pain levels, and intended effect durations. Some formulations also include abuse-deterrent properties to reduce the potential for misuse and addiction.

The main types of hydrocodone medications include:

  • Immediate-release hydrocodone combination products (Schedule III) combine hydrocodone with non-opioid pain relievers such as acetaminophen or ibuprofen to provide fast-acting relief for moderate to severe pain. They have a lower potential for abuse than Schedule II drugs.
    • Hydrocodone/acetaminophen (e.g., Vicodin, Norco, Lortab)
    • Hydrocodone/ibuprofen (e.g., Vicoprofen)
  • Extended-release pure hydrocodone products (Schedule II) contain only hydrocodone for longer-lasting pain relief with fewer daily doses.
    • Zohydro ER
    • Hysingla ER (with abuse-deterrent properties)
  • Cough suppressant combinations (Schedule III) are combined with other ingredients, such as pseudoephedrine or chlorpheniramine, to alleviate cough and cold symptoms. 
    • Hydrocodone/pseudoephedrine
    • Hydrocodone/chlorpheniramine
  • Pipeline products are new hydrocodone formulations with tamper-deterrent and extended-release options. These products provide effective pain management while minimizing the potential for misuse.

Gershman and Fass discuss a proposed amendment to reclassify hydrocodone combination products from Schedule III to Schedule II controlled substances, which could help decrease abuse through stricter regulation.

The immediate-release combination products, such as Vicodin and Norco, are the most commonly abused types of hydrocodone. They are easy to access and can be crushed and snorted or injected for a more intense high. 

How can hydrocodone be administered?

Hydrocodone is intended for oral administration, but people who abuse it often deviate from the prescribed method. Some common methods of hydrocodone abuse include:

  • Oral consumption. People may choose to take higher, or more frequent doses of hydrocodone orally to get stronger effects.
  • Chewing or crushing pills. Abusers may chew or crush hydrocodone pills before swallowing to speed up absorption and intensify its effects. This practice is particularly dangerous because it leads to a rapid release of the entire dose.
  • Snorting. Crushed hydrocodone pills may be snorted, allowing the drug to be absorbed more quickly through the nasal membranes. This method of abuse damages the nasal passages and increases the risk of overdose.
  • Injecting. Although less common, some people may attempt to dissolve crushed pills and inject the solution intravenously. This practice is extremely dangerous and often leads to infections, blood clots, and organ damage.
  • Mixing with other substances. Hydrocodone may be combined with alcohol, benzodiazepines, or other drugs to enhance its effects. This polysubstance abuse increases the risk of dangerous side effects, respiratory depression, and overdose.

Any of these methods of administration can lead to increased tolerance, physical dependence, and addiction, and severe health consequences. 

How does hydrocodone work?

Like other opioids, hydrocodone activates and binds to opioid receptors in the brain and central nervous system, particularly the mu-opioid receptors. This interaction triggers several effects:

  • Pain relief: hydrocodone reduces the perception of pain by inhibiting the release of neurotransmitters involved in pain signaling, such as substance P and glutamate. This action effectively diminishes the transmission of pain signals from the body to the brain.
  • Increased dopamine release: activation of opioid receptors by hydrocodone leads to an increased release of dopamine. Dopamine is a neurotransmitter associated with pleasure, reward, and motivation. This surge contributes to the euphoric effects.
  • Respiratory depression: hydrocodone acts on the respiratory center in the brainstem, causing a reduction in the responsiveness of this area to carbon dioxide levels in the blood. As a result, breathing becomes slower and shallower, which can be dangerous at high doses.
  • Opioid receptor activation by hydrocodone can also cause drowsiness, sedation, constipation, and a decreased cough reflex.

Researchers from the University of Toledo found that chronic hydrocodone abuse can lead to addiction by dysregulating the glutamatergic system in key brain regions involved in reward and drug dependence. The changes in glutamate transporter expression, mGluR5 receptors, and signaling pathways disrupt glutamate regulation, reinforcing drug-seeking behaviors and facilitating the transition to addiction.

Repeated use of hydrocodone can make you tolerant of its effects. Soon, you start to require higher doses to achieve the same level of pain relief or other desired effects. As the body adapts to the presence of the drug, you become physically dependent and experience withdrawal symptoms when you stop using or take a significantly lower dose.

All these factors contribute to the high addictive potential of hydrocodone, making it a challenging condition to overcome without proper support and treatment. For those struggling with addiction to hydrocodone or other types of drugs, there is hope.

Our hydrocodone rehab center in Provo, Utah provides a compassionate and comprehensive approach to addiction treatment. Set in a serene, picturesque environment, our facility.  offers all of the tools to heal the mind, body, and spirit. 

If you or a loved one is struggling with opioid addictions, Ardu’s opioid addiction treatment center is ready to welcome you with open arms. 

Signs of hydrocodone addiction

Hydrocodone addiction can be a difficult problem to face, but it’s important to recognize the signs and acknowledge the issue before it progresses beyond repair. Substance use disorder (SUD) involving hydrocodone can be identified by physical and behavioral indicators. 

Physical signs include:

  1. Constricted or “pinpoint” pupils
  2. Drowsiness or excessive sleepiness
  3. Slurred speech
  4. Slowed breathing
  5. Nausea and vomiting
  6. Constipation or paralytic ileus
  7. Itching, skin rash, or clammy skin
  8. Excessive sweating
  9. Confusion, blurred vision, or disorientation
  10. Rapid weight loss
  11. Chest pain or irregular heartbeat

Behavioral signs of hydrocodone abuse may include:

  1. Taking higher doses than prescribed
  2. Running out of prescriptions early
  3. “Doctor shopping” or seeking multiple prescriptions
  4. Neglecting responsibilities at work, school, or home
  5. Isolating from friends and family
  6. Mood swings, irritability, or mental depression
  7. Losing interest in hobbies or activities
  8. Engaging in risky behaviors
  9. Continuing to use despite negative consequences or adverse effects
  10. Failed attempts to quit or reduce use
  11. Spending significant time obtaining, using, or recovering from hydrocodone
  12. Experiencing withdrawal symptoms

If you notice these signs in yourself or a loved one, reach out to Ardu. Our state-of-the-art hydrocodone detox center offers a safe, comfortable environment where you can begin your recovery under the care of addiction specialists and medical professionals.

How much hydrocodone is too much?

Doctors typically prescribe between 10 and 40 milligrams of hydrocodone in a 12-hour period. Anything over 90 mg in a day is considered a potentially fatal amount. People who take this amount often seek euphoric effects, but even one excessively high dose of hydrocodone can lead to an overdose. 

The lethal dose becomes even lower when you crush and snort or inject the pill, or when you combine it with alcohol. Do not take more hydrocodone than your doctor prescribed or use it in any way other than as directed. 

How strong is hydrocodone?

Hydrocodone is a powerful opioid. On average, hydrocodone is considered about as strong as morphine. The potency of hydrocodone depends on the specific product and the presence of other substances. Everyone reacts to hydrocodone differently, and the effects will depend on factors such as body weight, metabolism, tolerance, and even the user’s genetic makeup. 

Follow your doctor’s guidance and do not base your dosage on the experiences of others. 

While hydrocodone is a potent pain reliever, stronger doesn’t always mean better. The goal is to find the right balance between effective pain management and minimizing the risk of side effects and addiction. Even when taken as prescribed, the potency of hydrocodone might be a determining factor in the development of tolerance and dependence. 

If you find yourself building an unhealthy tolerance or struggling to control your hydrocodone use, reach out for help. At Ardu Recovery Center, we understand the challenges you face, and we’re here to support you. 

Can you overdose on hydrocodone?

Too much hydrocodone can lead to an overdose. It can cause severe respiratory depression, cutting the oxygen supply to the brain and other vital organs. The risk of overdose is particularly high when you combine it with other substances that slow down breathing, such as alcohol, benzodiazepines, or other opioids.

The potency of hydrocodone is directly related to its potential for abuse and overdose. Even when taken as prescribed, the body can develop a tolerance to hydrocodone over time, requiring higher doses to achieve the same level of pain relief. This can lead to physical dependence and an increased risk of overdose.

Telltale signs of a hydrocodone overdose include:

  1. Slow, shallow, or irregular breathing
  2. Extreme drowsiness or loss of consciousness
  3. Pinpoint pupils
  4. Cold, clammy skin
  5. Bluish lips or fingernails
  6. Weak pulse
  7. Nausea or vomiting
  8. Choking or gurgling sounds
  9. Seizures
  10. Coma

If you suspect that someone has overdosed on hydrocodone, call 911 immediately. Naloxone, an opioid overdose reversal medication, can help restore breathing and save a person’s life while waiting for emergency medical services to arrive.

You can rely on our Ardu team to provide the support, guidance, and treatment needed to overcome addiction and build a foundation for a healthy, substance-free life.

What are the health effects of hydrocodone addiction?

Hydrocodone addiction can take a severe toll on your physical and mental health. It may lead to health problems that can be difficult to overcome without medical help. 

Common negative health effects caused by hydrocodone addiction include:

  1. Liver damage. Hydrocodone is often combined with acetaminophen. When taken regularly in higher than recommended doses, the combination of hydrocodone and acetaminophen can cause liver damage, eventually leading to liver failure. 
  2. Respiratory depression. Hydrocodone can slow down breathing, particularly when taken in high doses or combined with other substances with a similar effect, such as alcohol or benzodiazepines. Respiratory depression can lead to respiratory failure, brain damage, or even death.
  3. Constipation and gastrointestinal problems. Opioids such as hydrocodone can slow down the movement of the digestive tract, causing severe constipation, abdominal pain, and in some cases, bowel obstruction.
  4. Increased risk of infections. Hydrocodone can weaken the immune system, making users more susceptible to infections such as pneumonia, skin infections, and blood-borne diseases like HIV or hepatitis C, particularly if they inject the drug.
  5. Cardiovascular problems. Long-term hydrocodone use can cause damage to the heart and blood vessels, increasing the risk of irregular heartbeat, heart attack, and stroke.
  6. Cognitive impairment. Hydrocodone can affect brain function, causing memory loss, difficulty concentrating, and impaired decision-making skills. These effects may persist even after you stop using the drug.
  7. Increased risk of accidents and injuries. The drowsiness, confusion, and impaired coordination caused by hydrocodone can increase the risk of accidents, falls, and other injuries.
  8. Mental health problems. Hydrocodone addiction can worsen pre-existing mental health conditions, or even trigger the onset of new disorders. This creates a vicious cycle, as you may use the drug to self-medicate, only to have your symptoms worsen over time.

For those battling hydrocodone addiction, co-occurring mental health disorders such as depression, anxiety, or PTSD can make the journey to recovery even more challenging. In this complex interplay between addiction and mental illness, known as a dual diagnosis or co-occurring disorder, each issue feeds into the other, making it difficult to break free without comprehensive treatment.

At Ardu, we are familiar with the intricacies of dual diagnosis and are dedicated to providing compassionate, evidence-based treatment for co-occurring disorders. Our integrated approach addresses both the hydrocodone addiction and the underlying mental health concerns simultaneously, giving you the all-encompassing support needed to heal from the inside out.

We use proven therapies such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and trauma-focused interventions to guide you toward a life of wellness and sobriety.

Find out why addiction and mental health often go hand in hand.

How is hydrocodone addiction treated?

Ardu is such a warming place to be. The moment you walk through the doors you feel the love everyone has for one another. Staff genuinely cares about each other and the clients, they check in frequently and always try to make sure clients are getting the most out of the experience.

Melanie Ogden


The best time to seek the help of a hydrocodone addiction treatment program is before the addiction takes hold, but for most people, the decision to get clean often comes after hitting rock bottom.

Recovery from addiction may feel like an insurmountable task, but you don’t have to face this challenge alone. Our compassionate team is here to support you every step of the way, offering evidence-based therapies and programs tailored to your specific needs. These may include:

  • Medical detox: our state-of-the-art detox program provides a safe, comfortable environment where you can withdraw from hydrocodone under the 24/7 supervision of medical professionals. They will monitor your vital signs, alleviate symptoms of withdrawal, and help you transition to the next phase of treatment.
  • Medication-assisted treatment (MAT): we may incorporate medications such as buprenorphine, methadone, or naltrexone into your treatment plan to help manage cravings, reduce the risk of relapse, and support your ongoing recovery.
  • Dual diagnosis treatment: if you are struggling with both hydrocodone addiction and a co-occurring mental health disorder, our integrated dual diagnosis program addresses both issues simultaneously, giving you the comprehensive care needed to achieve lasting recovery.
  • Cognitive-behavioral therapy: CBT helps you identify and change negative thought patterns and behaviors related to hydrocodone use, develop healthy coping skills, and prevent relapse.
  • Residential treatment: our immersive inpatient program offers a structured, supportive environment where you can focus exclusively on your recovery, free from the stresses and triggers of everyday life.

We pride ourselves on providing the most effective, cutting-edge addiction treatment in the country. Our holistic approach to addiction combines proven therapies, personalized care, and a strong support system to address the physical, emotional, and spiritual aspects of addiction. We believe in treating the whole person, not just the addiction.

The first step in getting you clean is detox.

Hydrocodone detox at Ardu

Our hydrocodone detox program helps you to cleanse your body of toxins while safely and effectively managing withdrawal symptoms. Our team of experienced medical professionals will work closely with you to create a personalized detox plan that addresses your specific needs and goals.

Our medical detox program incorporates 24/7 monitoring, medications to alleviate withdrawal symptoms, and other proven medical and holistic therapies to support your physical and emotional well-being during this challenging time. Detoxing can be a difficult and uncomfortable process, which is why we prioritize your comfort and safety throughout your stay.

To complement our traditional medical approach, we also offer holistic therapies to help with withdrawal, reduce stress, and promote overall healing. These may include:

  • Nutritional therapy to support your body’s recovery and improve overall health
  • Yoga and meditation therapy to reduce anxiety, improve focus, and promote relaxation
  • IV amino acid therapy to replenish essential nutrients and aid in the detox process
  • Massage therapy to alleviate muscle tension, improve circulation, and promote a sense of calm

We also incorporate individual and group counseling sessions to address the psychological aspects of addiction and help you develop the coping skills needed for long-term success.

With our expert care, compassionate support, and innovative therapies, our detox program sets you up for success as you transition into the next phase of treatment. 

Hydrocodone rehab at Ardu

After detox, we address the underlying causes of your hydrocodone dependence and help you build the skills needed for long-term recovery. Our experienced team will work with you to create a treatment plan that may include:

  1. Individual sessions with a licensed therapist to explore the roots of your addiction, develop coping strategies and address any co-occurring mental health issues.
  2. Group therapy, peer support, and guidance from others who are also in recovery foster a sense of community and shared understanding.
  3. Family therapy and involving loved ones in the healing process can rebuild relationships, improve communication, and create a supportive home environment.
  4. Cognitive-behavioral therapy identifies and changes negative thought patterns and behaviors related to hydrocodone use.
  5. Dialectical behavior therapy helps you develop mindfulness, distress tolerance, and emotion regulation skills to manage cravings and prevent relapse.
  6. Trauma-focused therapies address underlying trauma that may have contributed to your addiction, such as eye movement desensitization and reprocessing (EMDR) or somatic experiences.
  7. Complementary holistic practices such as yoga therapy, meditation, and art therapy promote overall well-being and support your recovery journey.

We offer inpatient and outpatient treatment options to meet your unique needs in therapy. Our inpatient program provides a structured, immersive environment with 24/7 support. You’ll benefit from a structured daily schedule filled with individual and group therapy sessions, educational classes, and recreational activities. You’ll have constant access to medical care and support from our multidisciplinary team.

If you opt for our outpatient therapy programs, you’ll attend therapy sessions and classes on a regular basis, either several times a week or daily, depending on the program’s intensity. These programs allow you to receive treatment while maintaining work or family commitments.

You’re not alone in this struggle. Help is just a phone call away. Reach out to our team at Ardu today, and take the first step on your path to a healthier, happier life free from the chains of hydrocodone addiction. 

How to avoid prescription drug addiction

Many prescribed medications have the potential for addiction, so it’s imperative to enact preventative measures. Some of these measures include:

  • Take prescribed medications correctly. Doctors regularly prescribe pain-relieving medications for a short period, following an injury, surgery, or disease-related condition. Always take the medication precisely as prescribed, controlling the temptation to increase the dose. 
  • Never share paid medications. Do not share your medicines with anyone under any circumstances. This can contribute to their dependency. Also, never sell your medication; this is illegal and can result in misuse and overdose.
  • Keep medication in a safe and controlled location. Keep medication out of the reach of children, especially adolescents. 
  • Safely dispose of medications you no longer use. Dispose of medication as soon as you and your doctor decide they’re no longer needed. This reduces the chances of misuse, abuse, and theft.

Hydrocodone addiction FAQ

What is the strongest painkiller?

The strongest painkillers are opioid analgesics such as fentanyl, hydromorphone, oxycodone, and morphine. These narcotic analgesics are used to treat severe pain and have a high potential for addiction and fatal overdose if misused. Similar to oxycodone, they work by binding to opioid receptors in the brain and spinal cord to block pain signals.

Does hydrocodone make you sleepy?

Drowsiness and unusual tiredness are common side effects of hydrocodone. Hydrocodone binds to mu-opioid receptors in the brain, disrupting the brain’s wakefulness-promoting systems and altering the levels of dopamine and norepinephrine that regulate arousal and attention. Its depressant effects on the brainstem’s respiratory centers can lead to a build-up of carbon dioxide, which can further contribute to feelings of drowsiness and sleepiness. 

What happens if you take painkillers every day?

If you take hydrocodone regularly every day, you may become physically dependent and addicted. With long-term use, increased doses are often required to achieve the same pain relief, which develops tolerance. When you try to lay off hydrocodone or take smaller than usual doses, you’re in for severe withdrawal symptoms. Daily use also increases the risks of respiratory depression, liver disease, and overdose.

What are the side effects of hydrocodone?

Common side effects of hydrocodone include constipation, nausea, vomiting, lightheadedness, dizziness, drowsiness, and breathing problems. It can also cause more severe side effects such as adrenal gland problems, abuse, addiction, and life-threatening respiratory depression, especially with high doses or when combined with other depressants.

Which is stronger, oxycodone or hydrocodone?

Oxycodone is generally considered to be stronger and more potent than hydrocodone when comparing equivalent doses. Hydrocodone is converted into hydromorphone in the body, while oxycodone itself is the active opioid. Healthline suggests that oxycodone may be about 1.5 times more potent than hydrocodone as an analgesic.

Is hydrocodone a blood thinner?

Hydrocodone is not a blood thinner. It is an opioid pain medication used to treat moderate to severe pain. Blood thinners, also called anticoagulants, are drugs like warfarin that inhibit blood clotting. Hydrocodone does not have any anticoagulant effects.

Are opioids depressants?

Opioids such as hydrocodone, oxycodone, and morphine are classified as depressants because they depress or slow down the central nervous system. This can slow breathing, cause drowsiness, relieve pain, and bring a sense of emotional well-being. Excessive opioid use can dangerously suppress respiration.

Is tramadol stronger than hydrocodone?

Tramadol is a weaker opioid than hydrocodone. Tramadol has a lower binding affinity to the mu-opioid receptor than hydrocodone. At typical doses, hydrocodone provides greater pain relief but also carries a higher risk of abuse and respiratory depression than tramadol.

How do I recognize a person addicted to opioids?

Opioids are highly addictive with often devastating consequences. Here are some common signs of opioid abuse:

  • Drowsiness and unusual tiredness from the central nervous system depressant effects
  • Frequent constipation as a side effect
  • Sedation 
  • A slowed respiratory rate
  • Seeking early refills or “losing” prescriptions to obtain more opioids
  • Visiting healthcare providers to obtain prescription medications (doctor shopping)
  • Engaging in risky behaviors like stealing or buying street drugs to obtain opioids
  • Continuing use despite negative consequences on relationships, work, or health
  • Mood swings, increased secrecy, and general changes in behavior
  • Financial difficulties potentially related to funding an addiction
  • Withdrawal symptoms such as muscle aches, stomach cramps, and runny nose


Cardia, L., Calapai, G., Quattrone, D., Mondello, C., Arcoraci, V., Calapai, F., Mannucci, C., & Mondello, E. (2018, October 1). Preclinical and Clinical Pharmacology of Hydrocodone for Chronic Pain: A Mini Review. Frontiers in Pharmacology. https://doi.org/10.3389/fphar.2018.01122

Gershman, J. A., & Fass, A. D. (2012). Hydrocodone Rescheduling Amendment And Pipeline Products on the Horizon. Pharmacy and Therapeutics, 37(7), 399. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411214/

Wong, W., & Sari, Y. (2023). Effects of Chronic Hydrocodone Exposure and Ceftriaxone on the Expression of Astrocytic Glutamate Transporters in Mesocorticolimbic Brain Regions of C57/BL Mice. Toxics, 11(10), 870. https://doi.org/10.3390/toxics11100870

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