Hydrocodone Withdrawal: Symptoms, Timeline, and Treatment

Hydrocodone is among the top 10 drug causes of overdose deaths. While worrying, this isn’t surprising because it is the US's most commonly prescribed opioid (with over 130 million annual prescriptions).

The first step to helping affected individuals avoid fatal hydrocodone consequences is understanding hydrocodone withdrawal, its symptoms and treatment. 

What is Hydrocodone and How Does it Work?

Hydrocodone is a semi-synthetic opioid that doctors prescribe for pain and cough. It works by binding to opioid receptors in the brain and:

• Triggering the release of feel-good hormones such as dopamine, which relieves pain. 
• Suppressing the cough centers in the brain, alleviating cough. 

How Long Does it Take Hydrocodone to Act?

Hydrocodone takes between 15- 60 minutes to act following ingestion. 

Is Hydrocodone Addictive?

Users misuse hydrocodone seeking its feel-good effects (euphoria). Thus, long-term hydrocodone use can lead to drug tolerance (the need to take increasing doses for the same effect). This stems from hydrocodone-induced structural and biochemical brain changes. 

Over time, individuals become dependent on hydrocodone. In other words, trying to quit hydrocodone use causes uncomfortable withdrawal (which forces patients to reuse the drug).  

Is Hydrocodone a Regulated Substance?

The FDA classifies hydrocodone as a Schedule II substance. This means it carries significant potential for misuse.  

But, the FDA considers hydrocodone combination products a lower risk for misuse and classifies them as Schedule III substances. 

How Long do the Effects of Hydrocodone Last?

This depends on the hydrocodone formulation taken and its half-life (the time it takes for the body to eliminate half the drug):

• Immediate release formulations have a half-life of 4 hours; thus its effects last for 20 hours (the body takes 5 half-lives to eliminate any drug completely).
• Extended release formulations have a half-life between 7 to 12 hours and so remain in the system for 35-100 hours. 

Hydrocodone Effects on the Brain: The Science Behind Hydrocodone Withdrawal 

Abrupt discontinuation of hydrocodone triggers withdrawal. This is because of rebound excess noradrenaline (the fight or flight hormone) production by the locus coeruleus (a part of the brain that long-term hydrocodone use suppresses). 

How Long Does it Take for Hydrocodone Withdrawal Symptoms to Appear?

This, again, depends on the hydrocodone formulation taken and its half-life. Generally, users experience withdrawal symptoms:

• Within 12 hours of the last dose when taking immediate-release formulations
• 1-3 days after the last dose of extended-release formulation. 

• Hydrocodone Withdrawal Symptoms

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Common Symptoms:

Anxiety/restlessness

Irritability

Insomnia

Runny nose (rhinorrhea)

Runny eyes (lacrimation)

Ptosis (drooping eyelids) and pupillary dilation

Yawning

Excessive sweating

Muscle spasms

Tremors

Bone pain 

Diarrhea

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Severe Symptoms:

Progressive hearing loss

Blurring of vision

Palpitations

Changes in body temperature

High blood pressure

Teeth chattering

Loss of motivation

Hyperalgesia (enhanced pain sensitivity)

Hot flushes

Dehydration

Hydrocodone Withdrawal Timeline: How Long Does it Last?

Time since last dose and withdrawal features:

6-12 hours:

Patients begin to experience withdrawal symptoms

72 hours:

Withdrawal symptoms intensify

3-5 days:

Symptoms begin to abate

First week and beyond:

Most users are symptom-free by the end of the first week

Factors Affecting Hydrocodone Withdrawal Duration

Many elements affect hydrocodone withdrawal duration. These include:

• Hydrocodone dosing; Understandably misusing larger hydrocodone doses creates more structural brain changes and leads to more prolonged withdrawal than smaller doses. 
• Duration of hydrocodone use; Prolonged hydrocodone misuse leads to dependence which leads to more prolonged, more severe withdrawal. 
• Gender; Data suggests women start using opioids (such as hydrocodone) at a younger age than men (presumably because men are more likely to seek specialized healthcare). This means women experience withdrawal for longer (given their prolonged misuse).
• Genetics; Studies show specific genes predispose patients to drug misuse. Individuals with these genes also suffer from more severe hydrocodone withdrawal. 
• Multidrug use; Combining medications (such as benzodiazepines) and substances (e.g., alcohol) with hydrocodone can lead to longer, more dangerous withdrawal. This is because of the cumulative sedative effects of blending chemicals.  

Hydrocodone Misuse (and Withdrawal) Complications

Hydrocodone misuse can cause many complications. These include:

• Infections. Individuals dependent on hydrocodone often turn to injectable opioids seeking a ‘high.’ This (sharing and using of needles) increases the risk of infections such as:
• Viral hepatitis. Up to 90% of injection opioid users test positive for hepatitis A, B, and C. 
• HIV (Human Immunodeficiency Virus). Studies show that 60% of injection users test positive for HIV. 
• Tetanus and Clostridium botulinum (fatal infections that can cause breathing problems). 
• Tuberculosis and lung infections. Hydrocodone withdrawal-associated vomiting (and aspiration) also contributes to this. 
• Liver damage. Excessive hydrocodone use damages liver cells (because the liver breaks down opioids). 
• Dehydration and chemical imbalances. This is a direct consequence of hydrocodone withdrawal-associated vomiting and diarrhea.
• Sexual dysfunction. 
• Male users may experience erectile dysfunction (ED) because hydrocodone can lower testosterone levels. 
• Women may go through menstrual irregularities and, subsequently, fertility problems due to hydrocodone’s effect on gonadotropin (a hormone) secretion. 
• Neonatal Abstinence Syndrome (NAS).
• Post-Acute-Withdrawal Syndrome (PAWS). Up to 90% of users may experience PAWS, i.e., signs of withdrawal for months after their last hydrocodone dose. 

Hydrocodone Withdrawal Diagnosis

Doctors diagnose hydrocodone withdrawal based on detailed patient history and examination with supplementary laboratory investigations. A urine toxicology sample, in particular, can detect hydrocodone for 12-36 hours after the last dose. 

Clinical Opioid Withdrawal Scale (COWS): Quantifying Hydrocodone Withdrawal Severity

Clinicians use COWS to assess hydrocodone withdrawal severity and make case-by-case treatment decisions. Researchers base this scale on 11 patient signs and symptoms:

• Anxiety
• Gastrointestinal issues
• Restlessness
• Bone or joint pains 
• Excessive sweating
• Runny nose 
• Tremors
• Goosebumps
• Excessive yawning
• Dilated pupils
• Elevated pulse rate.

COWS has a total score of 47, and categorizes withdrawal as:

• Mild; if patients’ scores are between 5 and 12
• Moderate; for scores between 13 and 24
• Moderately severe; for scores between 24 and 36
• Severe; if patients score more than 37

Hydrocodone Withdrawal FAQs

How Long do Painful Hydrocodone Withdrawal Symptoms Last? 

Most hydrocodone withdrawal symptoms resolve by the end of the first week (since the last dose). However, these are general recommendations, and variations (based on individual circumstances) do exist. 

Can Hydrocodone Make You High? 

Yes, hydrocodone use can produce feelings of euphoria (due to ‘feel-good’ hormone release). 

How Fast Can You Get Dependent on Hydrocodone? 

This varies considerably on a variety of factors. Some users may develop a dependence within a few days, while the process may take longer for others.  

Tapering Hydrocodone Use to Prevent Withdrawal

Doctors do not recommend quitting hydrocodone abruptly because of the physical and mental risks. Instead, they recommend gradually reducing the dose over time (weeks to months) under professional supervision.

 During this time, the healthcare practitioner:

• Closely monitors blood pressure, pulse rate, and temperature to gauge patient response.
• Runs routine laboratory investigations to identify any complications.
• Coordinates with a therapist or pharmacist to address any problems. 
• Talks to family members so that they can support patients during this phase. 
• Prescribes medications as needed.

Understandably, adhering to a doctor-formulated plan is vital to a successful taper. 

Hydrocodone Withdrawal Treatment 

Hydrocodone withdrawal treatment seeks to achieve two main goals: relieve symptoms and prevent relapse.

Hydrocodone Withdrawal Symptom Relief:

Three evidence-based approaches can help alleviate hydrocodone withdrawal symptoms:

Lifestyle Habits That Help With Hydrocodone Withdrawal:

• Joining a detox program; Up to 85% of patients joining a detox program report improvements in their mental and physical symptoms. 
• Exercise; Studies show exercise can help relieve anxiety, cravings, and low mood associated with hydrocodone withdrawal. This stems from exercise-induced feel-good hormone release and structural brain changes. 
• Yoga; Research shows yoga can boost self-esteem, lower stress, and reduce drug cravings. 
• A healthy diet; Drug misuse can create nutritional deficiencies in patients. Following a healthy diet can help reverse these and prevent withdrawal complications. 
• Drinking lots of water; Hydrocodone withdrawal can cause vomiting and diarrhea, which leads to dehydration and electrolyte imbalances. Hydrating adequately (at least 8-12 glasses of water a day) can help combat this. 
• Getting good sleep; Sleep allows the body and mind to recover. This becomes increasingly important during withdrawal. 
• Moderate caffeine use; Studies show caffeine intake (of more than 400mg per day) can worsen withdrawal symptoms. 

Home Remedies to Ease Hydrocodone Withdrawal Symptoms:

• Cold sponging and loose, comfortable clothing; These can help with withdrawal-associated body temperature changes. 
• Diet rich in bread, bananas, and rice; This helps with nausea and vomiting (that accompanies withdrawal).  
• Distraction techniques (such as breathing)to combat drug cravings
• St. John’s Wort, which can help with tremors.

Medications for Hydrocodone Withdrawal Symptoms

• Loperamide for diarrhea
• Metoclopramide for nausea 
• Trazodone for insomnia
• Non-steroidal anti-inflammatory (NSAIDs) for pain 
• Tizanidine for stiff muscles
• Clonidine for hypertension

Medications to Prevent Hydrocodone Relapse

Withdrawal is among the most common causes of treatment failure and relapse. That is why doctors may substitute hydrocodone with less potent (or shorter-acting) opioids or opioid antagonists to combat withdrawal symptoms. Examples of such treatments include:

• Methadone(a short-acting opioid)
• Buprenorphine(a partial opioid agonist)
• Naltrexone(an opioid antagonist)

These medications are approved to treat opioid use disorder, such as Hydrocodone addiction and are proven to be effective and approved by the FDA.

Use Evidence-based Treatments at Confidant Health to Overcome Your Hydrocodone Dependence! 

Hydrocodone dependence and withdrawal can be tough, but it doesn’t have to be. The experts at Confidant Health can help you successfully overcome your hydrocodone dependence using evidence-based practices including therapy, medications, and lifestyle changes. So take the first step and get in touch today!