Hydrocodone: Risks of Addiction and Abuse

What Is Hydrocodone?

Hydrocodone is a semisynthetic opioid often found in combination with acetaminophen or ibuprofen. It’s most often prescribed to manage moderate to moderately severe pain.¹ Hydrocodone may be administered in both immediate- and extended-release formulations and is available in liquid solution, capsule, and tablet form.² Other formulations combine hydrocodone with chlorpheniramine or homatropine to treat cough and symptoms related to upper respiratory tract infections.¹

So is hydrocodone Vicodin? And what is Norco?

Vicodin and Norco were previously available brand name analgesic combinations of both hydrocodone and acetaminophen. Other perhaps familiar and previously available brands include:^3,4

• Lortab.
• Vicoprofen.
• Hycodan.
• Tussionex.

Though many previously available branded formulations have been discontinued, a variety of generic hydrocodone products are still in use today.

Along with its therapeutic uses, hydrocodone is sometimes misused for its rewarding opioid effects—which include feelings of relaxation and euphoria among others.⁵

So is hydrocodone addictive?

In a word, yes. As a schedule II drug under the Controlled Substances Act, hydrocodone has a high potential for misuse and can lead to severe dependence.^6,7 Additionally, the misuse of opioids such as hydrocodone can increase the risk of fatal overdose.⁵

To provide some context on the number of people using and misusing hydrocodone, results from the 2022 National Survey on Drug Use and Health reveal that of the more than 36.5 million people aged 12 and older who used hydrocodone products in the past year, 10.2% (or 3.7 million people) misused the drug.⁸ Among that same age group, an estimated 6.1 million people had an opioid use disorder in the past year.⁹

Mechanism of Action

Hydrocodone attaches to and activates opioid receptors throughout the brain to modify pain signals. Opioid receptor activation is associated with an increase in dopamine activity in key regions of the brain, which can significantly reinforce the act of taking a drug like hydrocodone and ultimately prompt the individual to repeat the experience.⁵

Hydrocodone Misuse and Addiction: Signs and Symptoms

The National Institute on Drug Abuse explains that misuse of opioids such as hydrocodone can involve:⁵

• Taking an opioid to get high.
• Taking someone else’s prescription.
• Taking the opioid in a dose other than prescribed.
• Taking the substance by a route other than prescribed (such as snorting or injecting).

As with many addictive substances, the dopamine reward associated with opioids such as hydrocodone can prompt people to use the substances again and again. Over time, functional changes in the brain may develop, which can additionally reinforce compulsive misuse. Ultimately, addiction (i.e., an opioid use disorder) can develop.¹⁰

Addiction treatment professionals and other clinicians may diagnose a hydrocodone addiction as an opioid use disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), criteria used to diagnose opioid use disorders include:¹¹

• Taking opioids for longer periods of time or in larger amounts than intended.
• Being unable to cut down or stop substance use.
• Spending a lot of time obtaining, using, and recovering from the effects of the substance.
• Experiencing cravings, or intense desires or urges for the substance.
• Failing to fulfill obligations at home, work, or school due to substance use.
• Continuing substance use despite having interpersonal or social problems that are caused or worsened by substance use.
• Giving up social, recreational, or occupational activities due to substance use.
• Using the substance in risky or dangerous situations.
• Continuing substance use despite having a physical or mental problem that is probably due to substance use.
• Developing tolerance or needing more of the substance to achieve previous effects.*
• Suffering from withdrawal, meaning that unpleasant symptoms occur when you stop using the substance of choice.*

*These criteria should not be considered met in those solely taking hydrocodone therapeutically under appropriate medical supervision.

Short-Term Side Effects and Long-Term Adverse Effects of Hydrocodone

While hydrocodone’s therapeutic effects involve pain relief and cough suppression, the drug has several potential short-term side effects including:¹²

• Sedation / Drowsiness.
• Dizziness / Lightheadedness.
• Nausea.
• Vomiting.
• Constipation.
• Skin itching.
• Respiratory depression.

Additionally, the National Institutes of Health indicate that hydrocodone use can lead to long-term adverse effects such as opioid withdrawal and addiction.¹

Unlike pure opioid medications (i.e., opioid monoproduct), hydrocodone and acetaminophen combinations are a potential cause of acute liver injury.¹ When too much is taken—as with too frequent dosing or other forms of misuse, overdose, etc.—acetaminophen can reach toxic levels in the body, ultimately leading to significant liver damage.¹³

Additionally, mixing hydrocodone with alcohol and other central nervous system (CNS) depressants can be particularly dangerous. Polysubstance use—the practice of using more than one substance (e.g., opioids and alcohol) within a short period of time—can lead to unpredictable effects that can be stronger than the effects of either drug alone.¹⁴

Both opioids and alcohol suppress respiratory activity. Combined, they can cause severe respiratory effects such as difficult or stopped breathing that can lead to death. Plus, mixing two CNS depressants can damage the brain, heart, and other organs.^15,16

Hydrocodone Overdose

A hydrocodone overdose is possible when a person takes enough of the drug to result in potentially fatal symptoms.⁵ Hydrocodone overdose symptoms include:¹²

• Drowsiness progressing to stupor or coma.
• Constricted pupils.
• Respiratory depression.
• Cold, clammy skin.
• Limp skeletal muscles.

In some cases, overdose can also include:¹²

• Pulmonary edema (i.e., fluid in the lungs).
• Slowed heart rate (i.e., bradycardia) and/or blood pressure (hypotension).
• Atypical snoring.
• Partial or complete airway obstruction.
• Death.

If you suspect someone is experiencing an overdose, the Centers for Disease Control and Prevention (CDC) provides the following guidance:¹⁴

• Call 911 immediately.
• Administer naloxone if available.
• Attempt to keep the individual awake and breathing.
• Position the individual on their side to prevent choking on vomit.
• Stay with the person until emergency responders arrive.

Hydrocodone Withdrawal

Withdrawal refers to a set of symptoms and signs that develop when a person discontinues or reduces use of a substance for which they’ve developed a physiological dependence.¹⁰

Most opioid withdrawal syndromes involve a similar range of withdrawal symptoms, and severity depends on the dose taken, the length of use, and the interval between doses.¹⁸ Common opioid withdrawal signs and symptoms include:¹⁸

Opioid withdrawal isn’t typically immediately life-threatening. However, it’s often severely unpleasant and can be associated with medical complications such as dehydration.¹⁸ To keep people as safe and as comfortable as possible during this challenging period of early recovery, medical withdrawal management (often including various medications) is the standard of care.

Treatment and Rehab for Hydrocodone Addiction and Other Opioid Use Disorders

Rehab for opioid use disorders such as hydrocodone addiction isn’t a one-size-fits-all solution. Rather, effective treatment is tailored to the unique needs of each individual. That said, common levels of care for hydrocodone addiction include:¹⁹

• Detox. At the start of treatment, detox helps to keep patients safe and as comfortable as possible during withdrawal. Medically supervised opioid detox can take place in both outpatient and inpatient settings.
• Inpatient treatment. Inpatient care involves 24/7 care and monitoring in a residential setting. Patients live within a rehab facility during the duration of this phase of treatment, which includes highly structured days filled with therapy, supervision, counseling, psychoeducation, and more.
• Outpatient treatment. Outpatient programs vary in intensity, including traditional outpatient rehab as well as partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), and telehealth services.
• Aftercare programs. To set patients up for success following inpatient or outpatient rehab, aftercare programs include sober living facilities, ongoing therapy, 12-Step programs, and more.

Providing all levels of care, American Addiction Centers is equipped to treat a host of substance use disorders including those involving opioids such as hydrocodone. Plus, AAC has facilities scattered across the country, each of which is filled with highly trained professionals who provide evidence-based treatment interventions.

If you or a loved one is struggling with an opioid use disorder, AAC is here to help—and to listen to your unique story. Take the first step by speaking with an admissions navigator at or by verifying your insurance benefits online. Available 24/7 for a free and confidential conversation, AAC staff can discuss payment options and treatment particulars and can help you begin your recovery today.