norco painkillerNorco (hydrocodone and acetaminophen) is composed of a narcotic pain reliever (hydrocodone) that is classified as a full opioid agonist. This means it is similar to morphine, heroin, oxycodone, and other opioid drugs.  It also contains acetaminophen, the main active ingredient in Tylenol and many other nonprescription painkillers.  Norco is primarily prescribed as a painkiller for people with serious chronic pain or post-operative pain.

Norco acts in the same way that other narcotic medications act, by attaching to certain receptors in the brain and stimulating the neurons in the brain to increase the amount of stimulation required for a person to feel pain (often referred to as the pain threshold).  This results in marked reduction of a person’s perception of the experience of pain. Thus, Norco acts as a central nervous system depressant as well.

Norco vs. Vicodin 

Both Norco and Vicodin are prescription narcotic medications – opioid analgesics that are prescribed for pain relief. Both of the drugs contain acetaminophen and hydrocodone bitartrate, and they are classified by the United States Drug Enforcement Administration as Schedule II drugs. Drugs in this class have a moderate potential for abuse and addiction and require a prescription to be legally obtained.

The major difference between Vicodin and Norco relates to the ratio of hydrocodone to acetaminophen in the drug.

Because acetaminophen is potentially toxic at higher doses and can cause liver failure, physicians like to have an option in its distribution when prescribing pain-relieving drugs for chronic pain. Norco has a higher rate of hydrocodone to acetaminophen than does Vicodin. Typically, the ratios are:

  • Norco: The acetaminophen dosage is consistently at 325 mg, but the hydrocodone can be 5 mg, 7.5 mg, or 10 mg.
  • Vicodin will typically have different options:
    • Vicodin is 500 mg acetaminophen with 5 mg hydrocodone.
    • Vicodin ES consists of 750 mg acetaminophen with 7.5 mg hydrocodone.
    • Vicodin HP is listed as 660 mg acetaminophen with 10 mg hydrocodone.

This gives physicians different options to treat pain, as they can prescribe different combinations of medication.

Effects of Norco

As an opioid or narcotic medication, the primary therapeutic effect of Norco is pain relief. As hydrocodone is a synthetic analgesic that is developed from codeine, it exhibits the same properties as many other opioids or opioid derivatives express. One of the effects of these drugs is that they produce feelings of mild euphoria and wellbeing at lower doses. Of course, these feelings increase as one takes more of the drug, to the point of heavy sedation. Therefore, these drugs have the potential for abuse. Moreover, they often produce physical dependence, which increases their abuse potential.

The typical effects of taking Norco can include:

  • Feelings of euphoria and wellbeing
  • Lightheadedness
  • Dizziness
  • Drowsiness or lethargy
  • Constipation
  • Nausea and/or vomiting
  • Mild to moderate issues with cognition such as attentional issues, memory problems, etc.

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For most individuals, the undesirable side effects, such as constipation or nausea, typically subside after the person has taken the drug for a few weeks. The individual will often develop tolerance to the effects of the drug and may need more of the drug over time to produce the initial pain-relieving effects.

Moreover, higher doses could potentially result in an exacerbation of the above symptoms or more serious symptoms/side effects. Some of these include:

  • Decreased reaction times
  • Sedation
  • Balance problems
  • Decreased cognition (confusion, poor decision-making ability, and difficulty forming new memories)
  • Autonomic nervous system effects that include but are not limited to suppression of breathing, decreased heart rate, and decreased blood pressure
  • Lethargy or even unconsciousness
  • Physical dependence if taken for extended periods (tolerance and withdrawal syndrome when discontinued)
  • Potential for abuse and addiction
  • Potential for liver damage
  • Hallucinations
  • Issues with mood, such as anxiety, panic attacks, or depressive symptoms

Signs of overdose may include:

  • Extreme lethargy
  • Confusion
  • Hallucinations or delusions
  • Anxiety
  • Unconsciousness/coma
  • Profuse sweating
  • Cold or clammy skin
  • Yellowish skin or yellowish tint to the whites of the eyes
  • Diarrhea
  • Respiratory suppression
  • Decreased heart rate
  • Decreased blood pressure
  • Cardiac arrest

If someone is suspected of overdosing on Norco, immediate medical attention is needed. Treatment with drugs, such as naloxone, can counteract the effects of opioid overdose; however, the drug needs to be administered as soon as possible.

Abuse of Norco 

man norco abuse riskThe abuse of prescription opiate drugs has risen steadily in the United States. The largest proportion of individuals at risk for abusing prescription medications like Norco are those between the ages of 18 to 25 (although all age groups are at risk) who live in the western part of the United States.

Typically, individuals at risk have a prescription for the medication, know someone who has a prescription, or can obtain the drug illegally. Prescription opioid medications are often abused in conjunction with other drugs, such as alcohol. When this poly-abuse occurs, the effects of both substances are enhanced, leading to potentially dangerous interactions.

The death rate from overdosing on prescription opioid drugs has risen, according to the National Institute of Drug Abuse. There is a relationship between prescription opioid abuse, such as Norco, and the use of heroin in the United States, as individuals often progress to heroin use when they can no longer get the prescription painkillers they abuse.

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Treatment for Norco Abuse or Addiction

Because Norco is an opioid medication, it can produce physical dependence in individuals. If people are abusing or addicted to Norco, they will need a multidisciplinary approach to recovery. The first part of this approach includes dealing with the withdrawal process. Because of the physical dependence, when people begin to cut down on use of an opioid medication or cease using the medication, they will experience a withdrawal syndrome that includes the following phases:

Phase 1: The first 1-2 days are typically the most challenging for individuals with physical dependence. Many will experience:

  • Intense cravings
  • Mental confusion
  • Agitation irritability
  • Heavy perspiration
  • Nausea and diarrhea
  • Anxiety
  • Fever and chills
  • Insomnia
  • Loss of appetite
  • Flulike symptoms
  • Diarrhea and vomiting

Phase 2: Typically, this phase occurs from days 3-5 and includes diminished symptoms, such as:

  • Muscle pain and cramps
  • Abdominal pain and perhaps vomiting
  • Chills
  • Continued feelings of being ill and jittery
Phase 3: This phase can last for some time and may include:

  • Nausea
  • Mood changes, such as anxiety and depression
  • Cravings that may be triggered by memories of drug use, stress, or environmental cues, such as being with friends or in places where one used to use the drug

The third phase of withdrawal may last for quite some time (weeks, months, or for some even longer), and it is often referred to as post-acute withdrawal syndrome (PAWS) if it extends beyond a few weeks.

Medical detox is required for withdrawal from Norco, as it is with all opiates. During the acute phase of recovery, it is extremely important to have a physician assist the individual in negotiating the withdrawal phase from Norco. Physicians will typically administer drugs like Suboxone to counter the physical effects of withdrawal and will slowly decrease the dose of this medication until the individual can function without any medication at all. Other medications, such as antidepressants, may also be included to counteract specific withdrawal symptoms. The use of any medication is determined on an individual basis. Individuals who attempt to withdrawal on their own have a higher probability of relapse.

The second component to treatment is for the individual to engage in some form of therapy to address the psychological issues that are associated with their addictive behavior. This can consist of individual therapy with a counselor or therapist, group therapy with a counselor or therapist, and/or participation in support groups such as 12-Step groups like Narcotics Anonymous. The particular type of therapy that one engages in is often decided by one’s preferences and one’s financial situation.

In counseling or therapy, the individual should:

  • Address expectations and belief systems that are related to abuse or addiction.
  • Identify more functional expectations that are consistent with a drug-free lifestyle.
  • Identify the signs of relapse and develop coping strategies and a plan to avoid relapse.
  • Develop long-term strategies for recovery.
  • Develop a support system (may take the form of long-term participation in a 12-Step program or family participation in therapy)

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Most often, formal therapeutic interventions are based on the principles of Cognitive Behavioral Therapy (CBT) or borrow from them. CBT is a family of therapies as opposed to one type of therapy that offer many different options for the individual. These options can be tailored to each specific individual to ensure the best therapeutic approach to recovery.