Norco (hydrocodone and acetaminophen) is composed of a 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 for people with moderate to severe pain.1,2
Like other opioid painkillers, the hydrocodone in Norco activates certain opioid receptors throughout the brain and, in doing so, alters the perception of pain signaling.1,2
It can be abused, and abuse can lead to an addiction, which requires professional treatment.
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Norco vs. Vicodin
Both Norco and Vicodin are prescription opioid medications 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 high potential for abuse and harm.3
The major difference between Vicodin and Norco relates to the ratio of hydrocodone to acetaminophen in the drug.
Typically, the ratios are:
- Norco: The acetaminophen dose is consistently at 325mg, but the hydrocodone can be 5mg, 7.5mg, or 10mg.1
- Vicodin will typically have different options:4
- Vicodin is 300mg acetaminophen with 5mg hydrocodone.
- Vicodin ES consists of 300mg acetaminophen with 7.5mg hydrocodone.
- Vicodin HP is listed as 300mg acetaminophen with 10mg hydrocodone.
These ratios give physicians different options to treat pain, as they can prescribe different combinations of medication.
Norco Side Effects
As an opioid medication, the primary therapeutic effect of Norco is pain relief. It can also produce feelings of euphoria and wellbeing. Therefore, it has the potential for abuse.5
Moreover, users often develop tolerance and physical dependence. Tolerance is the need to take more of the drug to achieve the desired effect, while dependence is when the person’s body becomes reliant on the drug to function normally. People with dependence will experience withdrawal symptoms when they stop using Norco or reduce the dose.1
The typical effects of taking Norco can include:1
- Drowsiness or lethargy.
- Clouded thinking.
- Nausea and vomiting.
- Trouble urinating.
- Skin rash.
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.1 However, the drug needs to be administered as soon as possible.
Signs of Norco overdose may include:1
- Slowed breathing.
- Extreme lethargy.
- Slow heart rate.
- Constricted pupils.
- Cold or clammy skin.
- Low blood pressure.
- Airway obstruction.
- Unusual snoring.
Abuse of Norco
The abuse of prescription opioid drugs is a major problem in the United States. In 2016, an estimated 239,000 adolescents aged 12 to 17, 631,000 people aged 18 to 25, and 2.5 million adults aged 26 or older abused pain relievers.6
Typically, people at risk for Norco abuse have a prescription for the medication, know someone who has a prescription, or can obtain the drug illegally. People who develop an addiction to the drug may make emergency calls or visits near the end of office hours, repeatedly lose their prescriptions, tamper with prescriptions, and refuse to provide prior medical records or contact information for healthcare provider(s). They may also “doctor shop” or visit multiple prescribers to obtain additional prescriptions.1
Prescription opioids also have a high risk of overdose. In fact, the death rate from overdosing on prescription painkillers has steadily risen since 1999, according to the National Institute of Drug Abuse. The number of drug overdose deaths from prescription opioids went from 3,442 in 1999 to 17,087 in 2016.7
In addition, there is a relationship between prescription opioid abuse, such as Norco, and the use of heroin in the United States, as people often progress to heroin use when they can no longer get the prescription painkillers they abuse. In many parts of the country, heroin is cheaper and easier to acquire than prescription opioids. However, the risk of overdose on heroin is higher because of the varying purity of the drug and the likelihood of it being mixed with other drugs such as fentanyl.5
Norco Withdrawal Symptoms
Because Norco is an opioid medication, it can produce physical dependence in individuals. When people who are dependent 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 symptoms:1
- Runny nose
- Increased blood pressure and heart rate
- Nausea and vomiting
These symptoms begin within 6-12 hours after the last dose. They will peak within 1-3 days and then begin to fade over a period of 5-7 days. Some people may continue to experience low-level withdrawal symptoms, such as anxiety, uneasiness, and insomnia for weeks or months. These are often called post-acute withdrawal symptoms.8
Treatment for Norco Abuse or Addiction
People who want to stop using Norco should work with their physician or seek medical detox in a drug rehabilitation program. People who attempt to withdrawal on their own have a higher risk of relapse due to the urge to end the discomfort of withdrawal by using again.
Physicians may use opioid replacement medications such as methadone or buprenorphine to counter the effects of withdrawal and make the process more comfortable.9 They may slowly decrease the dose of this medication until the person has completed withdrawal. However, some people may remain on these medications long term.
Other medications, such as antidepressants or over-the-counter medications such as Benadryl, may also be included to counteract specific withdrawal symptoms.9The use of any medication is determined on an individual basis.
After detox, people recovering from Norco addiction should engage in some form of therapy to address the psychological issues associated with their addiction. 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 or Pills Anonymous. Therapy can take place in an inpatient or outpatient setting.
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).
Do you need help with Norco abuse? Do you know someone who is abusing Norco or other drugs? If so, seek treatment as soon as possible. Norco users are at risk of overdose and other consequences of addiction that can impact their personal life, health, and finances. You don’t need to wait to hit “rock bottom” to reach out for help.
- U.S. National Library of Medicine, DailyMed. (2018). NORCO- hydrocodone bitartrate and acetaminophen tablet.
- Drug Enforcement Administration. (2018). Hydrocodone.
- Drug Enforcement Administration. (2014). DEA To Publish Final Rule Rescheduling Hydrocodone Combination Products.
- U.S. National Library of Medicine, DailyMed. (2018). VICODIN .
- National Institute on Drug Abuse. (2014). America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.
- Substance Abuse and Mental Health Services Administration. (2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health.
- National Institute on Drug Abuse. (2018). Overdose Death Rates.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.