Vicodin is a combination medication containing the powerful opiate hydrocodone and the over-the-counter analgesic acetaminophen. It is a prescription medication used to treat moderate to severe pain.
The Drug Enforcement Administration (DEA) classifies Vicodin as a Schedule II controlled substance, which means that it is a target for misuse with a high potential for criminal diversion, abuse, and addiction. On labeling information for Vicodin, the U.S. Food and Drug Administration (FDA) warns that the medication needs to be taken exactly as prescribed and under direct supervision from a medical professional.
It should also not be stopped suddenly when someone has been taking it regularly for a length of time. This is due to the fact that Vicodin can cause physical dependence even when the drug is being taken for a medical reason and with a legitimate prescription. In 2016, the FDA added a black-box warning (the strongest of its kind) to Vicodin and similar immediate-release opioid medications, indicating the high risk for abuse, overdose, and death from these drugs, Business Insider publishes.
Opioids bind to opioid receptors in the brain, helping to block pain sensations and also flooding the brain with the neurotransmitter dopamine. The central nervous system is depressed, meaning that blood pressure, heart rate, body temperature, and respiration rates are all lowered. Elevated dopamine levels cause a person to feel pleasant, relaxed, and mellow. Taken in larger amounts, Vicodin can cause a euphoric high.
With regular interaction of Vicodin in the brain, the system can get accustomed to its interference with its chemical makeup. The brain can begin to struggle to keep levels of its chemical messengers, like dopamine, regulated without Vicodin. When Vicodin then wears off and is not active in the bloodstream, levels of dopamine dip, creating withdrawal symptoms.
Physical dependence is a side effect of taking Vicodin regularly, even if taken as directed, and is not the same thing as addiction. Individuals battling addiction also commonly suffer from physical dependence as well; however, addiction is a chronic brain disease that impacts willpower and motivation, and stems from an inability to control drug use.
What to Expect During Vicodin Withdrawal
Vicodin contains hydrocodone, which is considered to be a fairly fast-acting opioid. With a half-life of around three hours, Vicodin usually stops being active in the body within six hours or so after taking it. This means that a person will need to take another dose in order to keep feeling the drug’s effects.
The National Library of Medicine (NLM) publishes that opiate withdrawal symptoms typically begin within 12 hours after the last dose of an opioid drug. Early symptoms include:
- Runny nose
- Watery eyes
- Muscle aches
About a day or two after the last dose, Vicodin withdrawal symptoms can progress and include:
- Stomach cramps and pain
- Joint and backaches
- Dilated pupils
- Irregular heart rate
- Loss of appetite and anorexia
- Trouble concentrating and thinking clearly
Vicodin withdrawal symptoms usually peak within the first 2–3 days and start to taper off after about 7–10 days. Symptoms like anxiety, depression, cognitive issues, insomnia, and drug cravings can last a few weeks to months, although professional care and management can help to manage them.
Withdrawal from Vicodin varies from person to person based on how significant dependence on the drug is. Drug dependence is influenced by how long a person has been taking Vicodin, how much they took with each dose, and the method by which they took it. Crushing and injecting the medication, chewing it, or crushing and then snorting or smoking the resulting powder sends it more rapidly into the bloodstream, which can increase drug dependence faster than ingesting the tablets. Genetics, including a familial history of drug dependence and addiction; biological factors like metabolism; the presence of any co-occurring mental health or medical disorders; and environmental aspects, including support systems and levels of stress at home, can all impact the duration and severity of Vicodin withdrawal.
How to Best Manage During the Process
Vicodin is not a drug that should be stopped “cold turkey,” or suddenly, especially not without proper professional help. Vicodin often needs to be tapered off slowly. The dose is lowered through a set schedule over an indicated period of time and in a controlled manner. In this way, the drug can be carefully weaned out of the body, which allows the brain and central nervous system to reset gradually.
Even though the side effects of Vicodin withdrawal are not usually considered life-threatening in and of themselves, they can be extremely uncomfortable, and drug cravings can be intense. Overdose is a serious concern during opioid detox as a person may go back to taking Vicodin at levels they used to in an attempt to minimize the withdrawal symptoms; however, the body may have already begun to regulate and will no longer be accustomed to the same amount of the drug. As a result the prior dose can overwhelm the system rapidly. The Centers for Disease Control and Prevention (CDC) calls opioid overdose an epidemic in the United States, as more than 350,000 Americans have died from an opioid overdose between 1999 and 2016.
Due to the potential intensity of the emotional and physical withdrawal symptoms, at-home or rapid detox methods are not recommended for Vicodin. Rapid detox is generally a hospital or inpatient procedure that was introduced to try and speed up detox. It usually involves general anesthesia and forces the body to process opioids out all at once. The CDC warns that it is a dangerous and potentially life-threatening method for detox.
Instead, medical detox is usually considered to be the optimal form of detox for managing Vicodin withdrawal symptoms. A medical detox program can include around-the-clock monitoring and supervision to ensure a person’s safety and security. It also provides a calm and safe environment for the bulk of withdrawal.
Withdrawal symptoms can be managed with medications during medical detox as well. Vicodin, as a rapid-acting opioid, is often replaced with a longer-acting opioid drug, such as buprenorphine or methadone, during medical detox. These opioids can be administered in lower doses less often to keep withdrawal symptoms manageable by maintaining a low level of opioid in the system. They can then be weaned off slowly to keep withdrawal symptoms from being as intense as they can be when Vicodin is stopped suddenly. Other medications can be helpful during medical detox as well, particularly ones that target specific symptoms of withdrawal, such as depression, stomach upset, or insomnia.
Trained professionals provide medical and emotional support and care during medical detox. Medical detox helps a person to reach a stable physical point, so they can enter directly into an addiction treatment program. On its own, medical detox does not constitute addiction treatment; additional therapy is needed.