Hydrocodone Use and Abuse
Opiate analgesics are commonly prescribed for pain management in the United States. Although prescription painkillers such as oxycodone have been highly publicized, there are other opiates that are less recognized but used and abused. Hydrocodone is of particular interest to drug treatment programs, clinicians, and clinical and forensic toxicologists alike. Escalating deaths have been reported throughout the country.
Hydrocodone can be diverted for illicit use through “doctor shopping”, fraudulent prescriptions, malpractice of physicians and pharmacists, and theft. The Office of Diversion Control of the DEA has placed hydrocodone on its “Drugs and Chemicals of Concern” list. Hydrocodone has been associated with more reported emergency room visits than any other pharmaceutical opiate.
Hydrocodone is a semi-synthetic analgesic derived from codeine. Available in capsules, tablets and elixirs, it is marketed as Lortab, Vicodin, and over 200 generic brands. Hydrocodone is the most frequently prescribed opiate in the United States. Hydrocodone has an analgesic potency greater than that of oral morphine and an antitussive potency six times that of codeine. Similarly, hydrocodone is the most frequently encountered opiate pharmaceutical among drug evidence submitted to the DEA’s System to Retrieve Information for Drug Evidence.
Dangers of hydrocodone abuse include a high risk of addiction and tolerance which promotes increased use. There has been an increasing trend of abuse in non-Chronic Pain suffering people. First time abuse has been surging, most commonly with the oxycodone and hydrocodone type painkillers. The two differ slightly in their chemical makeup but have a similar effect on the body.
Every age group has been affected by the relative ease of hydrocodone availability and the perceived safety of these products by professionals. Sometimes seen as a “white-collar” addiction, hydrocodone abuse has increased among all ethnic and economic groups. DAWN data demographics suggest that the most likely hydrocodone abuser is a 20-40 yr. old, white, female, who uses the drug because she is dependent or trying to commit suicide. However, Hydrocodone-related deaths have been reported from every age grouping.
The effects of hydrocodone abuse are anxiety, constipation, decreased mental & physical performance, difficulty breathing, difficulty urinating, dizziness, drowsiness, dry throat, emotional dependence, exaggerated feeling of depression, extreme calm (sedation), exaggerated sense of well-being, fear, itching, mental clouding, mood changes, nausea & vomiting, rash, restlessness, sluggishness and tightness in chest.
Overdose of hydrocodone can be fatal. Symptoms of a hydrocodone overdose include:
- bluish tinge to skin
- cold clammy skin
- extreme sleepiness
- heavy perspiration
- limp muscles
- nausea & vomiting
- slowed heartbeat or slowed breathing
Hydrocodone when abused is taken orally, chewed, crushed (then snorted like cocaine), or crushed (then dissolved in water and injected like heroin). The pills have been sold for $2 to $10 per tablet and $20 to $40 per 8 oz bottle on the street.
Laboratory urinalysis testing for hydrocodone can be accomplished by Thin Layer Chromatography (TLC) technique. Enzyme Immunoassay (EIA) technique can screen the presence of hydrocodone as an Opiate Class Positive. Gas Chromatography Mass Spectrometry (GC/MS) is the most common confirmation technique.
Hydrocodone is metabolized to hydrocodone and hydromorphone. The plasma half-life is approximately 4 hours. A 72 hour urine collection following a single dose resulted in 26% elimination with the following urinary profile:
- Hydrocodone 12%
- Hydromorphone 4%
- Other Metabolites 8%
