Opioid Information Series – HYDROCODONE

April 25, 2014 • Prescription Drugs • Views: 5659

It has been said that the “pen is mightier than the sword.”  Given the number of pens feverishly writing out hydrocodone prescriptions in our nation, I would say I have to agree.  The volume is staggering.  The U.S. consumes more hydrocodone than all other nations combined.  Some reports suggest we (Americans) use 99% of the hydrocodone produced globally.  Now, there may be many reasons that account for this, but this shocking statistic is hard to overlook.  It is also hard to overlook the thousands of deaths (granted, most are due to intentional misuse) that accompany the use of this drug.


Pharmacists and pharmacies are sometimes targeted as being complicit in this problem.  We fill the prescription.  The patient misuses the drug, or sells the drug, and someone dies.  This article is not  intended to defend pharmacies or accuse prescribers or blame patients.  I have come to the point in my career where I have seen such efforts are fruitless.  This article, and what I hope to be a short series of articles, is simply intended to INFORM.  Maybe the pen IS mightier than the sword.  But maybe, just maybe, the BLOG might be mightier than the pen.

I make no apologies about the fact that I write THIS article with the specific intent to CURB the over-utilization of hydrocodone products.  I am NOT anti-narcotic and I hate pain as much as the next guy.   But things have simply gotten out of control folks.  I’m doing what I can, and that’s all I can do.  You may fault me for my method, or my content.  You may not fault my motive.  I want to save lives.


What it is?  Hydrocodone is a prescription narcotic analgesic typically prescribed in combination with acetaminophen (sometimes ibuprofen).  Think of it as a cousin to codeine.  The most commonly prescribed combination has 5mg of hydrocodone and 325mg of acetaminophen per tablet, but other strengths  and combinations exist.  Common brand-names include Vicodin and Norco, though it is almost always dispensed generically.  The label on your bottle probably will say something like “hydroco/apap” or “hydrocodone/acetamin” followed by the strengths. 

How does it work?  Hydrocodone works by dulling the response to and transmission of pain by interacting with pain-receptors in the brain.  The pain is in your head…literally.  That is where hydrocodone [primarily] works..  That is why it works so well.  That is also why it can be very dangerous. 

Risks:  Hydrocodone can cause nausea, vomiting and upset stomach.  It may also cause constipation.  Drowsiness and dizziness are frequently experienced.  Allergic reactions, though rare, would include hives, rash and difficulty breathing.  Stop the medicine immediately if this [allergy] occurs. 

Addiction:  Hydrocodone in combination with acetaminophen is classified as a “Schedule III” controlled substance.  It has significant potential for addiction and abuse.  Some patients are more likely to become addicted, especially if they have a history of addiction-related problems (including alcohol or illicit drugs).  Addicted patients may seek to use multiple doctors and pharmacies to hide and satisfy their addiction.  They don’t have the word “addict” tattooed on their forehead.  They probably look an awful lot like you and I.  Many do not WANT to be addicted, they wish they could stop. 

Safety:  Hydrocodone is safe when used conservatively.  Hydrocodone is DANGEROUS when used in doses greater than recommended or in combination with other analgesic products or alcohol.  NEVER consume ANY alcohol when you have taken hydrocodone.  NEVER take more than prescribed and if possible use LESS than that.  NEVER take additional medications that contain acetaminophen while taking a hydrocodone/acetaminophen product. 

Disposal:  When you no longer need your hydrocodone product, DISPOSE of it appropriately.  Contact your town board of health and ask them for an appropriate site to drop off unused prescription drugs.  Alternatively, add a little water to the remaining pills in your bottle and toss the dissolved remains into used coffee grounds or kitty litter and throw it out in the trash.

Chronic Use:  If you MUST use a hydrocodone product long-term (more than a month) then you NEED to be vigilant in using the LOWEST effective dose.  Never take more than prescribed, and try to use LESS.  Talk to your doctor about non-narcotic options and use hydrocodone only for really severe breakthrough pain – NOT around-the-clock daily doses.  With your doctor’s permission, try to wean yourself off if possible.  ALWAYS keep your hydrocodone product safely secured.  If there are children in the house, it should be locked up.  Ask your pharmacist about lock-boxes.   

Discontinuation:  When it is time to stop using hydrocodone, talk with your doctor about your plan to taper off this medication, particularly if you have been on it for a while.  Small steps work!  You don’t need to do it in 1 week.  Even gradually reducing your dose by 1/2 tablet daily, every week, will eventually get you off.

This post isn’t EVERYTHING you need to know about hydrocodone.  I’m telling you, as a pharmacist, what I think is most important information for your safety.  I’m sharing this because it is, at this point, all I can do.  Will the blog be mightier than the pen?  Only time will tell. 

©Jason Poquette and The Honest Apothecary.  Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Jason Poquette and The Honest Apothecary with appropriate and specific links to the original content. 

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Author: Jason Poquette

7 Responses to Opioid Information Series – HYDROCODONE

  1. Pharmaciststeve says:

    Yes the US uses 99% of hydrocodone produced.. that is because the rest of the world uses dihydrocodeine for pain management.
    The pen may be mightier that the sword.. if those swinging the sword – IMO – have an agenda that they want to continue to swing the sword and are doing – or not doing – things so that they can remain doing so. Something about job security. According to a recent webinar I watched.. a former DEA attorney stated that pharmacies are targeted because the DEA can leverage their assets and they get more bang for their buck.. fining a large chain than shutting down John Smith’s medical practice. The former gets national news.. the latter only gets local news coverage.
    You are correct that a pt should never take more than prescribed, but those pts whose dose does not keep them below 5 (on a 10 scale) needs to talk to their prescriber about better managing their pain. Actually, Hydrocodone should not be used as the base drug for chronic pain.. only for break-thru pain. Most break-thru pain is activity induced and chronic pain pts generally knows what activity is going to increase their pain.. and in reality should dose their pain meds in anticipation of the elevated pain.. just like we recommend to those with allergies that they take their medication at the first signs of a allergy “kicking up”..
    What is normally down played or not mentioned at all is that opiates are POTENTIALLY ADDICTING. If they were flat out ADDICTING..given all the people who have been prescribed a opiate at one time or another.. probably the vast majority of our population would be abusing opiates or some other substance.. instead of a couple of per-cent that is reality

  2. jasonpoquette says:

    Thanks for the comments Steve. The politics of pain therapy is a tragic – and long – chapter in the U.S. health care story.

  3. johnny says:

    Why not put some Naloxone in every pain pill. Just enough to possibly reduce addictive qualities, is this possible?

  4. johnny says:

    Or better, would this work, similar to Bupronephrine just not to the extent the antagonist is used with the agonist.?

  5. johnny says:

    I also have a question, which I deal with daily- which are Doctor Shoppers. Is there not a computer system that stops these folks from getting 2 and 3, even more prescriptions for scheduled narcotics and amphetamines ? Is there or is there not a system that could stop this? I am in Calfornia. Thanks for this site, its very informative.

  6. jasonpoquette says:

    Hi Johnny, thanks for your questions. The naloxone thing was tried a while back with a drug called Embeda. Never really took off. As for doctor shopping, there are state PMP (prescription monitoring programs). They aren’t perfect – and of course they only work if the prescriber and pharmacist actually check it. Sadly, there are doctors (and pharmacists) who operate pill-mills and will just fill narcotics for anyone.

  7. Tye Lawson says:

    Hydrocodone bitatrate is prescribed more in the US than any other country. However, they do not tell us that in say Australia morphine has been prescibed in place of our formula here. Luckily, they reformulated hydroAPAP to a minimum of 325mg of the acetaminophen. We do use this, however, a far greater mortality and morbidity is emdemic in many other Rx’s in my way of thinking.

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