Hydrocodone serves as a lifeline for individuals suffering from severe pain who require round-the-clock relief. The name “hydrocodone” may suggest a connection to codeine due to the suffix “-codone,” but these substances are, in fact, distinct painkillers with similar applications. However, codeine may not provide sufficient relief for those experiencing severe pain.

Prescribed hydrocodone may include other substances, but it does not contain codeine.

What is Hydrocodone?

Hydrocodone is a semisynthetic prescription opioid analgesic.[1] This means that although it is derived from opium, it is partially man-made. Individuals who are unresponsive to other methods of pain relief for moderate to severe pain may need a stronger medication like hydrocodone for relief.

They may be administered single-ingredient hydrocodone by a physician or prescribed an adulterated version that contains acetaminophen or ibuprofen.[2] Common hydrocodone combinations include Vicodin and Norco.[2]

Dosage 

Proper use of hydrocodone is crucial for effective pain management. This medication is available as an extended-release capsule or tablet, designed for around-the-clock pain relief. A typical dosing schedule involves taking one pill by mouth with water every 12 hours.[1] It is important to take the medication at the same time each day to maintain a consistent level of the active ingredient in your system and prevent a resurgence of pain or the risk of hydrocodone toxicity.

However, it should be noted that single-entity hydrocodone is only available in an emergency room setting in tablet or capsule form.[1] Here, a typical initiated dose of 10 mg is given every 12 hours.[3] Patients over the age of 65 may receive a slower titrated dose.

Hydrocodone combination products vary in dosage from 2.5 to 10 mg and are to be taken every 4 to 6 hours as required.[4]

Off-label Uses 

Hydrocodone, in addition to its primary use as a pain reliever, has been utilized as a cough suppressant.[5] However, this treatment is not typical and should be discussed with a healthcare professional.

Does Hydrocodone Contain Codeine?

Hydrocodone does not contain codeine as an ingredient.[6] However, both medicines belong to a class of drugs called narcotic analgesics. While “codone” may seem to indicate the inclusion of codeine, they are not the same.

What is Codeine?

Codeine is an opioid painkiller used to treat moderate to severe pain.[7] It can be used as a standalone pain reliever or with other medications to reduce coughing. According to the Food and Drug Administration, codeine is available as a single ingredient product or in combination with acetaminophen or aspirin.[8]

Hydrocodone vs Codeine: A Comparative Analysis

Hydrocodone and codeine, while sharing some similarities, have distinct differences. Understanding these differences is crucial for making informed decisions about pain management.

Potency 

When it comes to potency, hydrocodone seems to be more effective than codeine for moderate to severe pain. According to the Dental Clinics of North America, hydrocodone is approximately six times more potent than codeine on a weight-for-weight basis.[9] It is also nearly equivalent to the pain reliever morphine, as stated by the Drug Enforcement Administration, Diversion Control Division.[10]

Origin

Codeine is derived directly from the opium poppy plant, while hydrocodone is synthesized from codeine in a lab setting.

Drug Schedule

Codeine and hydrocodone are both controlled substances due to their potential for abuse and addiction. However, they fall under different schedules.

• Hydrocodone is a Schedule II Controlled Substance.[12]
• Codeine’s schedule varies, depending on its combination. It is listed as a Schedule III Controlled Substance when combined with acetaminophen and a Schedule V Controlled Substance when found in cough syrup.[12]

Formulations

Hydrocodone is available by prescription as a combination product, usually containing acetaminophen, and is prescribed as a capsule or tablet.[6] Codeine is available as a liquid solution or tablet; it may contain acetaminophen.[7]

Side-Effects

Codeine is more likely to cause serious side effects, such as shortness of breath.[13] However, hydrocodone has a higher potency, which greatly increases the risk of developing serious side effects as well as a higher risk of misuse and abuse.[14] Common side effects of hydrocodone include drowsiness, nausea, and constipation.

Is Hydrocodone Addictive?

Once ingested, hydrocodone binds to opioid receptors in the brain, blocking pain signals while simultaneously releasing the feel-good hormone dopamine.[15] This contributes to a rush of euphoria, which can be a welcome prospect for individuals experiencing moderate to severe pain.

With continued use, hydrocodone can lead to tolerance, meaning individuals will need higher doses to achieve the original effects.[16] Unfortunately, tolerance can lead to physical dependence, meaning the body relies on hydrocodone for normal functioning.[17] Once tolerance develops, it isn’t uncommon for people to take larger doses than prescribed.

When a person stops using hydrocodone at this point, they may experience several unpleasant withdrawal symptoms due to physical dependence.[18] To avoid them, physicians often taper their patients’ doses.[19] The risk of hydrocodone dependence increases with prolonged use or misuse.[20]

Other ways that people can become addicted to hydrocodone include:[21]

• Taking it in a way other than prescribed, such as crushing it or snorting it
• Mixing hydrocodone with other addictive substances

Why do People Take Hydrocodone Instead of Codeine?

Healthcare professionals play a crucial role in determining whether a patient should be prescribed hydrocodone or codeine. They may prefer to administer hydrocodone for patients experiencing severe pain, but may opt for codeine in individuals who have or have had a substance use disorder or addiction. This guidance helps ensure the most appropriate and safe treatment for each individual.

What Are the Risks of Abusing Hydrocodone or Codeine?

Both codeine and hydrocodone carry the risk for abuse and misuse due to the way they interact with opioid receptors in the brain. It is important to use both medications as prescribed and only as needed. Using either for longer than prescribed or at a dose higher than prescribed can lead to dependency, addiction, and life-threatening complications.

Since combination formulations of hydrocodone and codeine contain acetaminophen, taking a toxic amount can result in liver damage and even death.[22]

Other potential risks of abusing hydrocodone or codeine include:[22]

• Respiration depression
• Coma
• Memory loss
• Death

Signs of Hydrocodone Addiction

If you answer yes to two or more of the following questions, you may have an addiction to hydrocodone:[23]

• Do you take more hydrocodone than you’re meant to?
• Have you tried cutting down or quitting hydrocodone without success?
• Do you spend a considerable amount of time using, acquiring, or recovering from hydrocodone use?
• Do you crave hydrocodone or have urges to use it?
• Do you have difficulty completing work chores at home or schoolwork due to hydrocodone use?
• Have you avoided social or recreational activities due to hydrocodone use?
• Do you continue to use hydrocodone despite having negative effects?
• Do you need more hydrocodone than usual to fill its original effects?
• Have you experienced withdrawal symptoms when trying to stop using hydrocodone?

According to the Diagnostic and Statistical Manual, these criteria point to a substance use disorder.[24] If a substance use disorder goes untreated, it worsens, leading to full-blown addiction.

Getting Help for Opiate Addiction

A person with hydrocodone addiction may no longer want to use the medication but struggles to quit. They may quit and relapse repeatedly and require professional help to wean themselves off the drug.

Current treatment options for hydrocodone addiction include:

• Medication-assisted detox
• Cognitive behavioral therapy, or talk therapy
• Group therapy

There are also a number of adjunct treatments, such as nature therapy and art therapy, which enhance the benefits of the above-listed evidence-based services. These services are offered on an inpatient or outpatient basis and can involve residing at a facility.

If you or someone you know has a hydrocodone addiction, work with your doctor to taper your doses. This can help you avoid some of the more serious withdrawal symptoms that cause people to relapse. However, if you’ve already tried this unsuccessfully, contact Engage Wellness MO to find out how we can help you achieve lasting sobriety.

Frequently Asked Questions