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Hydrocodone is a semi-synthetic opiate derived from codeine. Codeine is a naturally occurring substance in the poppy plant. Hydrocodone is a narcotic analgesic that is taken orally for the relief of moderate to severe pain. The drug can also commonly be taken in liquid form as a cough suppressant, which is its most common use in Canada. Like all other opiates, it is derived from the poppy plant, but the drug is considered semi-synthetic because it does not occur naturally. Hydrocodone is manufactured by chemically modifying the codeine molecule.

Hydrocodone is prescribed under some brand names like Vicodin, Lortab, Zohydro, and Norco. The drug is prescribed as a temporary solution to treat pain after serious injuries and minor surgeries or as a cough suppressant. Hydrocodone is also combined with acetaminophen and is called Tylenol 3. Unfortunately, hydrocodone has a high potential for abuse like any other opiate. The body and mind can develop a dependence and tolerance to the drug. The usual dose of hydrocodone is one to two tablets taken every four to six hours, yet prescriptions depend on the severity of pain.

Hydrocodone-based drugs are marketed under different brand names. According to Health Canada, hydrocodone is an opioid prescription drug used to treat exhausting dry cough. The drug has been marketed in Canada since the late 1950s. Some of the brands of hydrocodone found in Canada include Dalmacol, Hycodan, and Tussionex. Anyone in Canada who is using illegal hydrocodone recreationally is at risk of using counterfeit pills. Illegal hydrocodone is often tainted with substances like fentanyl or amphetamines to make it stronger.

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How does hydrocodone affect the mind and body?

The main effect of hydrocodone is pain relief, but like any other opiate, it causes the user to enter a state of euphoria with enhanced feelings of well-being. The euphoric effects are what make the drug appealing to addicts. How the drug affects the mind and body varies on how the drug is used, whether it is abused or taken as prescribed. However, the negative health effects increase as someone becomes addicted to it and or uses it longer than needed.

Some of the common side effects of hydrocodone are dizziness, drowsiness, light-headedness, nausea, constipation, vomiting, euphoria, mood swings, anxiety, and lethargy. Hydrocodone affects the brain by causing a lowered responsiveness, respiratory depression, mental depression, difficulty thinking, mental clouding, and slows down brain activity. Moreover, hydrocodone can affect the personality by causing low-self confidence and social isolation. It can also affect behaviour by causing anger, paranoid behaviour, and unusual thoughts.

Some of the psychological effects are, of course, addiction, cravings, compulsion, decreased awareness or responsiveness, and vivid dreams. Hydrocodone modifies pain signalling in the central nervous system through interaction with the body's numerous opioid receptors. The drug does not decrease the source of pain in the body but rather changes the user's perception of the pain. Most hydrocodone is prescribed for three to six months, and anything longer than that is considered long-term use, according to most medical professionals.

The effects on the body can be quite severe and cause a sudden drop in blood pressure, blood clotting, low blood pressure, high blood pressure, irregular heartbeat, kidney problems, acute liver failure, liver disease, and muscle weakness. Hydrocodone addiction can occur quickly, and it becomes a dangerous addiction without proper substance abuse treatment.

Some of the common street names used to describe hydrocodone are Vics, Hydros, Lorris, Tabs, Watsons, 357s, and Vicos. The street terms used to describe hydrocodone usually refer to hydrocodone brand names. According to Health Canada, some of the common brand names are Dalmacol, Hycodan, and Tussionex. According to the Drug Enforcement Administration, some of the common trade names for hydrocodone are Vicodin, Lortab, Lorcet-HD, Hycodan, and Vicoprofen.

Within Canada, hydrocodone is legal to possess so long as the person has a prescription for it. However, illicit hydrocodone has been encountered in tablets, capsules, and liquid form. Hydrocodone with acetaminophen is the most frequent form found illegally. Overall, the drug is not found to be clandestinely produced, and it is usually diverted pharmaceuticals that are the primary sources of illicit hydrocodone. Also, most addicts access the drug through doctor shopping, altered or fraudulent prescriptions, bogus call-in prescriptions, and drug theft.

Hydrocodone is a highly addictive drug, and it causes dangerous addiction. Hydrocodone can be abused by mixing the drug with other prescription medications, alcohol, or illicit drugs. Also, it is abused by taking the drug in higher doses than prescribed and taking it more often than prescribed. Hydrocodone could be snorted, chewed, or injected when it is abused. The drug is meant for short-term medical use, and the abuse of the drug does lead to addiction and severe withdrawal symptoms.

What Does Hydrocodone Look Like?

There are different brands/kinds of Hydrocodone or Hydrocodone-based drugs. Here are a few examples:

This is a picture of a hydrocodone pill called Anexsia
ANEXSIA
This is a picture of a hydrocodone pill called Lorcet
LORCET
This is a picture of a hydrocodone pill called Vicodin
VICODIN

The History of Hydrocodone in Canada

Hydrocodone was first synthesized in Germany in 1920 and was approved by Health Canada for sale in Canada under the brand name Hycodan in 1943. The drug was first marketed by Knoll as Dicodid in 1924 in Germany. Within Canada, the drug is commonly prescribed to control coughing that is exhausting and non-productive. The drug has been marketed in Canada since the last 1950s. Unfortunately, some hydrocodone-containing products are recommended for use in children under six years of age. However, per Health Canada, the number of prescriptions for children and adolescents has declined, and Health Canada now recommends not prescribing prescription cough suppressants to children.

Health Canada regulates opioid pain medications under the Food and Drugs Act and Controlled Drugs and Substances Act. Overall, Canada is second to the United States with the standard daily doses of opioids per million inhabitants, and this includes hydrocodone. Hycodan or hydrocodone is not widely abused in Canada, yet many Canadians become addicted to pain medication like hydrocodone because of long-term prescription drug use. Since 2010, the total number of prescriptions dispensed for opioids in Canada has been increasing. Canada is the world's second-largest per capita consumer of opioids.

Hydrocodone-based medications in Canada have not had a significant impact, unlike other opioids. Overall, according to the Angus Reid Institute, one in three Canadian adults say they are currently experiencing some form of pain that has lasted longer than three months. Countless Canadians are then prescribed drugs similar to hydrocodone and become addicted to them if they are not taken as directed.

The Long-Term and Short-Term Effects of Hydrocodone

There are numerous short-term side effects caused by hydrocodone, whether the drug is taken as prescribed or abused. Some of the common short-term effects of using hydrocodone are nausea, weakness, discomfort, drowsiness, constipation, indigestion, muscle tightening, low blood pressure, and numbness. However, there are more serious short-term effects like allergic reactions, vomiting, hallucinations, anxiety, muscle tremors, intense abdominal pain, impaired vision, and upper body swelling. These are some of the most common short-term effects and become more pronounced and problematic at higher doses.

The long-term effects of hydrocodone usually occur because of prolonged use and or abuse of the drug. These are potential adverse health effects that could cause serious damage. This may include narcotic bowel syndrome, which is when the bowl begins to function slower. Someone who abuses hydrocodone would also experience liver damage, especially if it is a mixture of hydrocodone and acetaminophen. Kidney damage may also occur because of this combination. Other long-term problems may involve hearing loss, tooth damage and loss of teeth, sexual dysfunction, dependence, tolerance, and addiction. Moreover, the drug user may experience chronic constipation, which occurs as soon as a person starts taking the drug.

Liver damage, as mentioned above, is a side effect because of acetaminophen, and it is quite severe. Large amounts of hydrocodone and prolonged use causes kidney failure, and cardiovascular damage occurs because of long-term use. Addicts also experience personality changes, memory loss, and difficulties with cognition. Severe respiratory depression occurs when large amounts of hydrocodone are used, and this could lead to coma or even death.

Hydrocodone Overdose, How Does it Occur?

Not everyone who uses hydrocodone experiences the same short-term and long-term effects. However, the risk of overdose is real, yet there are some determining factors. For example, how much of the drug is consumed, are there other drugs involved, underlying medical conditions, and a history of drug abuse, or was the dose cut with an unknown adulterant. Mixing hydrocodone with alcohol, street drugs, or other prescription drugs increases the likelihood of an overdose. Hydrocodone overdose is especially likely among young people like children and teens. Parents that may have Hycodan in the home or an opiate-based cough suppressant that is left unattended leads to children overdosing.

Even adults that are prescribed the drug are at risk if they are abusing it or using it with alcohol and or other prescription drugs. Opioid overdose can lead to death because of its effects on the brain that regulate breathing. The symptoms of a hydrocodone overdose are pinpoint pupils, unconsciousness, difficulties breathing, cold, clammy skin, confusion, nausea and vomiting, low blood pressure, and spasms in the stomach and intestines. Death occurs because of respiratory depression or because of an underlying health condition.

Some of the long-term complications associated with a hydrocodone overdose are pneumonia, brain damage from lack of oxygen, muscle damage from lying down for an extended time, liver failure, heart slowness, cardiac arrest, coma, respiratory depression, seizures, and death. Treating an overdose requires immediate medical attention or administer Naloxone to reverse the effects of the overdose. Hydrocodone causes an overdose when taken in excess. The exact amount needed to cause an overdose depends on opiate tolerance, age, weight, metabolism, and time of the last dose.

According to Health Canada, 17,602 apparent opioid toxicity deaths occurred between January 2016 and June 2020. Between April and June 2020, 1,628 opioid toxicity deaths occurred, which was the highest quarterly count since 2016. When compared to January to March 2020, this was a 58% increase and a 54% from the same time frame in 2019. In 2020, 97% of the opioid-related deaths were accidental, meaning too much was taken without knowing, or adulterants like fentanyl were mixed with the dose.

Western Canada was the most impacted and saw significant increases in opioid overdoses. However, since 2016, rates have increased in other Canadian regions like Ontario. Between January and June 2020, 86% of all opioid toxicity deaths occurred in British Columbia, Alberta, and Ontario. Men accounted for 77% of opioid deaths from that same time, and most individuals were aged 20 to 49 years old. However, adults aged 30 to 39 years old accounted for a higher proportion of accidental deaths where fentanyl was involved from January to June 2020.

Hydrocodone Addiction in Canada

Hydrocodone addiction occurs when the drug is taken longer than needed and or if it is abused in any way. According to the National Institute on Drug Abuse, long-term use of prescription opioids, whether prescribed by a doctor or not, does lead to the individual developing a tolerance. Tolerance results in a need for a higher and more frequent dose of the drug to achieve the same desired effects. Along with tolerance, there is a dependence, which occurs with repeated use causing the neurons in the brain to adapt, so they only function normally in the presence of the drug.

When the individual does not have the amount of hydrocodone they needed it causes a physiological reaction in the body ranging from mild to severe. Drug addiction occurs because of tolerance and dependence, leading to drug-seeking behavior to maintain the desired effects. There are numerous reasons why someone becomes addicted to hydrocodone. For example, taking a prescription longer than needed or abusing prescription hydrocodone. People also become addicted to opiates because of work or family stress and or struggling with physical or emotional trauma.

However, the most common reasons are long-term use and misuse of the prescription. Hydrocodone is a prescription pain medication and cough suppressant. Repeated misuse of prescription pain medication leads to drug addiction. Without proper drug rehabilitation, an opioid addiction becomes progressively worse. The best way to prevent addiction when using prescription hydrocodone is to take the drug as directed by the prescribing doctor. Someone who is addicted to hydrocodone requires immediate family intervention.

According to the Canadian Centre on Substance Use and Addiction, in 2017, opioid pain medication was used by an estimated 11.8% of Canadians. When compared to 2015, this was a decrease from 13%. Among those Canadians who used prescription pain medication, about 3% reported using them for non-medical purposes. Most Canadians that end up misusing or abusing hydrocodone become addicted and require substance abuse treatment.

Hydrocodone Addiction Treatment in Canada

Treatment for a hydrocodone addiction requires detox to manage withdrawal symptoms. Someone addicted to pain medication like hydrocodone struggle with severe and or dangerous withdrawal symptoms when they stop using the drug. Medical detox is needed to manage these symptoms safely and effectively. Withdrawal symptoms occur as early as a few hours after the drug was taken last. Common withdrawal symptoms include muscle and bone pain, sleep problems, diarrhea and vomiting, and cold flashes with goosebumps.

These symptoms become extremely uncomfortable and are the reason medical detox is needed. However, detox should not be considered the only substance abuse treatment approach. There is a range of drug addiction rehabilitation options to consider following medical detox. For example, behavioural therapies for opiate addiction help addicts modify their attitudes and behaviours related to drug use. The purpose is to increase healthy life skills and persist with other forms of treatment like after support.

A common behavioural therapy is cognitive behavioural therapy, and it has proven effective for treating opiate addiction. Other approaches include multidimensional family therapy, motivational interviewing, and motivational incentives. Most of these therapy approaches are incorporated with other forms of addiction treatment, like holistic approaches or 12-step facilitation. Following residential or outpatient drug rehabilitation, it is a good idea to consider recovery housing. Sober living communities offer short-term housing for recovering addicts and make the transition to an independent life more manageable.

According to the Canadian Centre on Substance Use and Addiction, every region of Canada collects information differently regarding substance abuse treatment admissions. For example, in Nova Scotia, opioids were the second most reported substance for which treatment was sought, accounting for 22.9% of drug addiction treatment admissions. In Ontario, opioids accounted for 2.4% of admissions in 2016. Substance abuse treatment is the best option to treat opioid addiction.

According to a report titled Pan-Canadian Trends in the Prescribing of Opioids and Benzodiazepines, 2012 to 2017—the overall quantity of opioids dispensed in Canada declined by 10.1% between 2016 and 2017. The report indicates that in 2017, the top four strong opioids (fentanyl, hydromorphone, morphine, and oxycodone) accounted for 57% of all opioid prescriptions dispensed in the country. At the time of this report, British Columbia had the largest decrease in the rate of prescribed opioids at 14%, followed by Nova Scotia, Ontario, and Alberta, each at 12%.

Overall, there is no statistical information regarding Hycodan (hydrocodone) abuse in Canada. Yet when looking at the past year's prevalence of non-medical use of prescription opioids in Canada, there are some trends. Among the general population who use opioid pain medication, 2.9% reported using them for non-medical purposes. The rate of non-medical use remains unchanged since 2013. In 2018, 9.6% of Canadians aged 15 and older reported some form of non-medical use of opioid medication. More men than women were misusing these drugs.

Additionally, there are significant health care costs associated with the abuse and misuse of hydrocodone and other opiate-based medications. Healthcare costs include inpatient hospitalizations, day surgeries, emergency department visits, substance use treatment, and the use of prescription drugs. Between 2015 and 2017, the per-person healthcare costs associated with opioids increased by 20.9%. In 2017, opioids were responsible for the third greatest proportion of costs attributable to substance use across Canada. During that same year, $438.6 million of healthcare costs was attributable to opioids.

Hospitalization rates due to opioid poisoning place a significant strain on the healthcare system. The rate of harm connected to opioid poisoning continues to rise nationally, especially during the COVID-19 pandemic. Over the past five years, hospitalizations have increased by 27%. According to Health Canada, between 2018 and March 2019, there were a total of 20,484 opioid-related hospitalizations. Approximately 5,068 were opioid-related poisoning hospitalizations, 6,185 for adverse drug reactions from prescribed opioids, and 10,082 for opioid use disorders.

Furthermore, more than 12,100 EMS responses to suspected opioid overdoses occurred in Canada between January and June 2020. Misusing drugs like Hydrocodone does lead to death. In 2018, there were at least 4,623 apparent opioid-related deaths in the country. In 2019, there were 3,823 deaths. However, most opioid-related deaths are accidental and occur among men aged 30 to 39 years old. Approximately 72% of these deaths involved one or more types of non-opioid substance.

Common Terminology Associated with Hydrocodone

Term Definition
Hydrocodone/Acetaminophen Hydrocodone is sold under many brand names but is typically sold as a combination of acetaminophen and hydrocodone. This is a combination of pain medication used to treat moderate to severe pain. Acetaminophen is a common ingredient in most cold medications.
Hycodan Within Canada, hydrocodone is sold under the brand name Hycodan, which is a prescription cough suppressant. The drug works within certain centers of the brain to help suppress a cough.
Semi-Synthetic Opiate Drugs like oxycodone, oxymorphone, and hydrocodone are semi-synthetic because they are only half natural. These drugs are a combination of natural opiates and synthetic opiates.
Opiate Agonist Hydrocodone is an opiate agonist, which is a drug that mimics the effects of naturally occurring endorphins in the body. The drug produces an opiate effect by interacting with specific receptors in the brain.
Codeine Codeine is an opiate pain medication that occurs naturally and makes up about 2% of opium. Hydrocodone is derived from codeine.

CONTRIBUTORS TO THIS ARTICLE

Marcel Gemme, DATS

Marcel Gemme, DATS

Author

on February 15, 2021

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