Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN
Written By: Phillippe Greenough
Article Updated: 01/24/2021
Number of References: 20 Sources
Hydrocodone withdrawal is a very painful and unpleasant experience. The withdrawal symptoms of hydrocodone manifest both physically and mentally and are often the reason someone keeps using the drug; this is known as withdrawal avoidance. Here we will take a look at the symptoms, timeline, and effects of hydrocodone withdrawal as well as some of the contributing factors regarding withdrawal severity, and some of the most effective treatments.
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The hydrocodone withdrawal timeline is similar to many other opioids, with the exception that it may last slightly longer. The half-life of hydrocodone is between 4 to 9 hours, depending on the particular formulation, which is fairly long compared to most other opioids. For some perspective, the half-life of both codeine and morphine is ~3 hours. This means that hydrocodone is cleared from the body more slowly, resulting in a relatively delayed onset of withdrawal symptoms; typically between 12 to 24 hours after the last time someone used the drug. Again due to its half-life, hydrocodone withdrawal symptoms may persist slightly longer than symptoms from other opioids, and it is common to experience the physical symptoms for between 5 to 8 days. The first phase to occur is the acute phase and this includes both physical and psychological symptoms. After about a week the acute phase will resolve and this marks the transition into the post-acute phase.
The acute symptoms of hydrocodone withdrawal, while not usually life-threatening, can become very severe. If someone were to have an underlying health condition, these symptoms could pose additional risks or even lead to fatal complications. For example, if someone had a heart condition then the cardiovascular changes could increase the risk of heart-related problems. Likewise, blood sugar frequently increases during hydrocodone withdrawal so someone with diabetes may be at an increased risk of a diabetic coma or diabetic ketoacidosis, depending on if their blood sugar drops or spikes too sharply or too frequently.
For a more fine-grained look at hydrocodone withdrawal symptoms and their common course of resolution, let’s take a week-by-week overview:
Within 24 hours of their last use, the symptoms of hydrocodone withdrawal will begin to emerge. The first symptoms are often increased anxiety, sweating, and minor chills. Within a day of these first symptoms emerging, the anxiety will intensify as will sweating and the chills may become alternating chills and hot flashes. The second night will be marked by insomnia and stomach issues and aches may begin at this time. Appetite will disappear and stomach cramps and diarrhea will become frequent. The aches may begin mild but often grow to encompass joints, muscles, and sometimes bones as well. Restlessness will be prevalent as well, with someone tossing and turning almost constantly. Depression may begin to appear a few days into withdrawal as will a total lack of energy or motivation. These symptoms will intensify over the first four days or so and then begin to stabilize before starting a slow resolution over the following four days.
Some of the symptoms commonly experienced during the first week of hydrocodone withdrawal may include:
By the beginning of the second week, the physical symptoms should be well on their way to resolution. Insomnia and stomach issues are often the last physical symptoms to subside, and they may persist throughout the second week. That being said, the psychological symptoms are still present and are often more noticeable once the physical symptoms dissipate. Severe anxiety, deep depression, and both mental and physical fatigue or lethargy are very common symptoms of hydrocodone withdrawal that are commonly at their worst during the second week after someone stops using the drug.
Some of the symptoms that may be expected during the second week of hydrocodone withdrawal may include:
The third week after ceasing hydrocodone use often sees some improvement in someone’s overall mental state, as the physical symptoms are often totally resolved by this time. The third and fourth weeks is when someone may first notice the psychological symptoms dissipating as well. This can instill hope and help strengthen resolve if someone has adequate support. Alternatively, if someone is without support it is unfortunately common for people to relapse around this time. When the symptoms begin to dissipate, the memory of the pain and discomfort can fade as well. Coupled with the strong cravings that are almost certainly still present, this makes for a dangerous situation if someone is without support and resources to aid their recovery.
Some symptoms of hydrocodone withdrawal that may persist into the third or fourth week may include:
It is highly recommended to continue treatment after withdrawal has been undergone. If someone had attended a hydrocodone detox center, these facilities can act as a liaison to further care as they often have multiple connections to their local recovery communities. While the most intense symptoms of hydrocodone withdrawal may be behind, continued work and effort are needed if someone hopes to stay sober and continue to build a life free from hydrocodone addiction.
The post-acute phase of withdrawal from hydrocodone can be very long-lasting. While the symptoms are strictly psychological in nature, this is still an extremely difficult and unpleasant phase of withdrawal. This phase can vary in duration between individuals, sometimes greatly, but often lasts several months at least.
Some of the most commonly experienced symptoms of post-acute withdrawal are:
While these symptoms may persist for long periods, they will lessen in intensity over time. There are some substantial differences between individuals regarding the severity of these symptoms, with some people experiencing a rapid and complete resolution quickly, while others may have lingering symptoms for many months or even years in some cases. If someone has help from mental health and addiction recovery professionals, as well as support from family and friends, they often stand a much better chance of making it through this difficult process comfortably and without relapse.
Every person has their own unique brain chemistry, and as such, their brain responds a little differently to hydrocodone addiction and withdrawal. That being said, there are some known factors that can contribute to the intensity and duration of withdrawal. Some of these may be within someone’s power to control, while others were set in place before they were born.
Some of the factors which heavily influence hydrocodone withdrawal include:
By far the greatest contribution to the intensity and duration of hydrocodone withdrawal symptoms are the amounts of hydrocodone use as well as the length of drug use. These factors will directly influence the amount of opioid system downregulation that occurs in the brain, and subsequently the intensity of withdrawal symptoms once hydrocodone is removed. In addition, the longer someone was addicted to hydrocodone, the more “concrete” the process of downregulation becomes as a separate process known as remodeling occurs after downregulation is maintained for a time. It is reversible, but the longer the brain has operated with a downregulated opioid system, the longer it will take to fully return to pre-hydrocodone function. This rarely affects the physical symptoms, but the psychological symptoms can linger for long periods; especially if someone was a long time hydrocodone user.
Genetics absolutely plays a role in addiction, although the exact extent of this role is still unknown. Addiction tends to run in families and the genetic component will not determine whether or not someone will be an addict, but it does influence the quickness with which someone can become addicted once they do start using drugs. While the influence is minor and indirect, it is still present nonetheless.
Co-occurring mental health issues also play a role, albeit a very indirect one. The common psychological symptoms of hydrocodone withdrawal, namely depression and anxiety, maybe more intense and longer-lived if someone were to struggle with a similar and independent mental illness prior to undergoing withdrawal. Psychiatric care can certainly help these symptoms, and seeking a detox center may provide resources to treat underlying mental health issues as well.
To get a better picture of the hydrocodone withdrawal experience, it may be useful to know more about how hydrocodone works. Hydrocodone is a semi-synthetic opioid painkiller that is derived from codeine and works in a similar manner, and to a similar degree. Hydrocodone works as a full opioid agonist (activator) at the μ- (Mu) opioid receptor and in a less intense way at δ- (Delta) opioid receptors. The opioid system is a natural system of the body and brain that is responsible, among many other things, for regulating the perception of pain (nociception), mood, and feelings of reward and pleasure. When taking hydrocodone, the effects often include pain relief (analgesia), relaxation, euphoria, and drowsiness along with a range of other physical effects.
The opioid system is meant to be stimulated by endogenous opioid peptides, neurotransmitters that are naturally occurring in the brain. When hydrocodone interacts with these receptors, especially the μ receptor, it does so in a much stronger way, and for much longer, than the endogenous opioids. This is at first responsible for producing the euphoria and strong analgesia, but repeated overstimulation in this way can have very negative consequences in the long term. When opioid receptors are chronically overstimulated, the brain will undergo a process known as downregulation so that it may try to maintain balance. In effect, downregulation is the act of turning down the sensitivity of these receptors so that the repeated overstimulation has less of an effect. In the short term, this will produce tolerance to hydrocodone, and in the long term, it will produce a physical dependence on the drug.
Once physical dependence on hydrocodone has developed, someone will become physically and mentally unwell when they do not use the drug. The body will become hyperactive and unbalanced in the form of gastrointestinal disruptions, cardiovascular abnormalities, shakes, sweating, and prone to aches and pains. The mind will likewise become unbalanced in the form of increased anxiety, depression, and strong cravings for hydrocodone. Withdrawal can begin anywhere from 12 to 24 hours from the last time someone used the drug. These will begin mild and can often become very intense and unpleasant.
Entering a hydrocodone detox center can be one of the most productive and constructive moves someone can make if they hope to make it through hydrocodone withdrawal. These centers can not only connect someone with continuing care, but they have the professional staff to provide medical monitoring, medications, and therapies that may help reduce the symptoms and increase someone’s chance of completing withdrawal without relapsing. The services provided at these centers not only increase their chances, but they will also make the experience much less unpleasant, using medications to treat the symptoms and reduce the risk of complications through medical monitoring and intervention if necessary.
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