Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN
Written By: Phillippe Greenough
Article Updated: 01/24/2021
Number of References: 15 Sources
Vicodin withdrawal can be a very uncomfortable and sometimes even painful experience. The symptoms are similar to those of other opiates such as morphine and can be so unpleasant as to cause someone to keep using Vicodin simply to avoid withdrawal symptoms. Vicodin withdrawal symptoms can last around a week and include nausea, diarrhea, anxiety, depression, and muscle pain. Here, we will take a look at the pharmacology of this drug, the particular symptoms and effects of Vicodin withdrawal, the timeline involved, and some of the effective treatments available.
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The immediate and most intense phase of Vicodin withdrawal is known as acute withdrawal. This is the phase that will begin 12 to 24 hours after the last use and exhibits physical and psychological symptoms. A common time for the resolution of the acute and most severe symptoms of Vicodin withdrawal is between 5 to 8 days from the last time someone used the drug. The post-acute phase may pick up where the acute phase left off, and post-acute symptoms, while only psychological, may persist for further weeks or even months.
While the symptoms of Vicodin withdrawal are rarely fatal, there have been rare cases of people dying due to complications from opioid withdrawal. Vicodin is about as potent as morphine so it has very similar withdrawal symptoms as this classical opiate. Even though the symptoms are not usually life-threatening, someone suffering from a pre-existing health condition may be at increased risk during withdrawal. Heart issues and diabetes can pose increased risks in particular, as cardiovascular changes and/or blood sugar changes could lead to complications with these pre-existing conditions.
The timeline for Vicodin withdrawal is similar to many other opiates, as it is a fairly average opiate in terms of potency and duration. The half-life of the active ingredient in Vicodin is between 3 to 4 hours on average, so depending on someone’s use habits, withdrawal symptoms may start between 12 to 24 hours since the last time they used the drug. This is fairly close to other opiates, although slightly longer than average. For comparison, the “gold standard” opiate morphine has a half-life of around 3 hours.
For those addicted to Vicodin, within a day from the last time someone used it they will begin to experience physical (acute) withdrawal symptoms. The first symptoms to arise are commonly increased anxiety, sweating, and chills or goosebumps. These symptoms may begin mild but will escalate over the next few days. They will also be joined by stomach cramps, nausea, and diarrhea along with insomnia during the first night of withdrawal. Profound exhaustion, both mental and physical, will descend along with restlessness and a decrease in appetite. Aches and pains in the bones, joints, and muscles will appear as well and heart rate and blood pressure may become increased. These cardiovascular changes are mostly due to anxiety and the other symptoms of Vicodin withdrawal increasing someone’s stress levels. Depression may appear a few days into withdrawal along with strong cravings for Vicodin. These symptoms will increase in severity over the first 4 days, and then benign a slow dissipation over the next 4 days or so.
Some of the symptoms of Vicodin withdrawal that may be experienced during the first week include:
At the start of the second week, someone will often be exhausted and very irritable. While the physical symptoms may be much reduced by now, the prior week of little sleep and food often takes a toll. The physical symptoms usually resolve early during the second week, if they haven’t resolved prior to the second week, although the psychological symptoms are still prevalent. Anxiety, depression, cravings, and irritability are often still strong and insomnia may still be present. Fatigue and lethargy are often present as well, although energy levels may begin returning to normal by the end of the second week.
Some of the symptoms of Vicodin withdrawal that may be expected during the second week could include:
The third week of Vicodin withdrawal usually shows significant improvement. While cravings and depression are often still present, anxiety may be somewhat reduced and insomnia should be almost fully resolved. Energy levels are commonly still lower than normal but have improved somewhat since last week. Appetite should be almost normal by now as well, and healthy eating habits will help improve the overall experience. During the fourth week of Vicodin withdrawal, depression and cravings are often still present, and anxiety may be lingering as well. These may be present for some weeks or months further, although they should see a slow and gradual resolution all the while. It is highly recommended for someone to continue treatment for Vicodin addiction.
Even though the symptoms are dissipating, this time can actually present increased risks. As the memory of the pain and discomfort of withdrawal fades, the resolve that held someone through the first weeks may benign to fade as well. This is a crucial time in recovery that requires support and care if someone is to have the best chance of not repeating the withdrawal process again in the future. Having a solid foundation in recovery and continuing care can be a huge benefit. The most severe symptoms of Vicodin withdrawal are over with, but there is still healing to be done.
The symptoms of post-acute Vicodin withdrawal are strictly psychological, although this should not minimize the challenges they may pose to long term recovery. The neurological disruptions caused by both opioid receptor downregulation and structural changes that arise from prolonged opioid receptor downregulation can lead to negative mental states for a long period after Vicodin use is ceased. The manifestation of these symptoms can vary quite a bit between people, but there is a roughly consistent trend in the symptoms.
Some symptoms common in post-acute withdrawal from Vicodin include:
These symptoms can frequently last for weeks or months and there is a large amount of variation between symptom duration between individuals. Some people will be totally fine after a few weeks, while others may experience symptoms for several months. Regardless of duration, the symptoms are most intense early in the withdrawal process and will resolve over time.
Vicodin withdrawal is, without a doubt, an unpleasant experience but the intensity of this unpleasantness can vary, sometimes greatly, between individuals. Some people make a full recovery within a few weeks, while others can experience symptoms for many months, or sometimes even years. There are multiple factors that can influence this experience; some of them involve a degree of choice, while others do not.
Some factors that can contribute to Vicodin withdrawal intensity include:
The largest contributing factors are directly related to Vicodin use habits, including the amounts and duration of use. The specifics of someone’s use can affect both the intensity and the duration of withdrawal symptoms. The amount of Vicodin someone uses can directly affect the amount of downregulation that occurs in the opioid system, and subsequently the severity of symptoms as more Vicodin use results in more downregulation, thus worse symptoms. The length of time someone uses can also play a role but this probably has more to do with the duration of withdrawal symptoms. The psychological symptoms are a result of structural changes the brain performs after the opioid system has been downregulated for a prolonged period. Thus the longer someone uses Vicodin regularly, the more profound these changes can become, thus taking longer to reverse once Vicodin use ceases.
The existence of co-occurring mental health issues can contribute to the psychological symptoms, albeit indirectly. Since depression and anxiety are quite common symptoms of Vicodin withdrawal, if someone were to already suffer from either of these conditions then they may become amplified during withdrawal. While medical and psychiatric help is often recommended for anyone going through Vicodin withdrawal, this is even more highly recommended for those who have a co-occurring mental health issue.
Genetics plays a role in addiction, although the extent and severity of this role is debatable. Addiction does tend to run in families, and while it may not make it certain that someone can become addicted, it seems to make it more likely if and when they do begin using drugs. This could mean that someone with a genetic predisposition towards addiction could become addicted to Vicodin more rapidly than someone without a genetic inclination; even if they had used the same amount of the drug for the same amount of time.
To better understand the specifics of Vicodin withdrawal symptoms, it will be helpful to know more about how this drug actually works. The main psychoactive ingredient in Vicodin is the semi-synthetic opioid drug hydrocodone, and the same goes for Lortab. These drugs also contain relatively large amounts of acetaminophen, an NSAID pain reliever that can be very toxic to the liver when taken in high doses. Both Vicodin and Lortab are about as potent as morphine milligram-for-milligram and work in a similar manner. The main mechanism of action of Vicodin is through strong activation of μ-opioid receptors and, a lesser but still relevant, agonist action at δ-opioid receptors. These receptors are a part of the opioid system of the brain and are normally activated by endogenous opioid peptides that are naturally occurring in the brain. This strong agonist action that Vicodin use produces is responsible for the strong painkilling, euphoric, relaxing, and general depressant qualities of the drug.
Using Vicodin, or similar drugs like Lortab, for long periods or in large amounts can cause the brain to undergo chemical, and later structural, changes in an attempt to maintain balance. The strong and frequent stimulation of opioid receptors will cause the brain to undergo a process known as downregulation. This is the process of the brain reducing the sensitivity of these opioid receptors and it causes them to require stronger stimulation to produce the same effects over time. This will initially create a tolerance to opioid drugs like Vicodin or Lortab and later will result in a physiological dependence on these drugs.
After dependence has occurred and Vicodin use is ceased, the brain will be thrown off balance in the absence of the drug. The downregulated opioid receptors require strong stimulation to do their job, and the natural opioid peptides in the brain simply aren’t potent enough to cross this high activation threshold anymore. The brain adapted to the high potency of Vicodin, and now it is unable to work properly once Vicodin has been removed. This process is capable of reversing itself, known as upregulation, but this will take time and the symptoms of Vicodin withdrawal exist while this process is taking place.
Entering a Vicodin detox center can give someone the support, care, and resources they need to make it through the experience of Vicodin withdrawal in the safest, most comfortable way possible. These facilities employ trained medical professionals, therapeutic and psychiatric care, and support services to help someone begin their journey out of addiction and into a new life. Aside from the direct and immediate benefits these centers provide, they can also act as a reference to further treatment options for continued recovery.
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