One of the lesser known facts about hydrocodone is that it is an opioid painkiller which is prescribed to treat moderate to severe pain. Drugs which contain hydrocodone include Zohydro ER, Vicodin, Lortab, Norco, Endacof HC, and others.
Facts About Hydrocodone
To understand what hydrocodone really is, one should first know two words:
Opiate: A drug (such as morphine, codeine or heroin) containing or derived from opium or the opium poppy, used to alleviate pain, or induce sleep or euphoria.
Opioid: A synthetic or semi-synthetic substance producing an opium-like effect, often prescribed for alleviation of moderate to severe pain; a prescription painkiller in the opiate class.
NOTE: The words opiate and opioid are often used interchangeably.
The Development of Hydrocodone
Hydrocodone was created in a lab in the early 1920s by Knoll Pharmaceuticals of Germany. The way they created the drug was by changing the opiate codeine on a molecular level. They added more hydrogen to the molecules of codeine in the hopes that the change would make it less addictive and easier on the stomach. (As a side note, codeine is a naturally occurring base of opium.)
In 1929, American pharmacologist Dr. Nathan Eddy of the National Research Council was charged with assessing the safety, efficacy, and side effects of 350 drugs. One of these drugs was hydrocodone.
During five years of extensive testing, Dr. Eddy found that hydrocodone was an effective painkiller with side effects consistent with those of most other synthetic and semi-synthetic opioids. He also discovered that hydrocodone caused an intense euphoric effect. It even induced euphoria in rats which had previously built a tolerance to morphine. (Tolerance denotes a diminishing of the body’s response to a drug after continued use.) The tests showed that relatively low doses of hydrocodone were effective on rats that had previously been administered enough morphine to need a higher dose in order to create an effect.
Another disquieting, but not surprising, part of the facts about hydrocodone is that it caused a steady dependence in the animals. This means a user could find himself experiencing withdrawal symptoms after taking the drug for a very short period of time. The drug, like all opiates, was addictive.
1970 saw the passage of the United States Controlled Substances Act. This act, among other measures, created five classifications – called schedules – which listed drugs by medical usefulness and likelihood for addiction. Hydrocodone in its pure form was listed as a Schedule II drug. According to current Drug Enforcement Administration (DEA) information, a Schedule II drug has the following characteristics:
- The drug or other substance has a high potential for abuse.
- The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.
- Abuse of the drug or other substance may lead to severe psychological or physical dependence.
There was however a proviso put on the scheduling of hydrocodone: Drugs containing less than 15 milligrams of hydrocodone (per pill) combined with another drug like acetaminophen (also known as Tylenol) are listed as Schedule III drugs. The DEA defines Schedule III drugs as follows:
- The drug or other substance has a potential for abuse less than the drugs or other substances in schedules I and II.
- The drug or other substance has a currently accepted medical use in treatment in the United States.
- Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.
Seven years later, in 1978, the original manufacturers of hydrocodone, Knoll Pharmaceuticals, introduced Vicodin to America. This drug contained five milligrams of hydrocodone plus 500 milligrams of acetaminophen.
Over-Prescription of Hydrocodone Drugs
The early 2000s saw the advent of so-called “pill mills” in many states across the U.S. These were locations where unscrupulous “doctors” prescribed opioid painkillers to patients – many of whom were addicts faking symptoms to get another hit. Florida in particular was host to a large number of pill mills. From 2003 to 2009, overdose deaths in Florida went up 61%. At the height of the pill mills, 7 Floridians were dying from overdose every single day.
Nationally, the numbers were indicative of a widespread problem. In 2002, emergency room reports showed that patients needing treatment for hydrocodone addiction or hydrocodone-related medical problems (like overdose and organ damage) had increased 500% since 1990. In 2006, Americans were written 130 million prescriptions for drugs containing hydrocodone. In 2008, 14,800 overdose deaths were attributed to two opioid painkillers: hydrocodone and oxycodone. In 2010, pharmacies dispensed the equivalent of 42 tons of pure hydrocodone. In 2011, the Centers for Disease Control and Prevention (CDC) named drug overdose as the leading cause of death by injury. More people die now from drug overdose than from auto accidents.
A Change in Legislation
With the high numbers of hydrocodone overdoses, injuries and deaths, the Food and Drug Administration (FDA) decided to change the scheduling of hydrocodone combination drugs. These drugs will be listed under Schedule II of the US Controlled Substances Act, going into effect as of October 6th, 2014, and as such will be subject to further restrictions and enforcement.
The effort to re-schedule hydrocodone goes back to 1999 or earlier, and the DEA’s subsequent recommendation to re-classify the drug. The advocacy group, Physicians for Responsible Opioid Prescribing, recently issued this statement: “Had FDA responded in a timely and appropriate manner to DEA’s urgent request, thousands of overdose deaths and tens of thousands of cases of opioid addiction might have been prevented.”
Drugs like Vicodin, Lortab, Norco and Zydone will be subject to tighter restrictions and oversight. This includes newest addition to the hydrocodone family, Zohydro ER, pure hydrocodone available in extended-release capsules of 10-50 mg hydrocodone. Zohyrdo has earned some well-deserved controversy due to its potency, as well as the fact that it is not tamper-proof, meaning users and addicts can crush it up and bypass the time-release.
This change in legislation comes after a crackdown on pill mills and a general tightening of penalties for physicians and pharmacists who provide pills for addicts. There is certainly still more work to be done, and it often feels like an uphill battle for those working diligently to curb the rate of drug abuse and overdose. But the hope here is that a change in the accessibility of hydrocodone drugs will result in fewer addicts and fewer overdoses. Proper education about this drug and the facts about hydrocodone can help with ending the epidemic it has become.
While enforcement is obviously part of the picture, only education on the facts about hydrocodone and effective treatment will ultimately turn the tide of opioid abuse.