Hydrocodone or dihydrocodeinone is a semi-synthetic opioid derived from either of two naturally occurring opiates—codeine and thebaine. Hydrocodone is a perorally active narcotic analgesic (pain reliever) and antitussive (cough suppressant). It is commonly available in pill, capsule, and syrup form, and is often compounded with other, generally less effective non-opioid compounds.
The particular niche in which hydrocodone is most commonly used is as an intermediate centrally acting analgesic and strong cough suppressant, especially in those for whom histamine release and attendant itching from codeine is a problem. For the latter indication, at the 5 to 10 mg dose range hydrocodone is more powerful than most cough suppressants, being roughly equal to its derivative dihydrocodeinone enol acetate, with the top of the list being morphine and hydromorphone and methadone (methadone linctus, about 33 percent the concentration of the liquid used for opioid physical dependence maintenance or detoxification) and dihydrocodeine being right below. The experiments in dogs conducted by Winder and Rosière in the mid-1950s reported in the Journal of Pharmacology in 1955 indicate that hydrocodone is 12 times stronger than codeine as an antitussive (morphine 14×, methadone 9×), and other tests from 1920 forward showed it was about six times stronger as an analgesic.
Due to its opiate-related side effects such as euphoria, sedation and somnolence, hydrocodone is now one of the most common recreational prescription drugs in America, along with oxycodone. Recreational hydrocodone use is particularly prevalent among teenagers and young adults because of the drug’s widespread availability. Like other opioids, long-term use of hydrocodone may cause physical dependency leading to a severe withdrawal syndrome when the dose is lowered or discontinued. Withdrawal effects may include, but are not limited to; severe pain, pins and needles sensation throughout body, sweating, extreme anxiety and restlessness, sneezing, watery eyes, fever, depression, and extreme drug cravings, among others. The presence of acetaminophen in hydrocodone-containing products allegedly deters many users, at least in theory, from taking excessive amounts. However, some users will bypass this danger by using cold water extraction to extract and dispose of a portion of the acetaminophen, taking advantage of the water-soluble element of the drug. It is not uncommon for users to have liver problems from consuming excessive amounts of acetaminophen over a long period of time; taking 10,000 to 15,000 milligrams (10 to 15 grams) of acetaminophen in a period of 24 hours typically results in severe hepatotoxicity, and doses in the range of 15,000–20,000 milligrams a day have been reported as fatal. It is this factor that leads many recreational users to use only single-entity opioids such as oxycodone. One of the major problems today with the illicit use of hydrocodone, especially in younger populations, is that users may not be aware that hydrocodone pills contain acetaminophen. Consuming more than 4,000 milligrams of acetaminophen a day can cause liver damage, jaundice, and even liver failure if the drug is being taken in excessive dosages for an extended period of time.