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Hydrocodone Withdrawal & Detox

Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN

Written By: Phillippe Greenough

Article Updated: 09/24/2020

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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Symptoms of Hydrocodone Withdrawal

The symptoms of hydrocodone withdrawal are very uncomfortable and sometimes even painful. The drug itself is roughly as potent as morphine so it will have similar withdrawal symptoms, although due to hydrocodone’s longer half-life the symptoms may not be quite as intense. While rarely fatal in and of themselves, hydrocodone withdrawal symptoms can lead to dangerous complications if someone were to have underlying health conditions. That being said, the experience is still extremely unpleasant and medical supervision at a hydrocodone detox center is often recommended if someone is attempting to undergo withdrawal.

To get a better picture of the hydrocodone withdrawal experience, it may be useful to know more about how this particular drug 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.

Some of the most commonly reported symptoms of hydrocodone withdrawal are:

  • Pains or Aches in the Muscles, Joints, or Bones
  • Nausea & Vomiting
  • Stomach Cramps
  • Frequent Diarrhea
  • Shakes & Tremors
  • Diaphoresis (heavy, constant sweating)
  • Rhinorrhea (very runny nose)
  • Piloerection (frequent goosebumps)
  • Tachycardia (rapid heartbeat)
  • Hypertension (elevated blood pressure)
  • Extreme Restlessness
  • Increased Anxiety
  • Depression
  • Fatigue & Lethargy
  • Strong Cravings for Hydrocodone
  • Chills & Hot Flashes
  • Allodynia (the perception of pain from normally nonpainful stimulus)
  • Insomnia
  • Lack of Appetite
  • Repeated Yawning
  • Extreme Irritability
  • Dilated Pupils

These symptoms, 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 lead to 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.

Post-Acute Hydrocodone Withdrawal

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:

  • Deep Depression
  • Strong Hydrocodone Cravings
  • Increased Anxiety (especially social anxiety)
  • Fatigue and Lethargy
  • Irritability
  • Insomnia

While these symptoms may persist for long periods, they will lessen in intensity over time. Usually beginning alongside the physical symptoms immediately after someone stops using hydrocodone, they are often most intense in the first few weeks and begin a slow resolution from there. 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.

The process of downregulation can reverse fairly quickly, but the subsequent structural changes that the brain underwent in response to chronic hydrocodone use can be reversed, but this is a slow process. The time while this is happening is often unpleasant and mentally challenging. Someone may feel as if their world is a bleak and hopeless place without hydrocodone, and this makes it difficult to readjust to life without it. If someone has help from mental health and 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.

Hydrocodone Withdrawal Timeline

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 around 8 hours, 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. As mentioned previously, this phase is strictly psychological and may persist for weeks or months, depending on the individual and their using habits.

For a more fine-grained look at hydrocodone withdrawal symptoms and their common course of resolution, let’s take a week-by-week overview:

First Week

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.

Second Week

By the beginning of the second week, the physical symptoms should be either totally resolved or 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, and maybe joined at this time by strong cravings for hydrocodone. 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.

Third Week

The third week after ceasing hydrocodone use often sees some improvement in someone’s overall mental state. While they are often still extremely depressed, anxious, and almost totally lacking energy both physical and mental, around three weeks is when someone may first notice the symptoms dissipating. 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.

Fourth Week and Onwards

Insomnia and stomach issues are most likely gone by now, and the fatigue and lethargy may also be improved by this time. It is quite common for depression, anxiety, and cravings to be present still, and these often take weeks or months to fully resolve. 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 Importance of Hydrocodone Detox

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.

Hydrocodone Detox Center Guide

Physical Effects of Hydrocodone Withdrawal

While the physical effects of hydrocodone withdrawal are extremely uncomfortable, they are rarely life-threatening. That being said, it is still highly recommended for someone expecting to undergo hydrocodone withdrawal to enter a detox center. The opioid system is responsible for moderating a variety of physiological processes, not just the perception of pain. It has a large impact on the gastrointestinal and cardiovascular systems as well, and during withdrawal, these systems are affected.

Gastrointestinal Effects

Aside from the brain, there is a large number of μ-opioid receptors in the gastrointestinal tract. In the gut, these receptors help to manage intestinal muscle contractions, aid the stomach emptying into the intestines, and helping control the sphincter muscles. During withdrawal from hydrocodone, the downregulation has lowered the sensitivity of these receptors to the point that the normal opioid peptides produced by the body have a negligible stimulatory effect. Due to this, the gastrointestinal tract becomes hyperactive as it does not receive the calming effect that is normally produced through μ-opioid receptor stimulation.

The effect of this gastrointestinal hyperactivity is often that the stomach will cramp, appetite disappears, and diarrhea is frequent. The occurrence of diarrhea, in particular, can lead to a worsening of other symptoms, as this can lead to dehydration if someone is not closely monitored and cared for. Becoming dehydrated can worsen cardiovascular issues and upset electrolyte balance in the body, possibly increasing the risk of other complications. Aside from increased risks, it is also very unpleasant. Diarrhea and cramping can become so frequent so as to make someone nervous to even leave the bathroom. This often improves greatly after the first week, but some degree of stomach issues may persist for a few days after.

Cardiovascular Effects

The opioid system is a large contributor to regular cardiovascular function, and as an effect of hydrocodone withdrawal, this system experiences some disruption. The opioid system not only affects the brain’s signals to the heart, but there are opioid receptors in the nerves of the heart itself. Both δ and μ opioid receptors can directly affect the heart’s functions, and these are the major receptors activated by hydrocodone. The downregulation that occurs at these receptors may lead to cardiac hyperactivity since the endogenous opioid peptides of the body can’t stimulate them strong enough to moderate and calm the heart down.

In addition to the direct effect of opioid receptors, there is an increase in norepinephrine, and subsequently, epinephrine when the body is going through opioid withdrawal. This is another word for adrenaline, so imagine a constant adrenaline rush for several days straight and the strain that would put on the heart. Adrenaline is normally released in short bursts during fight-or-flight responses, but the increased levels will act to increase heart rate, elevate blood pressure, and increase blood sugar levels. This is not only very uncomfortable for days on end but if someone had a heart condition, this could potentially be dangerous.

Peripheral Effects

There is a multitude of other processes that are disrupted during hydrocodone withdrawal, although they do not necessarily fit into a single body system. These can vary in intensity, but many of them arise either directly from the opioid system disruption, increased norepinephrine, or some have unknown causes.

Some peripheral effects caused directly by opioid system disruption include:

  • Aches in the joints, muscles, and bones
  • Allodynia

Some peripheral effects of increased norepinephrine include:

  • Dilated Pupils
  • Diaphoresis (sweating)
  • Rhinorrhea (runny nose)
  • Shaking & Tremors
  • Insomnia

Some effects due to endocrine system disruption include:

  • Body Temperature Fluctuations (hyper- or hypothermia)
  • Hot & Cold Flashes
  • Piloerection (goosebumps)

A peripheral effect with no known cause is:

  • Frequent Yawning (sometimes several times per minute)

Psychological Effects of Hydrocodone Withdrawal

The physical effects of hydrocodone withdrawal are very unpleasant, but the psychological effects can be just as severe, although less dangerous directly. These may also linger much longer than physical symptoms, sometimes lasting months or years. There is a great deal of variation between individuals regarding the duration and intensity of the psychological symptoms, but they almost always last at least several weeks longer than the physical symptoms.

While medical supervision is recommended for the physical symptoms, psychiatric and therapeutic care is highly recommended to help manage the psychological symptoms as well. It can often seem overwhelming and hopeless to someone experiencing these symptoms, and support and care can go a long way towards helping someone through this difficult time.

Cravings for Hydrocodone

Opioids in general can produce very strong cravings after chronic use, and hydrocodone is no exception. The opioid system can produce downstream changes in the brain when opioid drugs are used for long periods. This is through an interaction between the opioid system and the limbic system. Also known as the “reward center” of the brain, the limbic system is a very intricate complex that is responsible, in part, for motivation, behavior induced pleasure, and feelings of reward. In particular, when someone uses hydrocodone for a long time, downregulation may also occur in parts of the limbic system.

Dopamine is a very important excitatory neurotransmitter in the brain, and hydrocodone use causes dopamine to be released in a part of the limbic system called the nucleus accumbens (NAc), among other areas. The NAc is a known culprit in the development of drug addiction, and downregulation produced here through hydrocodone use can result in someone feeling awful when they are not using opioids. The other areas of the brain that are intertwined with the NAc, specifically the amygdala and hippocampus, are responsible for forming memories and linking these memories to emotions. The intensity with which hydrocodone use produces pleasure leaves an indelible mark in the brain through a process called remodeling that is a literal rewiring of neurological pathways that can reinforce certain behaviors, in this case, hydrocodone use. During withdrawal, someone is prone to associate any feelings of pleasure or wellness with hydrocodone. This results in very strong cravings for hydrocodone that can sometimes be overpowering. These cravings will fade, but this takes time and continued abstinence from hydrocodone use.


Depression is an extremely common effect of hydrocodone withdrawal and is often one of the longest-lasting symptoms. This is also due, in part, to changes in the limbic system and opioid system itself. Other downstream effects of strong opioid stimulation are an increase in the levels of dopamine and serotonin, both mood-elevating and feel-good neurotransmitters. After chronic hydrocodone use, both dopamine and serotonin receptors will also undergo downregulation. During withdrawal, the normal levels of these neurotransmitters in the brain are simply insufficient to stimulate their receptors to the degree required to maintain a normal and stable mood.

The result of insufficient serotonin levels may simply be depression, but may also include mood swings. These may sometimes be wild mood swings, alternating between almost normal and utter despair within a few hours. This can be a mentally exhausting experience and can worsen the subjective experience of the other psychological symptoms. Oftentimes psychiatric care is needed to give someone the best chance of avoiding relapse.


Increased anxiety is another extremely common psychological effect of hydrocodone withdrawal. Due to the disruptions in other neurotransmitter systems resulting from opioid system dysregulation, it is common for someone to experience constant anxiety which may worsen in social situations particularly. The neurotransmitters serotonin, dopamine, and norepinephrine can all contribute to anxiety disorders, and as all three of these systems are affected during hydrocodone withdrawal, it is no surprise that this is such a common symptom.

In addition to neurological factors, there is also a behavioral component to anxiety during hydrocodone withdrawal. Many people who use hydrocodone can end up using it as a coping mechanism, or a way to deal with the normal stresses of life. The euphoria and relaxation that hydrocodone use produces can become very important, even acting as a psychological crutch. Once this coping mechanism is suddenly removed, someone is without the relief they grew accustomed to, and this can lead to increased anxiety on its own. Coupled with the other symptoms of hydrocodone withdrawal and the stress they create, it is expected for someone to be very mentally uncomfortable. Having to endure this without such a powerful, although unhealthy, coping mechanism as hydrocodone can lead to high levels of anxiety.

What Factors Influence The Intensity of Hydrocodone Withdrawal?

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:

  • The amount of hydrocodone someone used
  • The length of time someone used hydrocodone
  • Genetic predisposition for addiction
  • Co-occurring mental health issues

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.

Hydrocodone Withdrawal Treatment

The experience of hydrocodone withdrawal is certainly unpleasant, but luckily there are a variety of treatments that have proven effective at reducing the risks and discomfort. Entering a hydrocodone detox center can provide a wealth of resources to make this difficult process more achievable and less painful. These include medical monitoring, medications, and therapeutic techniques leveraged to treat the physical and psychological symptoms and reduce the chance of dangerous complications.

Hydrocodone withdrawal is not usually fatal, but it is possible to die due to complications caused by withdrawal, although this is very rare. Having medical supervision is critical to safely make it through this difficult time. Medications can help reduce the discomfort of the physical symptoms and therapies can help with the mental strain of withdrawal and provide tools for further recovery.


The FDA recently approved a non-opioid medication specifically for the treatment of opioid withdrawal in the form of lofexidine (Lucemyra). Even prior to this, however, there were many medications that proved effective at treating independent symptoms. Many of these medications were used off-label for this purpose but nevertheless proved greatly beneficial to those undergoing hydrocodone withdrawal.

Some medications most commonly used to treat hydrocodone withdrawal include:

  • Certain Blood Pressure Medications
  • Anti-Anxiety Medications
  • Antidiarrheals
  • Antidepressants
  • Antihistamines
  • Non-Narcotic Sleep Medication

These are simply the broad categories of medications, and some of these classes contain multiple candidates that are effective. There can be great variability between individuals as to which medication is most effective, and working with a medical professional to find one that works is very important. Entering a hydrocodone detox center will provide someone with trained medical professionals that are very well versed in these medications and help them find the right one for them.


While the medications may provide immediate relief and benefit, therapies can be just as beneficial. That being said, the benefits of therapy may not be immediate, but take time and work to achieve. These can nonetheless offer a variety of tools and practices to begin living a life free of hydrocodone addiction. Additionally, the immense mental stress of hydrocodone withdrawal may be reduced somewhat by beginning, and continuing therapy during withdrawal.

Some common therapies used during hydrocodone withdrawal include:

  • Individual Counseling
  • Group Therapy
  • Art and Fitness Therapy
  • Relapse Prevention Skills Development
  • Addiction Education
  • Aftercare Planning

This is just a handful of the dozens of therapeutic techniques available. Similar to medication, someone will find different therapies more or less effective, and finding the right ones is a part of the journey. If someone had struggled with an underlying mental health issue or a past experience with trauma, then these therapies may be especially helpful. A hydrocodone detox center can provide the clinical and psychiatric staff to help someone find the right therapies for them based on their own unique history and needs.

Entering a hydrocodone detox center can provide someone with all of these benefits and then some. Aside from the immediate services provided at these centers, they often have deep connections to local recovery fellowships including 12 step programs, support groups, and other forms of recovery organizations. If someone has a desire to be free from a hydrocodone addiction, then entering a detox center can provide them with the most effective support system and the best treatments for safely and successfully beginning a new life free from hydrocodone.

References For This Article

  1. 1 FDA AccessData: Hydrocodone Bitartrate + Acetaminophen Label(s)
  2. 2 Department of Veterans Affairs Pharmacy Benefits Management: Hydrocodone Bitartrate Extended-Release Capsules Abbreviated Drug Monograph
  3. 3 StatPearls: Hydrocodone and Acetaminophen
  4. 4 StatPearls: Opioid Withdrawal
  5. 5 Case Reports in Critical Care: Opiate Withdrawal Complicated by Tetany and Cardiac Arrest
  6. 6 Society for the Study of Addiction: Yes, People Can Die From Opiate Withdrawal
  7. 7 Cardiovascular Pharmacology: Chronic μ-Opioid Receptor Stimulation Alters Cardiovascular Regulation in Humans - Differential Effects on Muscle Sympathetic and Heart Rate Responses to Arterial Hypotension
  8. 8 Iranian Journal of Medical Sciences: Attenuation of Withdrawal Signs, Blood Cortisol, and Glucose Level with Various Dosage Regimens of Morphine after Precipitated Withdrawal Syndrome in Mice
  9. 9 Canadian Family Physician: Opioid Use Disorder and Type 2 Diabetes Mellitus - Effect of Participation in Buprenorphine-Naloxone Substitution Programs on Glycemic Control
  10. 10 Contemporary Oncology: The Impact of Opioid Analgesics on the Gastrointestinal Tract Function and the Current Management Possibilities
  11. 11 Regulatory Peptides: Opioid Receptors in the Gastrointestinal Tract
  12. 12 European Heart Journal Acute Cardiovascular Care: Heart Failure Due to ‘Stress Cardiomyopathy’ - A Severe Manifestation of the Opioid Withdrawal Syndrome
  13. 13 American Society of Addiction Medicine: National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use
  14. 14 Anesthesiology: Profound Increase in Epinephrine Concentration in Plasma and Cardiovascular Stimulation after μ-Opioid Receptor Blockade in Opioid-addicted Patients during Barbiturate-induced Anesthesia for Acute Detoxification
  15. 15 Medical Principles and Practice: Opioids and Cardiac Arrhythmia - A Literature Review
  16. 16 Circulation Heart Failure: Enkephalins and the Opioid System of the Heart - Too Much of a Good Thing or the Goldilocks Syndrome?
  17. 17 Cardiovascular Research: Opioid Peptides and the Heart
  18. 18 British Journal of Anaesthesia: Cardiac μ-Opioid Receptor Contributes to Opioid-Induced Cardioprotection in Chronic Heart Failure
  19. 19 Current Cancer Drug Targets: Current Research on Opioid Receptor Function
  20. 20 Science & Practice Perspectives: The Neurobiology of Opioid Dependence - Implications for Treatment

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