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Vicodin Withdrawal & Detox

Written By: Phillippe Greenough

Article Updated: 08/12/2020

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. 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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Vicodin Pharmacology & Addiction

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. 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 (agonist activity) at μ- (Mu) opioid receptors, and a lesser but still relevant, agonist action at δ- (Delta) 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.

Symptoms of Vicodin Withdrawal

While the symptoms of Vicodin withdrawal are rarely fatal, they can be exceptionally unpleasant. 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. It is definitely encouraged for someone who is expecting to go through Vicodin withdrawal to enter a Vicodin detox center, as these facilities can reduce the discomfort of the experience as well as minimize and manage the potential risks.

Once someone has become addicted to Vicodin and subsequently stops using it, they will become physically and mentally ill for a time. These withdrawal symptoms are a heightened and hyperactive state and can include physical symptoms such as cardiovascular issues, gastrointestinal distress, tremors, and aches or pains. There are psychological issues as well in the form of cravings, depression, anxiety, and a general sense of unease. These symptoms can begin between 12-24 hours from the last time someone used Vicodin and the most severe symptoms often last about a week.

The most common symptoms of Vicodin withdrawal include:

  • Increased Anxiety
  • Depression
  • Mood Swings
  • Irritability & Restlessness
  • Diaphoresis (constant sweating)
  • Rhinorrhea (very runny nose)
  • Frequent Diarrhea
  • Piloerection (goosebumps)
  • Tachycardia (rapid heart rate)
  • Hypertension (elevated blood pressure)
  • Allodynia (feelings of pain from a normally nonpainful stimulus)
  • Aches and Pains in the Muscles, Joints, and Bones
  • Tremors and Shaking
  • Nausea & Vomiting
  • Hot Flashes and Chills
  • Insomnia
  • Lack of Appetite
  • Frequent Yawning
  • Fatigue and Lethargy
  • Dilated Pupils

The symptoms of Vicodin withdrawal are not typically dangerous, but if someone had additional health complications, there is a possibility for real risks. 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.

Post-Acute Vicodin Withdrawal

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:

  • Depression
  • Increased Anxiety
  • Irritability
  • Insomnia
  • Strong Cravings for Vicodin
  • Fatigue and Lethargy

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 Timeline

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 roughly 8 hours, 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. With a longer half-life, Vicodin is cleared from the body more slowly, so withdrawal symptoms may manifest a little later than with other opiates. Because of this, the withdrawal symptoms may last slightly longer than with other opiates, although not by much.

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.

First Week

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 a 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.

Second Week

At the start of the second week, someone will often be exhausted and very irritable. While the 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.

Third Week

Around three weeks after someone last used Vicodin they often begin to show some improvement in their state of mind. 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. 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.

Fourth Week and Onwards

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. As with the third week, the memory of withdrawal symptoms fades and the temptation to use Vicodin again may encounter less and less resistance as time goes on. 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 Importance of Vicodin Detox

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.

Vicodin Detox Centers

Physical Effects Of Vicodin Withdrawal

While rarely fatal, the physical effects of Vicodin withdrawal are very unpleasant. These effects often manifest as hyperactivity in a variety of physical systems and when combined with the psychological symptoms, make for an uncomfortable experience. The brain’s opioid system is, in part, responsible for functions other than pain relief including heart function, digestion, and a variety of other processes. During Vicodin withdrawal, these systems can be disrupted, sometimes profoundly so.

Gastrointestinal Effects

While we mentioned the opioid receptors in the brain, there are also large numbers of opioid receptors in the gastrointestinal tract as well. In particular, μ-opioid receptors are present in the intestines where they act to slow and calm intestinal muscle contractions, known as peristaltic contractions. These muscle movements help the intestines smoothly pass contents through the body, aiding smooth and effective digestion. One of the major effects of Vicodin withdrawal is the disruption of these peristaltic muscle contractions and digestive function in general.

Once an addiction to Vicodin has been achieved and the drug is removed, the downregulated opioid receptors in the gut cannot effectively moderate digestion. Some direct effects of this are nausea, stomach cramps, and frequent diarrhea. This can also worsen other symptoms and the subjective experience of withdrawal as a whole. Diarrhea and cramps are certainly unpleasant and this can also contribute to dehydration and electrolyte imbalances as well as reduce the effective digestion and nutrient absorption of food that is eaten during withdrawal.

Cardiovascular Effects

Opioid receptors in the brain also contribute to cardiovascular function as well. The opioid system in the brain is able to influence the signals that are sent to the heart which contribute to heart rate and contractility. Aside from downregulation, the increased levels of the neurotransmitter norepinephrine during Vicodin withdrawal can lead to elevated heart rate and blood pressure. Norepinephrine is a moderator of adrenaline levels in the body, and increased levels of this neurotransmitter can lead to elevated levels of adrenaline in the blood. This may also be amplified by the anxiety and stress that is created by other withdrawal symptoms. While normally not dangerous, if someone has a pre-existing heart condition this could lead to potentially dangerous complications and health risks.

Aside from the gastrointestinal tract, there are also opioid receptors in the tissues of the cardiovascular system, including the heart. While their exact role is currently unknown, downregulation that leads to withdrawal may have an effect here as well.

Secondary Effects

There is a wide range of other effects of Vicodin withdrawal that don’t fit into one single physical system. These may not necessarily be dangerous but they are frequently uncomfortable. The effects may be either directly, or indirectly, caused by Vicodin withdrawal, and some of them have no currently identified causes but are closely associated with opiate withdrawal in general and Vicodin withdrawal in particular.

Some effects that are directly caused by opioid system disruption include:

  • Allodynia (inability to feel pleasure)
  • Aches and Pains in the Bones, Joints, and Muscles

Some effects that are most likely a result of increased norepinephrine levels include:

  • Tremors
  • Rhinorrhea (very runny nose)
  • Diaphoresis (constant sweating)
  • Insomnia
  • Dilated Pupils

Some effects of integumentary system disruption include:

  • Piloerection (goosebumps)
  • Hot Flashes and Chills
  • Body Temperature Fluctuations (either hypo- or hyperthermia)

A secondary effect with no known cause is:

  • Frequent Yawning

Psychological Effects of Vicodin Withdrawal

While the physical effects can be quite uncomfortable, the psychological effects of Vicodin withdrawal are similarly unpleasant. In addition, these mental and emotional symptoms often last much longer than the physical symptoms, sometimes weeks or months longer. While downregulation is responsible for the majority of physical symptoms, the psychological effects are caused bu changes the brain makes in response to chronically downregulated neurotransmitter levels. Because of this, the brain must reverse these structural changes to reduce the mental effects, and this process can take more time than simply upregulating neurotransmitter levels.

Medical supervision is often recommended for the physical effects, and therapeutic and psychiatric care is often recommended for these emotional and mental effects as well. These can sometimes be severe and having care and treatment to reduce the psychological discomfort of these symptoms can increase someone’s chances of completing detox and continuing into long term recovery.

Anxiety

Increased levels of anxiety are one of the most common symptoms of Vicodin withdrawal. This can be generalized anxiety and is often accompanied by increased social anxieties as well. The opioid system in the brain can have multiple downstream effects on other neurotransmitter systems including those involving serotonin, dopamine, and norepinephrine.

All of these neurotransmitters can contribute, in some degree, to anxiety levels and mood in general. In the case of anxiety, norepinephrine is most likely to blame, as it is associated with increased vigilance levels, being a major component of the fight-or-flight response. Prolonged increases in norepinephrine levels can result in a constant state of hypervigilance and being in social situations may present more targets and potential threats to observe, resulting in increased social anxiety.

Depression

Another very common effect of Vicodin withdrawal, depression can persist for some time after Vicodin use ceases. Similar to anxiety, the neurotransmitters that can affect depression are indirectly impacted by opioid system dysregulation. Again, dopamine and serotonin systems are strongly disrupted during Vicodin withdrawal, and these neurotransmitters play large roles in someone’s mood. Dopamine is a direct contributor to feelings of wellness and pleasure while serotonin is a minor mood elevator and a mood regulator.

Aside from direct neurotransmitter imbalances, the fact that Vicodin use is a powerful coping mechanism also plays a role. Being able to control someone’s mood at will is an extremely powerful, although very unhealthy, way to cope with life. Suddenly having this removed as an option can leave someone feeling vulnerable and helpless. These symptoms will resolve with time, but this is a slow process compared to the resolution of the physical effects. Psychiatric and counseling support, as well as medications, may be required to help someone through this difficult time and give them a solid chance at long term recovery.

Cravings For Vicodin

The exact causes of this are currently subject to a heated debate in the medical community. There is probably no single cause for cravings, but multiple factors may contribute to this common effect of Vicodin withdrawal. For one thing, the opioid system is capable of affecting dopamine levels, particularly in the limbic system as a whole and the nucleus accumbens (NAc) in particular. The limbic system is a powerful center for consolidating memory, emotions, and behavior reinforcement. The surges of dopamine in the NAc that can result from Vicodin use can lead to very strong associations between Vicodin use and pleasure. During withdrawal with the brain and body in distress, a desire to feel good can naturally bring to mind memories of the pleasure produced through Vicodin use.

In addition, and similar to the symptoms of depression, the potency with which Vicodin can help someone cope with their life should not be underestimated. Being able to take some pills and suddenly feel okay about anything is a very powerful coping mechanism. Even though someone knows it may be harming them, the peace of mind and euphoria that Vicodin produces can be very powerful. While someone is experiencing withdrawal, they often want relief of any kind and they may mentally default to Vicodin use and crave the drug as their means of relief.

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What Factors Influence The Intensity Of Vicodin Withdrawal?

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 length of time someone used Vicodin
  • The amounts of Vicodin someone used
  • Co-occurring mental health issues
  • A genetic predisposition towards addiction

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 Vivcodin 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 an addict, 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.

Vicodin Withdrawal Treatments

Vicodin withdrawal is an uncomfortable experience, but there is help available. Treatment options including medications and therapeutic techniques have been used to effectively reduce Vicodin withdrawal symptoms and increase the chances of gaining long term recovery. Entering a professional detox center is often the first step on this journey, and the medical professionals, medications, and clinical therapists can provide a wealth of resources to provide support for someone hoping to achieve this goal.

Medications

Recently, the FDA has approved the first non-opioid medication to treat opioid withdrawal in the form of lofexidine (Lucemyra). Aside from this particular medication, there are many options that can effectively treat the symptoms of Vicodin withdrawal. These may reduce the discomfort of the withdrawal and detox experience, and may reduce the risks if someone has other health complications.

Some medication types commonly used for the treatment of Vicodin withdrawal include:

  • Antidiarrheals
  • Non-Benzodiazepine Anti-Anxiety Medications
  • Sleep Aids
  • Certain Blood Pressure Medications (β- blockers in particular)
  • Antidepressants
  • Antihistamines
  • Opioid Antagonists

Some of these medications may be used early in the withdrawal process, such as antidiarrheals, anti-anxiety medications, and sleep aids. Other medications may be more appropriate for the long term symptoms, such as blood pressure medications (for anxiety), antidepressants, and opioid antagonists. Everyone has their own unique tolerances and responses to different medications, so entering a Vicodin detox center will help someone find the right treatment medications for them.

Therapies

Medication can help the physical symptoms and some of the post-acute, longer duration psychological symptoms but therapeutic techniques have proven quite effective at treating the mental and emotional effects of Vicodin withdrawal as well. These approaches do not provide immediate relief, as some medications may, but through continued effort, someone can reap real benefits from therapy. Aside from dealing with the emotional wreckage of someone’s using days, any trauma someone may have experienced prior to drug use may begin to be healed through therapy. Additionally, therapies can provide a wide range of healthy coping tools that will help someone live a life after Vicodin addiction.

Some therapies commonly used during Vicodin withdrawal treatment include:

  • Group Therapy
  • Individual Counseling
  • Coping Skills Development
  • Addiction Education
  • Behavioral Therapy
  • Aftercare Planning

These are just a few examples, but there are many more therapies used during Vicodin withdrawal and detox that have proven effective. Different people will find certain therapies more or less effective, and having trained mental health workers available can help them find the right ones for their unique needs and circumstances. Having a team of professional therapists, counselors, and psychiatrists for support can greatly increase someone’s chances of recovery and can help them build a solid foundation in a life free from Vicodin addiction.

Aside from the medical professionals, medications, and mental health experts at Vicodin detox centers that can help reduce symptoms and risks, these facilities have a wealth of resources and connections with local recovery fellowships and communities. Entering one of these centers can be a boost to someone’s recovery, putting them in touch with dozens of people who are on a similar path. Freedom from Vicodin addiction is possible, and seeing this reality in the lives of others can be motivational and inspirational. Help is available, but someone must be willing to reach out and ask.

References For This Article

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