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Vicodin Withdrawal

Pain impacts more people in the U.S. than cancer, heart disease, and diabetes combined, according to the National Institutes of Health (NIH).  Pain is what primarily drives people to access the health care system. All told, an estimated 50 million Americans — or 20 percent of the adult population — have chronic pain. 

As a result, many have turned to prescription opioid medications like Vicodin for relief. In the 1990s, drug manufacturers were able to persuade doctors to prescribe opioid medications for common ailments like back pain and bone fractures. This practice helped fuel the opioid drug crisis that we know today, considered the deadliest drug epidemic in U.S. history. 

In fact, from 1999 to 2017, 400,000 people died from an overdose involving any opioid, including prescription and illicit varieties. OxyContin and Vicodin were once the primary drivers of this epidemic, which is now more than 20 years old. Lately, powerful synthetic opioids like fentanyl are driving the latest iteration of this crisis. 

Nevertheless, Vicodin remains a substance of abuse for many, leaving them prone to debilitating withdrawal symptoms and relapse, which can produce a fatal overdose. When Vicodin is taken with other substances like alcohol, the risk of death heightens. Read on to learn more about Vicodin withdrawal and its perilous effects along with available treatment options.  

What Is Vicodin?

Vicodin is a narcotic medication comprised of the opioid hydrocodone and the non-opioid pain reliever acetaminophen. It is used to relieve pain that is moderate to severe. Acetaminophen was first employed for medical use in 1893, years before Vicodin was to be developed. Nearly 30 years after acetaminophen’s introduction to medicine, a German pharmaceutical company synthesized hydrocodone. Then that same company, Knoll, introduced Vicodin to the United States in 1978. A generic version was made available in 1983. 

What resulted was a generational answer to pain relief. Vicodin became one of the best-selling medications of the 20th century, a blockbuster drug many times over. In 2006, nearly 30 years after its introduction, Americans were written 130 million prescriptions for medications containing hydrocodone.     

Vicodin comes as a capsule, tablet, or liquid. What’s more, its potency is on par with morphine.  The acetaminophen in Vicodin works to reduce the experience of pain, and the hydrocodone aspect can produce feelings of euphoria. The euphoric effect of Vicodin can lead people to abuse it. Yet, addiction can also cause liver damage, due to the acetaminophen.

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Vicodin and Dependence

The U.S. Drug Enforcement Administration (DEA) reclassified Vicodin from Schedule III to Schedule II under the Controlled Substances Act, which went into effect in October 2014. 

The move essentially recognized the ability of Vicodin and other hydrocodone products to cause physical and psychological dependence. 

“Almost 7 million Americans abuse controlled-substance prescription medications, including opioid painkillers, resulting in more deaths from prescription drug overdoses than auto accidents,” said former DEA Administrator Michele Leonhart, “[This] action recognizes that these products are some of the most addictive and potentially dangerous prescription medications available.”

Additionally, a U.S. Food and Drug Administration (FDA) advisory panel suggested that the regulatory body consider a ban on Vicodin and other medications like it because of the twin risks they pose of overdose and acute liver injury. Consequently, the FDA requested that pharmaceutical companies limit acetaminophen amounts in their products.

Prescription Opioid Abuse: Down But Not Out 

Evidence exists that fewer people are using prescription opioids or engaging in their abuse. 

For example, fewer people being admitted to emergency departments for opioids. The U.S. Centers for Disease Control and Prevention (CDC) stated that between 2010 and 2015, the percentage of emergency department (ED) visits involving opioids decreased for people ages 18-44 and 45-64, which represents a reversal from 2006 to 2010. 

Woman, sick in bed from withdrawal

What’s more, the use of prescription opioids like Vicodin and OxyContin was down in 2018 by 17 percent, which is the largest annual decline ever recorded, according to the IQVIA Institute for Human Data Science. 

Also, there were roughly 72 pain pills per adult in 2011, which is considered the peak period for opioid prescriptions. Now that number is down to 34 per adult. However, that figure is still higher than what it was two generations ago.

Plus, those numbers do not account for the number of people who were prescribed opioids only to resort to using illicit opioids like heroin due to affordability, a common pattern. The National Institute on Drug Abuse (NIDA) reported that nearly 80 percent of Americans who use heroin, including people in treatment, misused prescription opioids like Vicodin before switching. 

When Addiction Is Present

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), considered the principal source for psychiatric diagnoses, has outlined criteria that comprise opioid use disorder (OUD). 

To confirm an OUD diagnosis, at least two of the following criteria are observed within a 12-month period: 

  1. Opioids are often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
  3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
  4. Craving, or a strong desire or urge to use opioids.
  5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
  7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.
  8. Recurrent opioid use in situations in which it is physically hazardous.
  9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  10. Exhibits tolerance.
  11. Exhibits withdrawal.


When someone develops Vicodin tolerance, it means they have to take a higher dose of the medication to achieve the same effect a previous dose yielded. Tolerance does not indicate addiction itself, but it may cause users to take more and more of a drug, predisposing them to dependence and, finally addiction. 

Dependence and Withdrawal Symptoms

NIDA defines opioid dependence as a state when the body only functions normally when the substance is present. When a person stops using Vicodin, they almost immediately experience withdrawal symptoms. For people with OUD, withdrawal can feel like having the flu. 

Vicodin is no different. 

The early symptoms of Vicodin withdrawal include:

  • Yawning
  • Anxiety
  • Runny nose
  • Muscle aches
  • Bone pain
  • Irritability
  • Sweating
  • Trouble sleeping

Later withdrawal symptoms include:

  • Nausea
  • Stomach cramps
  • Vomiting
  • Diarrhea
  • Insomnia

Vicodin Withdrawal Timeline

A regular dose of Vicodin can provide up to eight hours of pain relief. Depending on the health of a user’s liver, the acetaminophen in Vicodin has a half-life of up to three hours. However, most of the drug leaves the body within 24 hours. 

Traces of the medication can remain in the body a lot longer. A hair follicle screening, for example, can reveal evidence of Vicodin up to 90 days after the last use.

Still, users will almost always experience withdrawal once the Vicodin exits the system. The onset and duration of withdrawal can vary from person to person. The following represents a general withdrawal timeline:

DAYS 1-2

Withdrawal symptoms for Vicodin begin to manifest within eight to 12 hours after the last dose. A user can experience early, flu-like symptoms such as muscle aches, runny nose, sweating, and stomach cramps.

DAY 3-5

By Day 3, the worst withdrawal symptoms will have likely passed. However, symptoms like appetite loss, diarrhea, chills, and even vomiting can persist. 


By Day 6, most, if not all, of the physical symptoms will have subsided. Heavier Vicodin users will likely deal with enduring symptoms for several more days. Because Vicodin artificially boosts dopamine levels, the brain has to readjust when the drug is no longer present in the body. However, many people feel better within two weeks of the last use.

Post-Acute Withdrawal Symptom (PAWS)

There is a distinct possibility that some Vicodin users can develop post-acute withdrawal syndrome or PAWS, which are emotional symptoms that can linger for a month or more.

PAWS can generate the following effects: 

  • Emotional blunting
  • Irritability
  • Fatigue
  • Insomnia
  • Depression
  • Anxiety

Vicodin Overdose and Why Treatment Is Necessary

Fatal opioid withdrawal is rare. However, the danger of Vicodin withdrawal is that the uncomfortable and painful symptoms can compel someone to relapse. In relapse, a person can take a large enough amount that leads to a fatal overdose. 

Symptoms of overdose can include the following, according to MedlinePlus:

  • Slow, shallow, or stopped breathing
  • Slowed or stopped heartbeat
  • Loss of consciousness
  • Seizures
  • Death
  • Excessive sleepiness
  • Narrowed or widened pupils
  • Cold, clammy, or blue skin

Treatment for Vicodin 

For opioid addiction, professional treatment is recommended over a cold turkey detox because it affords the client a medically supervised process.

Treatment starts with medical detoxification, the process in which Vicodin and other toxins are safely and comfortably removed from your body by a team of doctors, nurses, and other personnel. To block the associated withdrawal symptoms, patients can be administered approved opioid treatment medications like Suboxone or Subutex. 

After detox, clients can be placed in residential treatment, which addresses the psychological and emotional effects of Vicodin addiction, including PAWS. A residential program allows you to stay at a facility where you will receive treatment, which allows you to concentrate on your recovery full time. 

Plus, residential treatment will provide an array of evidence-based treatment modalities to address the root of your Vicodin abuse. Those programs include:

  • Addiction education classes
  • Nutritional therapy
  • Behavior therapy
  • Couples counseling
  • Individual therapy
  • Family therapy
  • Group therapy
  • Life Skills training
  • Medication management/Medication monitoring
  • Aftercare services/Alumni programs
  • Access to support groups

You can continue to receive therapy and care through an intensive outpatient program (IOP) or a partial hospitalization program (PHP). Both will allow you access to comprehensive therapy and care, while you live at home or some other independent living arrangement.  

You can also get connected to a recovery community like 12-steps to give you support after treatment.  


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Family Recovery Specialists. (n.d.). Vicodin Withdrawal. Retrieved from

FDA advisers vote to take Vicodin, Percocet off market. (n.d.). Retrieved from

Module 5: Assessing and Addressing Opioid Use Disorder (OUD). (n.d.). Retrieved from

National Institute on Drug Abuse. (n.d.). Prescription Opioids. Retrieved from

Ocean Breeze Recovery. (n.d.). Vicodin Withdrawal. Retrieved from

Opioid Overdose. (2018, December 19). Retrieved from

Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults-United States, 2016 | MMWR. (n.d.). Retrieved from

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