How Much Hydrocodone Is Too Much in One Day?
Hydrocodone is currently the most commonly prescribed opioid painkiller in the United States. A semi-synthetic narcotic medication that is sold as a generic or under the brand names Vicodin, Hysingla, Zohydro, Norco and Lorcet, hydrocodone is also one of the most commonly misused or abused opioid painkillers.
Like all opioids, hydrocodone is highly addictive, particularly if a person takes too much of the medication for too long. How much hydrocodone is too much? The threshold for safe opioid prescribing is actually lower than most people think. Until very recently, most agencies recommended that doctors prescribe 90 MME to 200 MME (morphine milligram equivalents) of an opioid medication per day for pain management. However, new research findings indicate that even a 90 MME hydrocodone dosage would be too much for most patients to take in one day.
How do you become addicted to hydrocodone?
Too much hydrocodone taken for too long can lead to addiction. How does this happen? Opioids such as hydrocodone, oxycodone, oxymorphone and others activate opioid receptors in your brain and nervous system, inhibiting pain signals. At the same time, they activate the reward signals in your brain, filling the pleasure circuits with dopamine (a “feel-good” neurotransmitter), which leads to euphoria. The pleasure surge caused by opioid medications is what makes them so powerfully addictive. Addiction occurs when a person’s neurons adapt to the drug, even if they are taking it as a prescription to manage pain.
With opioids, the transition from an initial prescription to chronic use or overuse can happen surprisingly quickly, depending on the dose level and treatment duration. How does a person get hooked on hydrocodone? Studies show that the initial opioid painkiller prescription a person receives will influence their likelihood of becoming dependent or addicted to it—if too strong for too long, they may have difficulty stopping the medication. People on long-term hydrocodone often need to undergo several days of medically assisted detox to help them manage difficult withdrawal symptoms, which can include a spike in pain.
Safer Opioid Dosage Guidelines
Due to widespread problems with prescription painkiller addiction and overdose, the Centers for Disease Control and Prevention (CDC) has issued new opioid/opiate painkiller dosing guidelines designed to help reduce risks. Since even small to moderate doses of hydrocodone and similar medications may be problematic, the CDC recommends that each patient be prescribed the lowest effective dose for their individual needs.
According to the new CDC guidelines, 20 to 30 morphine milligram equivalents (MME) per day is considered a low opioid dose for chronic pain that will be suitable in most cases, but still carries an addiction risk. Around 50 MME per day is the dose threshold at which the CDC advises clinicians to exercise extreme caution with opioid prescriptions.
In accordance with safety guidelines from the CDC, six U.S. states limit the length or prescription opioid treatment to five to seven days to prevent addiction (Connecticut, Massachusetts, Rhode Island, New York, Maine and New Jersey). Experts believe that, depending on the dosage, a person can become dependent or addicted to opioid painkillers in seven days or less. Given the potential for addiction within a short timeframe, many doctors will transition patients to non-opioid painkillers after seven to 14 days.
How much hydrocodone can kill you?
It is important to note that a safe hydrocodone dosage will differ from person to person, depending on their condition and size, but people of varying sizes and conditions often receive prescriptions for the same daily dose. This means that a relatively small-sized person with only moderate pain management needs might receive the same prescription as someone much larger—far more than they need. What is a safe hydrocodone dose for one person may turn out to be a hydrocodone lethal dose for another person, particularly if they are mixing it with alcohol or other medications that raise the toxicity levels in their system. If a person is taking hydrocodone along with another opioid medication, even as a cough medicine, they are at increased risk of overdose. This is because opioids repress respiratory function, which can lead a person to stop breathing.
Other factors influencing hydrocodone safety include a person’s individual tolerance to opioid medications, as well as the mode of ingestion. If a person has become physically tolerant to opioids and begins misusing them by taking far more than prescribed to get the desired effect—one in 32 patients who died of opioid-related overdose in 2013 had increased their dose to more than 200 MME per day — their risk of overdose is higher. People who misuse hydrocodone by crushing the pills and snorting the powder or dissolving it in liquid to inject it are putting themselves in grave danger. Hydrocodone is an oral medication that is typically compounded with acetaminophen as a combination painkiller — the acetaminophen renders hydrocodone particularly toxic at higher doses, and more dangerous to snort or inject.
Signs of Hydrocodone Addiction
What are the symptoms of addiction to hydrocodone or other pain pills? If someone is taking too high a dose or is otherwise overusing hydrocodone, some symptoms to watch out for are a slower heartbeat, lightheadedness, confusion, depression, blurred vision, headaches, nausea and vomiting. Some people even experience seizures. If you notice any of these symptoms in yourself or a loved one, notify your doctor.
CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016.
Opioids. National Institute on Drug Abuse (NIDA), 2017.
Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. SAMHSA, 2016.
Hydrocodone. Drugs.com, 2017.