Which prescription pain drug is more addicting, Oxycodone or hydrocodone?
When someone asks which drug is stronger, oxycodone vs hydrocodone, they may mean one of several things. They might be wondering about which drug relieves pain better.
If someone is suffering from moderate to severe pain, and they are offered a Vicodin prescription by their doctor, they may feel as if the doctor is choosing a lower strength option which might not work as well.
For many years, the impression of health professionals and patients was that hydrocodone was the weaker of the two drugs. Oxycodone was clearly, in the minds of many people, the more powerful opioid pain reliever.
When someone has acute extremity pain, low back pain, tooth pain, or diabetic neuropathy, they might think of Vicodin or Norco. Yet, when it comes to cancer pain, oxycodone is more likely to be prescribed.
Additionally, oxycodone had a reputation for having a higher abuse potential, compared to hydrocodone. People who were trying to get high off of an opioid pain pill preferred oxyocodone over Vicodin. Addiction treatment programs that deal with addiction treatment for opioid abuse see more issues with oxycodone compared to vicodin problems.
Why did people think that Oxycodone pills, such as roxycodone or percocet were stronger than hydrocodone pills, such as Norco, Vicodin, Lorcet, and others.
Do people still feel that oxycodone is stronger? In 2014, hydrocodone was moved from the schedule III category up to Schedule II. Schedule II drugs are prescription drugs with the highest potential for abuse and addiction.
After decades at the Schedule III level, where doctors could give refills and call in prescriptions on the phone, the narcotic pain medication hydrocodone was bumped up to the same controlled level as oxycodone, where prescriptions could not have refills or be called in on the phone.
This change in the federal government’s treatment of hydrocodone tablets was a significant inconvenience for many patients. There were patients who were given up to six months of refills for Vicodin, Vicoprofen, Norco, Lorcet, or Lortab.
While the concern was abuse of hydrocodone, there were many patients with chronic pain, and also with acute pain, who did not abuse the drug. Yet, the level of abuse was enough to cause concern.
Many people believed that hydrocodone was abused mostly because it was relatively easy to get. Doctors were not as concerned about writing a prescription, because it was a schedule III. They were under the impression that it had a lower abuse potential compared to schedule II opioids, such as oxycodone, Dilaudid, Morphine, and OxyContin.
How addicting is hydrocodone compared to oxycodone?
Did hydrocodone become stronger and more addicting after 2014? No, hydrocodone remained the same drug that it had always been. The reason for the change was that abuse levels of hydrocodone were rising, in part, because people thought it was safer and less addicting.
Also, hydrocodone was, before October 2014, easier to obtain from doctors and pharmacies. By raising the control level of the drug, the government was able to reduce diversion and street sales of hydrocodone.
Yet, the question remains, how does hydrocodone stack up to oxycodone? Is it as strong of a drug for pain relief? Does it have the same abuse and addiction potential?
If you look at an opioid conversion chart, you can get a better idea of the relative potency of various opioids. Most charts treat the opioid medication morphine as the standard, giving it a potency value of 1.
How does hydrocodone compare to oxycodone on an opioid potency conversion chart? Surprisingly, these two drugs are considered to be equally potent. Both should, at the same strength, provide about the same level of pain relief.
For example, if a person takes a percocet 10mg tablet for back pain, they are taking oxycodone 10mg and acetaminophen 325 mg. Or, if a person takes Norco, they are taking 10mg of hydrocodone and 325mg of acetaminophen.
Is it possible that hydrocodone and oxycodone are of equal strength?
These two tablets should work about the same. Even though people have long held the opinion that the Norco will be less potent, the fact is that it is not less potent.
What about the potency of getting high for hydrocone vs oxycodone? Does oxy get people higher than hydrocodone? From discussing the topic with people who previously abused these opioids, the impression is that oxycodone is a preferable drug of abuse.
Part of the reason why oxycodone is preferred may be that it is available in much stronger tablets. For example, there are short acting oxycodone 30mg tablets.
There are also OxyContin 80mg tablets, which are far more potent than a hydrocodone 10mg tablet. Another benefit for people looking to abuse pain pills is that it is far easier to get a form of oxycodone that does not contain tylenol, compared to hydrocodone.
Opioid pain pill abusers do not want to have to worry about the liver toxic effects of tylenol added to their pain pill. For this reason, they seek out oxycodone 30mg or OxyContin 80mg tablets.
There are extended release forms of hydrocodone, just like OxyContin is a time release version of oxycodone. For example, there is Zohydro, and Hysingla ER.
These extended release versions of the opioid, hydrocodone, make it possible for hydrocodone abusers to take high dosages of the drug without worrying about added tylenol.
Are high potency hydrocodone extended release tablets, such as Zohydro and Hysingla ER, becoming a problem on the streets?
However, these newer extended release opioid brand name drugs are not as well known as brands such as OxyContin, Percocet, and Vicodin. With less street recognition, there tends to be less misuse of a particular brand name drug.
What about when other drugs are added to the mix? What if an opioid pill user combines one of these two opioids with Xanax, Soma, gabapentin, or another drug that might potentiate the effects?
It is possible that the intensity or quality of the high that an opioid abuser experiences with cocktail of drugs that includes oxycodone might be more intense than if hydrocodone were used instead. It is hard to say definitely, because any data would be anecdotal.
It is unlikely that any doctors or scientists will ever conduct a study on this subject, of which combinations of prescription drugs are preferable to drug abusers. Possibly, hydrocodone is just as potent with various mixes of sedating drugs, compared to oxycodone.
For example, in Texas, many years ago, there was a combination of drug commonly taken together, which was so common, it was named, “The Holy Trinity.” These drugs were hydrocodone, Soma, and Xanax.
Were abusers using hydrocodone because it gave them the best high, or because it was more readily available? We may never know for sure, other than to get the feedback of a former opioid-addicted person with experience with these drugs.
Is it important to determine which opioid is stronger or more addicting, oxycodone or hydrocodone?
Law enforcement officials do have interest in which drugs are preferred by drug users. It helps them to contribute to new policy and it helps them to direct their efforts in preventing further diversion of prescription opioids.
Rather than looking at how users experience the high of one drug versus another, law enforcement officers pay more attention to the street values of the drugs.
How can a drug enforcement officer know what pain pills are selling for on the streets? They may go undercover, attempting to buy pills from dealers.
Or, they may question drug users whom have been arrested. The street price data is collected and studied.
When a drug has a higher street value, it indicates that it is more preferred by drug users. With all other things being equal, if there is plenty of hydrocodone and oxycodone being sold by street dealers, and oxycodone is sold for a higher price per milligram, drug agents may infer many things from this information.
A drug with a higher street value is considered to have higher abuse potential. It is likely to be more addicting, indicating that it gets users more high, reprogramming the brain’s reward center to want more and more of the drug.
Is hydrocodone still considered to be as strong as oxycodone, now that it is also a schedule II drug?
Back before October 2014, hydrocodone was a top opioid of abuse, mainly because it was relatively easy to obtain. Patients were able to fill large prescriptions with little difficulty.
With hydrocodone filling medicine cabinets, it was inevitable that some would be diverted to the streets. Updating hydrocodone to CII status has cut way back on availability of hydrocodone.
Are opioid abusers still seeking out hydrocodone? Are they paying top dollar on the streets to obtain what is left of the dwindling supply of this prescription opioid?
The fact is that, even with oxycodone and hydrocodone being difficult for street users to obtain, oxycodone seems to still be the top attraction. When an opioid-addicted person is looking for pain pills, they are typically seeking oxycodone.
Oxycodone is bought on the streets for a dollar per milligram. This means that a Roxicodone 30mg tablet sells for $30.
A patient filling a prescription for the same drug at a pharmacy may pay only a small copay of a few dollars to obtain hundreds of these tablets. Hydrocodone is not likely selling on the streets for the same hyperinflated price as oxycodone.
Another indicator might be the consideration of fake pain pills being sold on the streets. As you may have heard, various pills sold by street drug dealers are not real pharmaceutical products.
Dealers are selling pills that look exactly like Xanax or oxycodone, but they are fake pressed pills filled with fentanyl. Fentanyl is a deadly, highly potent synthetic opioid.
What is the most common fake pill being sold currently? Is it Vicodin, Norco, or Lorcet? Is it Lortab, Zohydro, or Hysingla ER?
I am not aware of any fake versions of these hydrocodone pills being sold on the streets, though it is always possible that clandestine drug labs and dealers will start making them at any time.
By far, the most commonly faked pain pill is the oxycodone 30mg blue tablet. These oxy pills are known on the street simply as “blues.” Additionally, Xanax bars are also being sold as fentanyl fakes.
Could it all be in my head, which pain pill is stronger?
Getting back to legitimate use of these pills and judging which works best for real pain, has it been determined if one works better than the other? Even though the charts say they are about the same, per milligram, are the equigesic charts correct?
Interestingly, there are patients who state that hydrocodone works better for their pain. They would rather take a Norco 10mg than a Percocet 10mg for chronic or acute pain.
Is it possible that hydrocodone is the stronger opioid? Or, could it be a genetic difference between different people, where the mu opioid receptors respond better to one opioid than another?
More likely, the difference is a psychological preference for what has worked best for a person in the past, or what has worked for a trusted family member or loved one. For example, if Vicodin helped with Mom’s arthritis, then Vicodin seems to work best for daughter or son.
This psychological effect, where a particular brand, or chemical formulation of a drug works best for a person, is true for many medications. For example, it is well known that there is a similar effect with antidepressants, where there are multiple drugs in a class that are nearly identical in effect, but one works best for a particular person.
If Zoloft works best for a family member, rather than Paxil, Prozac, or Lexapro, then Zoloft will likely work best. Sometimes it is best for a doctor to listen carefully to a patient, rather than insisting on making arbitrary medical decisions.
The same goes for pain medicines. A person may also have a prejudice against oxycodone, due to the many news stories about abuse and addiction.
If someone has worked in a heroin addiction treatment center, or other types of opioid substance abuse treatment programs, they have likely heard many more stories of heroin addicts starting out with oxycodone, compared to hydrocodone. Addiction therapy services for opioid pain pill addictions are much more familiar with oxycodone addiction compared to hydrocodone addiction.
They may feel that hydrocodone is the safer drug, even though there may be little difference between hydrocodone and oxycodone. Both drugs work on the same receptors and have very similar effects.
Yet, the perception of a patient about which is safest and which will work best is significant. When a patient is convinced that a medical treatment is unsafe, or ineffective, it is unlikely that it will work for them.
Should doctors even prescribe either of these two opioids anymore?
This is an interesting question. Why, after the serious consequences of pill mills and the opioid crisis, would doctors continue to prescribe these pain pills?
Now that we know that Purdue, the maker of OxyContin, was heavily influencing the medical community with propaganda, should doctors carefully rethink their position on opioid prescribing? Of course, doctors should always do their research and understand the issues surrounding pharmaceutical products.
We are discovering that many FDA approved drugs may not be as safe as we once thought. The dangers of the system for approving and allowing drugs on the market are now better understood.
Doctors, and patients, should both read and re-read the literature about prescribed medications. The fine print contains many warnings that may have been missed, with the misleading colorful marketing material provided by the drug corporations.
While prescribing of hydrocodone or oxycodone must be done very carefully, these drugs have been around for a very long time, and their effects are well understood. We know that they may cause some people to become addicted, yet they are otherwise safer than many alternative drugs in treating pain.
Doctors should not prescribe these drugs when there are non-drug alternatives, or non-opioid short-term meds, such as Tylenol or ibuprofen. Yet, if a patient benefits from an opioid pain pill, and has not had problems with it, effective treatment should not necessarily be withheld.
An alternative pain med is buprenorphine, an opioid with unique properties that reduces the likelihood of leading to addiction, tolerance, or dependence. Buprenorphine is mostly used to treat opioid addiction, but it is also used to treat pain.
There are at least two buprenorphine brands approved by the FDA for treating pain. There is the Butrans 7-day patch, and the Buprenex injection.
Of course, in addition to these opioid medications, there are many non-medication methods for treating both acute and chronic pain. We must always explore and consider non-drug therapies for all medical conditions to reduce our reliance on the simple fix of prescription and over-the-counter drugs to treat symptoms.
