A Guide to Norco (Acetaminophen and Hydrocodone)
What is Norco?
Norco is available only in combination with other ingredients, and different combination products are prescribed for different uses. Some Norco products are used to relieve moderate to severe pain. Other Norco products are used to relieve cough.
Norco is in a class of medications called opiate (narcotic) analgesics and in a class of medications called antitussives. Norco relieves pain by changing the way the brain and nervous system respond to pain. Norco relieves cough by decreasing activity in the part of the brain that causes coughing.
A combination of two drugs, acetaminophen and hydrocodone. Acetaminophen is an over-the-counter analgesic drug that is found in popular medications like Tylenol. While long-term use of large amounts of acetaminophen is associated with liver damage, it is not normally considered to be a significant drug of abuse. Hydrocodone, on the other hand, is a narcotic pain reliever that is a full opioid agonist. It works very similarly to other drugs in its class, such as heroin and morphine. Hydrocodone is the same narcotic ingredient that is also present in Vicodin.
Norco is primarily used in the treatment of chronic pain and postoperative pain. The drug can only be legally obtained with a prescription from a physician. The drug has a significant potential for the development of abuse and physical dependence, and the DEA classifies Norco (and all hydrocodone products) as Schedule II controlled substances. As a result, they are tightly controlled.
Norco is in a group of drugs called narcotic pain relievers. It is similar to morphine. Its pain relieving effect is much stronger than codeine but weaker than that of morphine or dilaudid. Used for the relief of moderate to severe pain.
Typical solid oblong pills, usually marked with dosage size (30, 40, 80, etc…)
Tabs, Norco, Vikes and Viko
Anexsia, Co-Gesic, Dolorex Forte, Hycet, Liquicet, Lorcet 10/650, Lorcet Plus, Lortab 10/500, Lortab 2.5/500, Lortab 5/500, Lortab 7.5/500, Lortab Elixir, Maxidone, Norco, Polygesic, Stagesic, Vicodin, Vicodin ES, Vicodin HP, Xodol, Zamicet, Zolvit, Zydone
Routes of Administration:
Short – Term Effects
- Feelings of Relaxation
- Respiratory Depression
- Papillary Constriction
- Cough Suppression
Long – Term Effects
- Can produce severe respiratory depression
- Skeletal muscle flaccidity
- Reduction in blood pressure and heart rate
- Respiratory arrest
How Do Norco and Vicodin Differ?
Norco and Vicodin are both narcotic or opioid medications since they both contain hydrocodone. They are primarily prescribed for the control of chronic or acute pain. The drugs differ in the amount of acetaminophen that each drug can potentially contain. Vicodin offers different amounts of both acetaminophen and hydrocodone to allow an individual to have different doses of both of these substances, whereas Norco always contains 325 mg of acetaminophen. Norco can contain differing levels of hydromorphone, depending on the needs of the patient. The use of acetaminophen offers additional pain control, anti-inflammatory effects, and the potential to control fever if necessary.
Hydrocodone is a drug that has a mechanism of action similar to other drugs in its class. It readily attaches to specific receptors in the central nervous system that are associated with the subjective experience of pain. These receptors have an affinity for natural substances, such as endorphins and enkephalins, and the structure of endorphins and enkephalins is similar to the chemical structure of opiates. This results in their effectiveness in pain control and also their potential for abuse, as these drugs produce feelings of mild euphoria, anxiety reduction, mild sedation, and a relaxed feeling. These drugs also have indirect effects on other neurotransmitters, such as dopamine, that are involved in feelings of reinforcement.
Effects of Taking Norco
Because there is little abuse potential from acetaminophen, and this drug is an over-the-counter medication, the primary focus of this article is a discussion of the effects of the hydrocodone in Norco. Hydrocodone is developed from codeine, which is extracted from the opium in the poppy plant. At low to moderate doses, hydrocodone reduces the subjective experience of pain, increases feelings of relaxation and wellbeing, and has other effects, such as slowing respiration, heart rate, etc. Some people initially experience other side effects that can include nausea, vomiting, headache, and constipation, but these often subside over time. Taken at higher doses, the drug becomes more involved in the suppression of the functions of the central nervous system and may significantly lower respiration rates and heart rate to a dangerous point. The sedating effects of hydrocodone at higher levels also lead to severe impairment in cognitive abilities and judgment.
Like all opiate drugs, tolerance develops rapidly to hydrocodone. Individuals abusing hydrocodone for its psychoactive effects often find they need to rapidly increase their dose to get the same sensation they got at much lower doses. This need to keep increasing the dose continues and the individual eventually becomes physically dependent on the drug as their system adjusts to its presence. When levels of the drug fall, the individual experiences withdrawal effects.
Other issues that may occur with hydrocodone use include:
- Decreases in heart rate, blood pressure, and respiration rate
- Sustained feelings of lethargy, chronic sedation, and decreased motivation
- Issues with coordination and balance
- Decreased reaction times
- Cognitive issues, such as trouble with attention, forming new memories, and decision-making
- Psychological effects, such as increases in anxiety, feelings of depression, and, in some cases, hallucinations or delusions
- Seizures, in rare cases (Seizure potential is increased when individuals abuse hydrocodone products with drugs like alcohol, cocaine, and other central nervous system depressants.)
- Potential damage to the cardiovascular system, liver, respiratory system, and central nervous system as a result of long-term abuse (This can occur as a result of both the hydrocodone and acetaminophen.)
- The development of a formal substance use disorder
Even though individuals develop tolerance rapidly, there is always the potential that an individual will begin to have issues with judgment as they take more and more of the drug, and this can lead to the potential for overdose. An overdose of a narcotic medication is an extremely serious issue and a potentially life-threatening event due to the potential for the individual to stop breathing as a result of the drug’s effects in areas of the brain that control life-sustaining functions, such as heart rate and respiration.The National Institute on Drug Abuse (NIDA) lists some warning signs of an overdose:
- Profuse sweating accompanied by cold or clammy skin, a yellowish tint to the skin, and/or yellowish tint to the whites of the eyes
- Gastrointestinal issues that can include diarrhea, nausea, vomiting, and stomach cramps
- Suppressed respiration rate
- Decreases in heart rate and blood pressure
- Marked confusion, extreme lethargy, unconsciousness, or a comatose state
- Hallucinations, delusions, severe anxiety, or depression
Individuals who are suspected of overdosing on any narcotic medication, such as Norco, require immediate medical attention. Call 911, and attempt to place the person in a position where they will not choke if they vomit.
Dealing with an Opiate Use Disorder
In the current clinical nomenclature, the terms substance abuse and addiction have been replaced by the term substance use disorder. Because research has recognized that the link between what was formally recognized as abuse and addiction occurs on a continuum and is not easily separated, this term is used to replace these formal notions and more accurately described the issues that occur with individuals who have problems with drugs or alcohol.NIDA reports that abuse of prescription medications is a significant problem in the United States and that one of the classes of drugs that is most commonly abused by individuals are the opiate drugs. Treatment for the abuse of opiate drugs like Norco requires several important considerations.
If a person struggles with addiction to Norco, they should first undergo a full physical, psychological, and cognitive evaluation. Because individuals with substance use disorders often have other co-occurring mental health conditions, it is important to formally recognize and diagnose any of these at the start of the treatment program. In addition, many individuals with substance use disorders come from other situations that need to be considered when undergoing treatment, such as poverty, abusive relationships, unemployment, etc. Because a substance use disorder is partially fueled by an individual’s subjective experiences, it is important to have a clear picture of the person’s state of functioning before developing a treatment program for them.
A good number of people who have abused Norco for a significant length of time will have developed some level of physical dependence on the drug. Once the individual begins treatment and discontinues use of the drug, it is extremely important to address the withdrawal syndrome. Fortunately, medical detox from opiate drugs will typically make use of an opioid replacement medication, such as Suboxone. These medications will control withdrawal symptoms and also reduce cravings for Norco. Over time, the supervising physician will taper down the dosage of the opioid replacement medication at specific intervals to allow the person to slowly be weaned off narcotics.
Because relapse rates are extremely high in the early stages of recovery and especially high for individuals who have substance use disorders to drugs that produce physical dependence, it is extremely important to control the withdrawal syndrome.
Successful participation in a physician-assisted withdrawal management program is typically best achieved when the individual is administered the program as an inpatient. This allows 24-hour monitoring of the person and the ability of the treatment team to immediately deal with any complications. Unfortunately, not everyone can participate in a residential withdrawal management program. In some cases, an outpatient withdrawal management program may be sufficient.
Simply undergoing detox, or the withdrawal management process, is not sufficient to have a successful recovery. While medical management of any co-occurring conditions should continue, the cornerstone of any recovery program is some form of substance use disorder therapy. Therapy is formally defined as an intervention by a trained professional who uses psychological principles to help someone change their behavior.
Typically, substance use disorder therapy is based on the principles of Cognitive Behavioral Therapy (CBT). CBT addresses an individual’s belief system, attitudes, and expectations and how these affect their behavior. Individuals in therapy for substance use disorders need to understand the reasons that drive their substance abuse, develop coping skills that are not dependent on the use of drugs or alcohol, learn stress management techniques, and develop long-term plans for relapse prevention.
Even though most sources recommend the use of CBT for the treatment of substance use disorders, CBT is not appropriate for everyone, and other therapeutic interventions can be used. Formal substance use disorder therapy is often administered on an individual basis; however, any type of substance use disorder therapy can also be administered in a group therapy format. Many times, clients receive combinations of both individual therapy and group therapy.
Social support is an extremely important aspect of recovery. Individuals in recovery need assistance from family, friends, and others to help them adjust and move forward. Social support can be obtained in the form of formal therapy groups, social support groups, family therapy, and other community activities. Twelve-Step groups are useful social support groups for those in recovery. These groups are ongoing, and participation in them can continue long after one has completed formal therapy.
Other interventions and supports can be used depending on the needs of the person. It is important that an individual in recovery for substance use disorder be addressed as a complete person, and their substance use disorder not be considered a separate condition that is mutually exclusive of any other issues.