Drug Enforcement Administration

Office of Diversion Control

Drug & Chemical Evaluation Section

HYDROCODONE

(Trade Names: Vicodin®, Lortab®, Lorcet-HD®, Hycodan®, Vicoprofen®)

October 2014

DEA/OD/ODE

Introduction:

Since 2009, hydrocodone has been the second most 

frequently encountered opioid pharmaceutical in drug 

evidence submitted to federal, state, and local forensic 

laboratories as reported by DEA’s National Forensic 

Laboratory Information System (NFLIS) and System to 

Retrieve Information from Drug Evidence (STRIDE).

Licit Uses: 

Hydrocodone is an antitussive (cough suppressant) 

and narcotic analgesic agent for the treatment of moderate 

to moderately severe pain. Studies indicate that 

hydrocodone is as effective, or more effective, than codeine 

for cough suppression and nearly equipotent to morphine 

for pain relief.

Hydrocodone is the most frequently prescribed opiate 

in the United States with more than 136 million 

prescriptions for hydrocodone-containing products 

dispensed in 2013 and with nearly 65.5 million dispensed in 

the first six months of 2014 (IMS HealthTM). There are 

several hundred brand name and generic hydrocodone 

products marketed, most of which are combination 

products. The most frequently prescribed combination is 

hydrocodone and acetaminophen (Vicodin®, Lortab®). 

Chemistry/Pharmacology:

Hydrocodone [4,5α-epoxy-3-methoxy-17-methylmorphinan-6-one tartrate (1:1) hydrate (2:5), 

dihydrocodeinone] is a semi-synthetic opioid most closely 

related to codeine in structure and morphine in producing 

opiate-like effects. The first report, that hydrocodone 

produces euphoria and habituation symptoms, was 

published in 1923. The first report of hydrocodone 

dependence and addiction was published in 1961.

Illicit Uses: 

Hydrocodone is abused for its opioid effects. 

Widespread diversion via bogus call-in prescriptions, 

altered prescriptions, theft, and illicit purchases from 

Internet sources are made easier by the present controls 

placed on hydrocodone products. Hydrocodone pills are 

the most frequently encountered dosage form in illicit traffic. 

Hydrocodone is generally abused orally, often in 

combination with alcohol.

Of particular concern is the prevalence of illicit use of 

hydrocodone among school-aged children. The 2013

Monitoring the Future Survey reports that 1.4%, 4.6% and 

5.3% of 8th, 10th, and 12th graders, respectively, used 

Vicodin® for nonmedical purposes in the past year.

The American Association of Poison Control Centers 

(AAPCC) reports that in 2012, there were 29,391 total 

exposures and 36 deaths associated with hydrocodone in 

the U.S. The 2013 National Survey on Drug Use and 

Health (NSDUH) reports that 24.4 million people in the U.S. 

population, aged 12 and older, used hydrocodone for 

nonmedical purposes in their lifetime, compared to 25.7 

million in 2012. There was a significant decrease in reports 

of lifetime nonmedical use among those aged 12 to 17 and 

aged 18 to 25, compared to 2012. According to the Drug

Abuse Warning Network (DAWN ED), an estimated 82,480

emergency department visits were associated with 

nonmedical use of hydrocodone in 2011. This number of 

ED visits represents a 107% significant increase from the 

number of ED visits reported in 2004 (39,846). The Florida 

Department of Law Enforcement reported 431 deaths as 

being related to hydrocodone from January to June 2013, 

an 8.8% increase from the previous six months (396 

deaths, July – December 2012). Of these 431 deaths, 158 

of them were determined to be caused by hydrocodone.

As with most opiates, abuse of hydrocodone is 

associated with tolerance, dependence, and addiction. The 

co-formulation with acetaminophen carries an additional 

risk of liver toxicity when high, acute doses are consumed.

Some individuals who abuse very high doses of 

acetaminophen-containing hydrocodone products may be 

spared this liver toxicity if they have been chronically taking 

these products and have escalated their dose slowly over a 

long period of time.

User Population:

Every age group has been affected by the relative ease 

of hydrocodone availability and the perceived safety of 

these products by medical prescribers. Sometimes viewed 

as a “white collar” addiction, hydrocodone abuse has 

increased among all ethnic and economic groups.

Illicit Distribution:

Hydrocodone has been encountered in tablets, 

capsules, and liquid form in the illicit market. However, 

hydrocodone tablets with the co-ingredient, acetaminophen, 

is the most frequently encountered form. Hydrocodone is 

not typically found to be clandestinely produced; diverted 

pharmaceuticals are the primary source of the drug for 

abuse purposes. Doctor shopping, altered or fraudulent 

prescriptions, bogus call-in prescriptions, diversion by some

physicians and pharmacists, and drug theft are also major 

sources of the diverted drug.

The National Forensic Laboratory Information System 

(NFLIS) is a DEA database that collects scientifically 

verified data on drug items and cases submitted to and 

analyzed by state and local forensic laboratories. The 

System to Retrieve Information from Drug Evidence 

(STRIDE) provides information on drug seizures reported to 

and analyzed by DEA laboratories. In 2013, there were 

34,961 hydrocodone reports identified in the NFLIS and 

STRIDE systems, a decrease from 41,401 reports in 2012.

Control Status:

The DEA published in the Federal Register the final 

rule placing hydrocodone (in bulk, single entity products, 

and combinations) in Schedule II of the CSA. This rule is 

effective as of October 6, 2014.

Comments and additional information are welcomed by the Drug and 

Chemical Evaluation Section, Fax 202-353-1263, telephone 202-307-

7183, or E-mail ODE@usdoj.gov.