Opioid Epidemic: Uses, Abuses, and Innovation: Hydrocodone Zoe Boomgarden and Danny Peters

Identity Hydrocodone (dihydrocodeinone) is a semi-synthetic opioid Often taken in conjunction with acetaminophen, ibuprofen, or aspirin Examples of prescription drugs: Vicodin, Lorcet, Lortab, Hycet etc.

Structure Hydrocodone Oxycodone

Uses and Abuses Commonly prescribed for moderate to severe pain although it is sometimes prescribed as a cough medicine The effects of hydrocodone can last four to six hours depending on the specific medication Due to the effects of hydrocodone (relaxation, calmness, pain relief, euphoria) abuse and addiction is often seen In 2013, 46% of drug-related medical emergencies involved opioids. “Hydrocodone Addiction and Abuse” https://www.addictioncenter.com/opiates/hydrocodone/ (Accessed 5 Mar. 2018)

Synthesis with Thebaine Carroll, R.J.; Leisch, H.; Rochon, L.; Hudlicky, T.; Cox, D.P.; “One-Pot Conversion of Thebaine to Hydrocodone and Synthesis of Neopinone Ketal”; pp.747-52; Journ. O. Chem. 2008

Analytical Data Mass spectrum of hydrocodone Mass spectrum of oxycodone

Function and Dosage Binds to mu receptors which keeps pain signals from being sent to the brain Hydrocodone also sends signals of euphoria Activates the midbrain reward system -- signals in VTA -- releases dopamine to NAc VTA: ventral tegmental area NAc: nucleus accumbens PFC: prefrontal cortex LC: locus coerulus Kosten, T.; George, T; “The Neurobiology of Opioid Dependence: Implications for Treatment” National Center for Biotechnology Information. 2002

Function and Dosage The dosage amount and combination with other medication is mostly based on the doctor’s diagnosis and the patient’s tolerance to opioids It has been recommended that hydrocodone not be prescribed in excess of 90 - 200 MME Therefore, doses that may lead to addiction is highly subjective to each patient’s case 1 in 32 patients who died from an opioid-related overdose had increased their dosage to more than 200 MME Hydrocodone, like other opioids, activates the midbrain reward system (Scheme 3). The reward system produces signals in the ventral tegmental area, which releases dopamine into another part of the brain called the nucleus accumbens.This is the design behind the feeling of pleasure and the medical function of hydrocodone. The medical intention of an opiate’s function is to provide the patient pain relief. MME = morphine mg equivalents “How Much Hydrocodone Is Too Much in One Day?” https://www.promises.com/articles/opiate-drugs/much-hydrocodone-much-one-day/ (Accessed 6 March 2018)

Merits and Deficiencies In 2013 there were more than 136 million prescriptions for products containing hydrocodone A research study was able to develop a pure hydrocodone medication that had fast and long lasting effects. Side effects include: sedation, respiratory depression, mental clouding, euphoria, agitation, constipation, diarrhea, abdominal bloating, nausea, vomiting, headaches, and dizziness Krashin D; Murinova N; Trescot AM; “Extended-release hydrocodone - gift or curse?” J Pain Res. 2013; 6:53–57.

Merits and Deficiencies “Hydrocodone And Ibuprofen (Oral Route) Description and Brand Names.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 1 Mar. 2017, www.mayoclinic.org/drugs-supplements/hydrocodone-and-ibuprofen-oral-route/description/drg-20062862.

Merits and Deficiencies Compared with other Opioids Hydrocodone is more orally available than codeine and is six times more active1 It is equally as strong as morphine and 50% weaker than oxycodone 2 Can be combined with a decongestant or an expectorant so that it can be used as a nasal decongestant or cough suppressant 2 Oxycodone and hydrocodone are both used with acetaminophen to relieve pain and inflammation 1 LiverTox; “Hydrocodone”; National Institute of Health; https://livertox.nih.gov/Hydrocodone.htm;(Accessed 06 March 2018); 2018 2 Office of Diversion Control; “Hydrocodone”; Drug Enforcement Administration; 2014

Summary Hydrocodone and Morphine are similar in pain relieving efficacy It is most commonly mixed with acetaminophen Although it is extremely similar to oxycodone is terms of structure, it is 50% weaker than oxycodone Hydrocodone is an effective opioid used to treat moderate to severe pain although it may be abused

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