How harmful are low doses of Vicodin?
August 23, 2010 12:22 AM   Subscribe

How harmful are low doses of Vicodin?

My doctor has prescribed Vicodin (standard 5/500 dosage) for a chronic pain condition, to be taken as needed when pain flares up. It's quite effective for my pain, even if I take only a quarter of a pill at a time.

I am trying to judge what threshold of discomfort/pain I should tolerate before I take the Vicodin. A lot of the time the severity of my pain is in a gray area: I would benefit from the Vicodin, but I could get by without it.

To get a reference point, I'm interested in assessing how the health effects of Vicodin use compare in severity to other drugs, such as alcohol and marijuana, especially long-term. Right now I have no idea: is it way worse? Way better? About the same? This 2007 Lancet paper would be a useful starting point, but it doesn't include Vicodin in its ranking.

For those who are well versed, which of the following would you be most/least willing to tolerate the negative health consequences of?

(a) Taking half a pill of Vicodin
(b) Drinking 4 beers
(c) Vaporizing a typical amount of marijuana

(I ask only about the negatives because I can easily quantify the positives.)

About me: male, mid-20s, with moderate chronic pain, otherwise in good health.
posted by wireless to Health & Fitness (29 answers total) 1 user marked this as a favorite
 
A data point you may find useful: A good red flag for potential Vicodin addiction (in my personal experience, knowing people who have become addicted to it) is when you can get by without it, but you take it anyway.
posted by davejay at 12:34 AM on August 23, 2010


I'm somewhat averse to taking alcohol as a painkiller, so I'd put that at the bottom of the list.

If medical marijuana is available in your area as an option, that one's in the middle.

Vicodin would be at the top of the list.

For the love of god, don't take alcohol and vicodin. Or mix any two of the three, really. If you're only taking it once every few days, maybe try alternating methods? That's what I used to do for my migraines.

IANAD, IANAPothead.
posted by Heretical at 12:36 AM on August 23, 2010


c, then a, then b. Lots of factors, depends on how your personal biochem fits the list. But that's the order for my own perception of danger/damage. Definitely do not take acetominophen (the "500" in 5/500) and alcohol at the same time, veddy bad for the liver.
posted by telstar at 12:38 AM on August 23, 2010


Good answers so far.

I want to clarify that I'm not asking how effective alcohol/marijuana/Vicodin are at pain control. Only how harmful they are to one's health. (I'm just looking at the "Con" side of the Pro/Con table for now.) In fact, alcohol doesn't help my pain, and I've never used marijuana.
posted by wireless at 12:56 AM on August 23, 2010


This is really something to discuss with your doctor, but as I understand it, the only real danger of low doses of Vicodin is developing a tolerance (so you have to increase the dosage over time as low doses become less effective) and addiction (which is not the same as tolerance). The only real reason there's acetaminophen in those pills is so that you can't take a high dose, as you might recreationally, without hurting yourself or feeling very sick. To me, that suggests that the Vicodin itself is not terribly harmful in low doses.

IANAD; talk to yours. A pain specialist, if you can manage it.
posted by spaceman_spiff at 1:41 AM on August 23, 2010


The only real reason there's acetaminophen in those pills is so that you can't take a high dose

Acetaminophen and opiates work synergistically via separate mechanisms. You get a greater pain benefit from the combination than the simple sum of the pain reduction from each component.

posted by zippy at 2:08 AM on August 23, 2010 [1 favorite]


A correction of one small part of spaceman_spiff's post. You will not feel sick from taking too much acetaminophen. At least not quikcly. That's one reason it's so dangerous. Damage to the liver is what will produce the symptoms of OD and may take a day or more to become apparent. One can take a lethal dose and feel fine until it's too late to do anything about it.
posted by wjm at 2:21 AM on August 23, 2010 [2 favorites]


zippy: Hmm. Point. But that's not the only reason it's there.

wjm: I've heard that, but I've also taken too much acetaminophen, and it was not pleasant. (Not enough to be harmful in the long term ... I just took a few times the normal dose in a feverish haze.)
posted by spaceman_spiff at 2:44 AM on August 23, 2010


My own personal experience with vicodin was pretty unpleasant. For whatever reason, it did little to nothing to help me deal with recovery from back surgery. However, when I finished my prescription (one month), I had all of the joys of going through withdrawal. I was irritable, unpleasant to be around, and all around miserable. I'm actually pretty glad that it did nothing for me, considering how much my body seemed to want it after it was gone.
posted by Ghidorah at 3:40 AM on August 23, 2010


Talk to your doctor about managing Vicodin use and also any reputable alternative pain management treatments that don't involve drugs.
posted by Burhanistan at 5:27 AM on August 23, 2010


The problem with this kind of question is that the data you want is personal (if the average person tolerates a drug well but it causes you to throw up your lungs, you probably don't care that it is normally well tolerated).

My advice to people in your position is to look at the know issues associated with a drug and be watchful, but don't slide headlong into hypochondria.
posted by Kid Charlemagne at 5:34 AM on August 23, 2010


Those doses are so small that none of those things pose any serious risk of long-term health consequences. The liver is an amazing thing.

Half a pill of vicodin isn't going to hurt you, even if you do it every day. Still, watch to see if you're developing a tolerance. You can develop a nasty dependence if you aren't careful.
posted by valkyryn at 5:35 AM on August 23, 2010


I'd say half of a prescription Vicodin, for me, would be safer than four beers, but not as safe as just a single beer. Marijuana is far more dangerous than either, simply because of our insane drug laws (which may be different for your location and situation); job loss and prison time could certainly be considered as significant side effects. If marijuana laws were more reasonable, I'd still avoid it for pain relief, because, in my experience with it long ago, it made pain worse for me. People vary.

Vicodin makes me feel sick, with a little nausea, a little itchiness, and a general feeling of not-happy. I hate it. After surgery, I always end up discontinuing the painkillers before the pain is really bearable, because nausea feels worse than pain to me. Vicodin also causes major constipation for most people.

Consider whether there are any other drug options that might work for you as well. For my chronic pain condition, all I really need (and I feel fortunate) is one particular muscle relaxant, usually just to sleep, in addition to an anti-inflammatory for another condition. Some people find that an antidepressant can take the place of a painkiller, in spite of their not being depressed, because of the effects of antidepressants on pain.
posted by Ery at 5:36 AM on August 23, 2010


I was first prescribed Vicodin when I was 17. That was a bad idea. At that age I had no real understanding of how tolerance worked so when I noticed I wasn't getting the same effect from one pill as I had before, I just increased the dose. And took it just to sleep and other nasty habits. Vicodin is tricky because the addiction and tolerance sneaks up on you, so the most important thing is to be aware of that and watch how much and how often you take it. I am now living with chronic back pain and rarely take Vicodin unless I really really need it, at which time I take half a pill.

Physically, the only real health problem is the acetaminophen which is what leads to overdose in people who abuse Vicodin or try to commit suicide with it. If you're concerned about it, I would consider talking to your doctor about different options that don't include acetaminophen or non-narcotic options for pain, like Tramadol.
posted by threeturtles at 5:51 AM on August 23, 2010


why are you not having this conversation with your doctor?
random strangers spouting theories as if they were facts is no way to make medical descisions.
posted by swbarrett at 6:45 AM on August 23, 2010 [1 favorite]


I think it's interesting that some people view medications of any type, in any dose, as toxic. those same people oftentimes think nothing of taking all kinds of sketchy "natural" herbal preparations, drugs, and unhealthy foods. Not talking about you specifically, OP, just thinking out loud. In any case, IANYD, but there is nothing inherently dangerous about taking the prescribed dosage of Vicodin, unless you are one of the many people who get side effects with it such as nausea and vomiting. As everyone else is commenting, the risks associated with it are from overdose (Tylenol toxicity, or getting sleepy/comatose from too much of the narcotic). Those risks are not present if you take the regular dose, because you have enzymes in your liver that do their job of processing the acetaminophen, and the damage is only caused if you overwhelm the enzymes' capacity. That doesn't happen, generally, until you are taking >4grams of acetaminophen in a day (8 Vicodin). I always tell my patients not to drive or operate heavy machinery after takin Vicodin or any other narcotic because they could hurt themselves while they're not at 100% mentally.

threeturtles, don't be fooled. Tramadol is an opiate, some people considered it 'non-narcotic' initially, but it is not. It is addictive, just less so than some of the other options.

OP, if the number of beers was decreased, I would say that beers are best for you, then Vicodin, then marijuana, healthwise. My reasoning? Moderate alcohol intake has been associated with health benefits such as decreased risk for coronary artery disease. Vicodin does not have any health benefits aside from relieving pain. Marijuana has pain relief and appetite-stimulating properties, but in the long term, causes cancer just like anything else you smoke. So, in moderate amounts, alcohol can theoretically help you live longer, Vicodin can only help you live happier, and marijuana may shorten your lifespan. That being said, in moderation I don't consider any of them to be dangerous drugs, and in terms of addiction/dependence, I am much more frustrated by alcoholics (who die a horrible, miserable death from cirrhosis) and opiate addicts who constantly harass me for another prescription.
posted by treehorn+bunny at 7:00 AM on August 23, 2010 [1 favorite]


Anecdata: I was prescribed a low dose of Vicodin (10/325, but cut in half) for chronic pain last year. I took it for about three months on an as-needed (daily, but sometimes just once a day) basis but decided that, due to addiction issues in my family, it wasn't a good idea. I could sense that I was building a tolerance to it and needing full, rather than half, doses to get any pain relief.

The orthopedist who prescribed it for me said there was *no* chance of developing an addiction at that low of a dose. When I stopped taking it, I went through about two weeks of withdrawal symptoms - nausea, dizziness, irritability, nothing too severe but unpleasant. I ran this past my GP, whose second specialty is addiction treatment, after the fact, and he told me in his opinion it's definitely possible (and even likely) to develop an addiction on a low dose, and that what I experienced was indeed withdrawal.
posted by chez shoes at 7:29 AM on August 23, 2010


IANAD.
One thing that may be useful to take into account, and maybe you already know this -- but the key to pain management is staying ahead of it. For example: if you have a headache for a couple of hours, it's going to require more pain meds to make the pain go away then if you'd taken something as soon as you began to feel the pain.

Also, ibuprofen is much more effective on muscular pain than acetaminophen -- which is better for headaches/toothaches, etc. Aleve seems to work on both, but not as well (in my experience).

I have a history of addiction, so I would be pretty wary of the vicodin (for myself) as well. I had to take it post-surgery and took it as directed for 3 days (instead of the 7 they rx'd) and then stopped. If I needed it for chronic pain, I suspect what I would do is take the 'normal' dose of whichever of the above meds was appropriate for my type of pain, and then if I was still in pain an hour later ~then~ I would take the vicodin. Most days, once the OTC meds kick in, one would then go about their day and forget about the vicodin entirely. If you still had pain, you'd take the vicodin. If you didn't have pain and still thought of the vicodin, then you could wonder about it's addictive qualities.

As far as acetaminophen & liver issues, I haven't researched that. However, ibuprofen will cause ulcers -- the pain from which I've been able to be rid of by stopping the ibuprofen and taking pepto bismol pills (not antacids) -- there's something in them that helps to restore the lining of the stomach. Also, I always take them with milk to reduce the chance of vomiting.

Hope some of that was useful!
posted by MeiraV at 8:05 AM on August 23, 2010


Hydrocodone is extremely safe. The acetaminophen (Tylenol) in Vicodin is orders of magnitude more dangerous. To the extent that the USA has proposed banning Vicodin and Percocet... not because of the hydrocodone but because of the tylenol.

I would ask for something without acetaminophen in it. That crap is dangerous. Hydrocodone is nothing.
posted by Justinian at 8:59 AM on August 23, 2010


The worst thing about low dose Vicodin usage - in my observation of several friends and family members - is that it tends not to remain "low dose" for very long. Eventually the dose starts to creep upwards, and then... yeah.
posted by ErikaB at 11:16 AM on August 23, 2010


My reasoning? Moderate alcohol intake has been associated with health benefits such as decreased risk for coronary artery disease. Vicodin does not have any health benefits aside from relieving pain. Marijuana has pain relief and appetite-stimulating properties, but in the long term, causes cancer just like anything else you smoke.

It's odd to see a doctor write something like this. The alcohol bit is correct, though please remember correlation does not equal causation. But as a biologist who's been working on developing cannabinoids for post-operative pain relief for several years now, I'd love to see some credible citations for stating that marijuana causes cancer. Most of the papers I've seen indicating there may be a link confound cigarette and marijuana smokers. Hell, there are many papers coming out these days that indicate cannabinoids inhibit cancer cell proliferation, induce cancer cell apoptosis, and impair tumor angiogenesis.
posted by Thoughtcrime at 11:43 AM on August 23, 2010 [1 favorite]


Forgot to mention, alcohol consumption has been shown conclusively to increase the incidence of cancers of the mouth, esophagus, pharynx, larynx, liver, stomach, ovaries, and breast cancer (in women). Alcohol is a IARC Group 1 carcinogen. Alcohol would definitely not be on the top of my list.
posted by Thoughtcrime at 12:01 PM on August 23, 2010


The only one of those three options which is non-toxic and impossible to overdose on (either accidentally or purposely) is marijuana. If you live in a state that allows for medical marijuana, it's certainly worth trying for a few weeks to see what you think of the relief it offers. The people who work at your local dispensary can guide you to strains that are specifically grown to help chronic physical pain rather than ones that are grown for anxiety or other problems.
posted by Asparagirl at 7:01 PM on August 23, 2010


As long as you only get the Vicodin/hydrocodone from one doctor, and you trust that doctor, that will help with any concerns as well. I also take it for chronic pain and my doctor woudl notice if I suddenly started asking for more of it (she's mentioned this when I commented that my only concern was possible addiction). Basically I'm on a low dose and she's keeping me on that, and any increase would involve a conversation with my doctor.

Of course, I could cheat and try to do this trick with multiple doctors, but I'm not really worried about that personally, so I figure between me and my doctor we have this under control.

And like you I find it incredible useful/effective.

I don't get why marijuana is supposed to help with physical pain, but maybe it's different for different people. All I can say is if that were true I wouldn't be on the hydrocodone...
posted by wildcrdj at 7:18 PM on August 23, 2010


Oh, and I don't actually take Vicodin but Hydrocodone+Ibuprofin (rather than acetaminophen). Much like Vicodin itself, the ibuprofen is probably more dangerous than the hydrocodone (ibuprofen can cause stomach issues among other things).
posted by wildcrdj at 7:21 PM on August 23, 2010


Re: comments from Thoughtcrime.

You are right regarding the link between alcohol and cancer. Alcohol can cause increased incidence of cancer but that generally has been linked with greater doses of alcohol (>1 drink daily for women, and greater than 2 drinks daily for men). Also, it has an additive effect with smoking in terms of carcinogenesis. That's why I qualified my statement regarding alcohol. It's absolutely not safe. It can be terribly dangerous.
Here is a nice Mayo Clinic article about risks vs. benefits. I drink red wine mainly because I think resveratrol is probably a good thing, though we need more studies.

Regarding marijuana, I think your crusade may need greater clarity. When you smoke something, it produces carcinogens, whether it is your bacon or your pot. This is because the process of burning/smoking produces polyaromatic hydrocarbons (PAH). My statements do not apply to cannabinoids when they are not smoked, which have been insufficiently studied to draw health conclusions about. But how many people out there use cannabinoid pills? I see them in my practice, but not very often.
posted by treehorn+bunny at 8:16 PM on August 23, 2010


wjm: "A correction of one small part of spaceman_spiff's post. You will not feel sick from taking too much acetaminophen."

Usually. If I take 2 Tramadol or a Tramadol and a Vicodin less than 6 hours apart, I shake like I drank 2 pots of coffee. Don't know if that's a result of the acetaminophen or not.

Justinian: "Hydrocodone is extremely safe. The acetaminophen (Tylenol) in Vicodin is orders of magnitude more dangerous. To the extent that the USA has proposed banning Vicodin and Percocet... not because of the hydrocodone but because of the tylenol.

I would ask for something without acetaminophen in it. That crap is dangerous. Hydrocodone is nothing.
"

Just to be clear (and careful), hydrocodone + APAP (acetaminophen) is the generic of Vicodin. I think Justinian is specifically talking about hydrocodone separated from the acetaminophen here.
posted by IndigoRain at 11:40 PM on August 23, 2010


Yeah. I refuse to take anything with acetaminophen in it but if prescribed hydrocodone or similar for pain I'd take it without blinking. If I were in pain. Hypothetically speaking possibly even if not.

To a first approximation it is fair to say that low doses of Vicodin are essentially as harmful as low doses of Tylenol.
posted by Justinian at 12:30 AM on August 24, 2010


Regarding marijuana, I think your crusade may need greater clarity. When you smoke something, it produces carcinogens, whether it is your bacon or your pot. This is because the process of burning/smoking produces polyaromatic hydrocarbons (PAH).

That's a good theory, but it hasn't been borne out by actual studies. Another theory is that smoking a substance that inhibits cancer cell proliferation, induces cancer cell apoptosis, and impairs tumor angiogenesis may actually reduce the risk of getting cancer, or at least counteract any potential harm from inhaling PAH.

Also, plenty of people ingest marijuana. Not as a pill (though of course there are two FDA approved cannabinioids in pill form), but in brownies, cookies, etc.
posted by Thoughtcrime at 8:19 AM on August 25, 2010


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