Theresa A. Cassidy, MPH, Natasha K. Oyedele, MPH, Jared Beaumont, MPH, Stephen F. Butler, PhD

Presented at PAINWeek 2015

“Patterns of abuse of hydrocodone combination products: Results from an Internet survey of recreational drug users”

Summary: Researchers conducted this study to examine the progression of hydrocodone combination products (HCP) abuse, routes of administration, and reasons and motivation for abuse. It was concluded that abuse of HCP impacts a large number of prescription opioid abusers who demonstrate a level of progression and severity of abuse, which may indicate that this substance acts as a gateway drug.


  • Adult participants completed a web-based survey on medical and non-medical use of HCP—the survey was found on drug-related discussion forums.
  • Between December 2014 and March 2015, researchers recruited 304 U.S. participants.
  • They examined demographic characteristics, history of abuse, specific routes of administrations, and knowledge and opinions of HCP.
  • Abuse and/or misuse was described as using the product when it was not prescribed to the patient or used in a manner not prescribed.
  • Researchers also assessed the participants’ knowledge and opinions of rescheduling of HCP from schedule III to schedule II.


  • Ninety-four percent (n=285) of participants reported either medical or non-medical use of a prescription opioid at one point in their lifetime, while nearly 6% (n=17) of respondents indicated use of only a prescription opioid for medical reasons and use as prescribed.
  • Over half of the first-time opioid users reported non-medical use, and, of note, first-time HCP users were very young (17% were between 10 to 13 years).
  • Almost 60% of lifetime HCP users indicated their first use was non-medical, and were primarily between 14 and 18 years old at first use.
  • Most lifetime users obtained the pills from family or friends and swallowed the drug whole.
  • Of the 288 lifetime HCP users, approximately 60% (n=175) were former HCP users who advanced to more potent prescription opioids to get a more quality high (n=28).
  • The following were the preferred routes of administration among lifetime users: swallowed whole (58.6%); chewing, drinking in a solution, or snorting (41.4%).
  • Lifetime HCP, oxycodone combination product (OCP), and other opioid users equally reported using 10 or more prescription opioids in their lifetime.
  • Almost all of the participants (97.2%) knew the dangers associated with the acetaminophen in hydrocodone combination products; the majority tried to reduce the risk by decreasing the amount of opioids taken orally.
  • Additionally, nearly three-quarters of the participants (73%) were aware of the HCP rescheduling and indicated that the change would not affect their use of opioids.