What’s the Difference Between Oxycodone & Hydrocodone?

Oxycodone and hydrocodone are very similar, but they aren’t identical drugs. 

Both are opioids used to treat moderate to severe pain. They both have legitimate medical uses as well as a high risk of misuse that can lead to opioid use disorder. 

Oxycodone is sometimes considered the stronger of these two opioids, with a higher potency. Although the drugs have very similar effects, it usually takes less oxycodone to produce the same type of effect that an equal amount of hydrocodone might have on the same person.

Understanding the Similarities Between Oxycodone & Hydrocodone

Oxycodone and hydrocodone are both powerful prescription opioid pain medications that are commonly prescribed to treat moderate to severe pain.[1,2] Despite some differences in their chemical composition, they share several similarities.

Fundamentally, both drugs work in the same basic way. They bind to receptors in the brain called opioid receptors, which reduces the ability for pain signals to get to the brain and produces a feeling of sedation and euphoria. This is part of what makes opioid use feel so chemically rewarding and why they have a significant addiction risk.

Similar Risk for OUD

Repeated misuse of either drug can cause opioid use disorder (OUD). Even if a person only uses the drugs as prescribed, there is the potential to develop physical dependence, meaning a person will experience withdrawal if they suddenly stop taking the drug. 

Continual use of any kind of opioid will also cause a person to develop tolerance, meaning more of an opioid will be needed to produce the same effect.[5] When people misuse opioids like hydrocodone and oxycodone, this generally leads to a dose increase over time.

Because of their various dangers and the ongoing opioid epidemic, both opioids are Schedule II controlled substances. This is a classification used for drugs that have legitimate uses but are also considered to be dangerous enough that they must be tightly regulated.

Which Are the Specific Differences Between Hydrocodone & Oxycodone?

There are some key differences between the two medications. While they are fairly close in potency, oxycodone has been shown to potentially be slightly more potent than hydrocodone, meaning that it requires a lower dose to achieve the same level of pain relief.[6] 

Another difference is their chemical structure. Oxycodone is a semi-synthetic opioid derived from thebaine, while hydrocodone is a semi-synthetic opioid derived from codeine.[7,8] This difference in chemical structure may affect how the drugs are metabolized in the body, and it can also impact their potential side effects.

Hydrocodone tablets and pills often don’t just contain hydrocodone. They often also contain non-opioid painkillers such as acetaminophen or ibuprofen. This can further cause a disparity in how potent a given amount of hydrocodone might be compared to oxycodone. Acetaminophen and ibuprofen, while they should still be used with care, are not nearly as dangerous or prone to misuse as opioid painkillers.

Both hydrocodone and oxycodone should only be used as prescribed. Both drugs are generally considered comparable in strength.

Side Effect Similarities & Differences

The side effects of oxycodone and hydrocodone are very similar, as is true for most opioids. Both hydrocodone and oxycodone can cause nausea and vomiting, constipation and drowsiness.[3]

However, constipation is more likely to be experienced by patients taking hydrocodone. In one study, 21% of patients experience constipation while taking hydrocodone, while none did while taking oxycodone.[12]

One of the more serious side effects associated with opioids is respiratory depression, where a person’s breathing is weakened. In severe cases, such as if a person takes too much of an opioid or has certain health conditions when on an opioid, this depression can become so serious that the body physically can’t draw in enough air to support itself, which can be fatal or cause permanent brain damage if not treated promptly.[4]

How to Transition From Hydrocodone & Oxycodone

In some cases, your doctor may want you to switch from hydrocodone to oxycodone, or vice versa. For example, some studies show that it is better to be treated with hydrocodone on a long-term basis than oxycodone.[13]

Follow your doctor’s instructions carefully when transitioning from one opioid medication to another. Your doctor will calculate the conversion factor of your current dose and determine the appropriate dose of the other opioid.

Sometimes, they may recommend gradually lowering your dose of one medication, as you slowly ramp up intake of the other. This allows the body to gently adjust to the new medication and the lack of the old medication. Your doctor will also monitor your symptoms closely until you fully stabilize on the new medication, whether it’s oxycodone or hydrocodone.

The Opioid Misuse Epidemic

Both hydrocodone and oxycodone are major contributors to the opioid misuse epidemic in the U.S. Around the world, over 600,000 have opioid misuse issues, including OUD, and over 100,000 die every year due to opioid overdoses.[14]

Many people begin taking oxycodone or hydrocodone as part of a valid prescription. The drugs can produce euphoria, and this effect can be addictive. Once misuse begins—which often involves taking doses too close together, taking higher doses than prescribed, or mixing opioids with other substances like alcohol—it doesn’t take long for OUD to develop.

The Value of MAT Therapy for Opioid Use Disorder

Medication for Addiction Treatment (MAT) is an evidence-based treatment approach for individuals with substance use disorders, particularly those struggling with opioid use disorder.[9] MAT for OUD involves the use of either methadone or buprenorphine-based medications to manage withdrawal symptoms and cravings, enabling recovery. 

Buprenorphine-based medications like Suboxone also contain the drug naloxone, which makes them even harder to misuse. Suboxone is often the preferred form of MAT for OUD.

It’s been shown that MAT can help to reduce the spread of infectious diseases, in large part because they reduce the risk that an individual will engage in unsafe drug injection practices, such as sharing used needles.[10] MAT has been shown to have numerous other benefits as well, improving addiction recovery outcomes, making it easier for people in recovery to function, and reducing the risk of engaging in criminal behavior.

MAT often also incorporates the use of therapy and counseling, helping a person to build the foundation of a new life in recovery and learn techniques to manage their relapse risk.

This combined approach deals with OUD on multiple fronts, reducing both the physiological and psychological obstacles that may interfere with a patient’s ability to recover.[11] The more of these obstacles that treatment can help a patient overcome, the more likely they are to recover and the less likely they are to relapse.