Navigating addiction treatment can feel overwhelming, especially when you are comparing widely prescribed opioid drugs. At Insight Recovery Center in Swannanoa, NC, our team helps adults understand the hydrocodone/oxycodone difference so each person can make informed choices. Our partial hospitalization program (PHP) supports people working to reduce opioid use and rebuild health through evidence‑based care. For questions about prescription drug addiction treatment in Asheville, contact our team online or call 828.826.1376.
What to know about prescription drug abuse and addiction
Prescription opioids are prescribed by a physician to treat acute pain after surgery or injury, and sometimes chronic pain when other options do not help. Over time, the body can become dependent, meaning it needs the substance to feel normal. Misuse can occur if a person takes a higher dose than prescribed, takes it more often than prescribed, mixes it with other drugs, or uses someone else’s prescription. Addiction is a medical condition, not a moral failing, and compassionate, professional treatment can help.
Commonly prescribed opioids
Opioids, which can be derived from the opium poppy or made synthetically, include hydrocodone, oxycodone, morphine, codeine, and fentanyl. These drugs act on opioid receptors in the brain and spinal cord to reduce pain. While they can be effective for pain relief, they also carry risk for dependency, overdose, and other adverse effects.
What is hydrocodone?
Hydrocodone is an opioid drug prescribed to treat moderate to severe pain in adults. It is widely combined with acetaminophen in a single tablet. There are also extended‑release versions for around‑the‑clock pain management in select cases. Drowsiness, nausea, and constipation can occur. The dose depends on the person’s age, weight, pain severity, and medical history, and should always be used exactly as prescribed.
What is oxycodone?
Oxycodone is an opioid also prescribed for moderate to severe pain, that also comes in immediate‑release and extended‑release forms. Some formulations combine oxycodone with acetaminophen. Like hydrocodone, oxycodone can cause dizziness, drowsiness, constipation, and nausea.
Both medications have important safety warnings and should be taken only as directed. This comparison chart demonstrates how hydrocodone and oxycodone are similar or identical on most counts:
Feature |
Hydrocodone |
Oxycodone |
| Drug class | Opioid (semi-synthetic) | Opioid (semi-synthetic) |
| Primary use | Moderate to severe pain | Moderate to severe pain |
| Potency | Slightly less potent | Slightly more potent |
| Formulations | Usually combined with acetaminophen (e.g., Vicodin, Norco) | Available alone or with acetaminophen (e.g., OxyContin, Percocet) |
| Duration of action | 4–6 hours (IR); 12–24 hours (ER) | 4–6 hours (IR); 12–24 hours (ER) |
| Common side effects | Drowsiness, dizziness, nausea, constipation | Drowsiness, dizziness, nausea, constipation |
| Metabolism | Metabolized in the liver to hydromorphone (pain relieving compound) | Metabolized in liver to oxymorphone (pain relieving compound) |
| Risk of dependence | High | High |
| Controlled substance schedule | Schedule II (U.S.) | Schedule II (U.S.) |
| Common brand names | Vicodin, Norco, Lortab, Zohydro ER | OxyContin, Percocet, Roxicodone, Xtampza ER |
Hydrocodone vs. oxycodone in real‑world care
Both medications can treat acute pain episodes. Analgesic potency is similar at standard doses when combined with acetaminophen. In an emergency department clinical trial involving adults with fractures, two groups received either hydrocodone plus acetaminophen or oxycodone plus acetaminophen. Pain scores at 30 and 60 minutes were comparable, and outcomes were similar overall; constipation showed a higher incidence with hydrocodone on subsequent follow-up. This suggests oxycodone and hydrocodone offer similar short‑term efficacy for fracture‑related pain in the first hours after dosing.
See the randomized trial summary in Academic Emergency Medicine via PubMed: RCT comparing oxycodone and hydrocodone in fractures.
A second emergency department clinical trial compared combination pills for acute musculoskeletal pain and found no clinically important difference in pain scores at 2 hours between oxycodone plus acetaminophen, hydrocodone plus acetaminophen, codeine plus acetaminophen, and a non‑opioid combination. These results add evidence that many adults respond similarly to each opioid in the short term, and that non‑opioid combinations can also be effective depending on the condition and the study design. Pain management should always be individualized with careful follow-up.
Safety, side effects, and interactions
Side effects for opioids such as hydrocodone and oxycodone can include drowsiness, dizziness, nausea, vomiting, and constipation. Serious effects, such as slowed breathing, can occur at higher doses or when opioids are combined with other drugs that depress the central nervous system. The CDC offers guidance to reduce risk when opioids are prescribed, including storing medication securely and avoiding alcohol or sedatives unless a physician confirms it is safe.
Mixing opioids with benzodiazepines, sleep medications, or muscle relaxants also raises risk. Never share prescriptions and never change your dose without permission from your physician. If side effects occur or pain does not respond, ask your care team about alternatives, such as non‑opioid medicines or multimodal management strategies.
Acute pain versus chronic pain
Acute pain often follows injuries, fractures, or surgery and typically improves as tissues heal over days to weeks. Chronic pain persists longer than 12 weeks and needs a broader plan, such as physical therapy, behavioral therapies, non‑opioid medications, or procedural options. Opioids may be considered in select cases, but benefits must be weighed against risks. Actual treatment decisions depend on the person, baseline function, and goals. Your physician will review the correct dose range and expected duration.
How these medications work
Hydrocodone and oxycodone bind to mu opioid receptors, which helps reduce how the body perceives pain. Efficacy and effectiveness vary by person, age, weight, genetics, other conditions, and concurrent medications. Morphine is a commonly used reference point in comparison studies; some evidence suggests similar pain relief for hydrocodone and oxycodone at comparable doses, though individual response can differ. Talk with your physician if pain persists for hours without improvement or if adverse effects occur.
Overdose awareness and emergency steps
The rise of synthetic opioids like fentanyl has increased risk across the United States, including Western North Carolina. If someone shows signs of opioid overdose, such as extreme sleepiness, slowed breathing, blue lips, or unresponsiveness, call 911 immediately.
Naloxone can reverse opioid overdose temporarily. Learn about reversal options from SAMHSA: opioid overdose reversal medications. Even if reversal is immediately successful, medical evaluation and treatment should follow any overdose.
When opioids are not the only option
Non‑opioid strategies can help many conditions. Acetaminophen, nonsteroidal anti‑inflammatory drugs, and physical or behavioral therapies may reduce pain and improve function. In some clinical trial data extracted from university emergency department research, non‑opioid combinations performed as well as opioid combinations for acute extremity pain at early time points. Your prognosis depends on the condition, the severity of symptoms, and how you respond to a tailored plan.
Treatment and support at Insight Recovery Center
If opioid use has become difficult to manage, help is available. Insight Recovery Center serves Asheville, Buncombe County, and surrounding communities in Western North Carolina. Our PHP provides structured daytime care, therapy, education, and recovery support. We also help people evaluate medications and identify safer pain management strategies in coordination with medical providers.
Ready to take the next step in Asheville? Contact our team online or call 828.826.1376. If you are seeking help related to heroin or other opioids, you can also learn about options on our Opiate Addiction Treatment Program page. We will listen, review your goals, and help you build a plan that fits your life.