What’s The Difference Between Oxycodone And Hydrocodone?

By Lauren Smith

Updated: 22 May 2023 & medically reviewed by Dr. Kimberly Langdon

What is oxycodone?

Oxycodone is a narcotic pain medication synthesized from thebaine, an alkaloid found in the opium poppy plant. Oxycodone is an opioid, a substance that binds to opioid receptors in the central and peripheral nervous systems and gastrointestinal tract, suppressing the perception of pain and increasing feelings of pleasure.^[1]

Oxycodone was first created in 1916 and has been prescribed to patients in the U.S. since 1939. But it became famous decades later, in the 1990s, when drug company Purdue Pharma released Oxycontin, an extended-release form that it falsely claimed was non-addictive and could be safely prescribed to patients with moderate pain long-term. As Oxycontin, oxycodone fuelled the recent opioid crisis in the United States.^[2] Oxycodone is therefore a Schedule II drug.

Oxycodone is also sold in combination with non-narcotic analgesics such as acetaminophen (Percocet) or aspirin.

Like other opioids, oxycodone reduces the sensation of pain. As a painkiller, it’s around 1.5 times as strong as morphine.^[3] It also produces euphoria and relaxation, effects that promote its abuse. Common side effects are constipation, nausea, sleepiness, dizziness, and itching. 

What is hydrocodone?

Like oxycodone, hydrocodone is also a semi-synthetic opioid, with very similar effects and side effects, from pain relief to itching. However, oxycodone is most commonly made from codeine, a substance found in the sap of the opium poppy. Much like codeine, it’s also used as a cough suppressant. 

As a pain reliever, hydrocodone has around the same potency as morphine.^[4] Hydrocodone is the most frequently prescribed opioid in the US. ^[5] It’s usually given in a combination pill with a less powerful analgesic such as acetaminophen or ibuprofen. The combination of hydrocodone and paracetamol is marketed under the brand names Vicodin, Norco, or Lortab. 

Abuse of hydrocodone has increased over the last twenty years. Since 2009, it’s been the second most frequently encountered opioid pharmaceutical in drug evidence submitted to forensic laboratories, according to the Drug Enforcement Administration (DEA).^[5] 

That prompted the DEA to reschedule hydrocodone from schedule III to schedule II in October 2014. This made writing and filling hydrocodone prescriptions more difficult: for instance, prescriptions for schedule II controlled substances can’t be phoned in, faxed in, or put on autofill.^[6] Alongside revised clinical guidelines and other measures put in place to combat the opioid crisis, this led to a fall in hydrocodone prescriptions, from 136.7 million in 2013 to 70.9 million in 2018.^[5]

How are oxycodone and hydrocodone different?

As you can see, oxycodone and hydrocodone have many similarities. They’re both semi-synthetic opioids, produced using parts of the poppy plant and prescribed on their own or in combination with a non-narcotic painkiller for moderate to moderately severe pain. They’ve both been abused by users for the euphoria and relaxation they produce and have been largely implicated in the opioid crisis.

There are some differences between oxycodone and hydrocodone, however. First, they’re produced from different natural opiates from the poppy plant: oxycodone is synthesized from thebaine, while hydrocodone is typically made from codeine. 

Hydrocodone is an antitussive: it acts on the cough center in the brain the relieve coughing.^[7] Studies have found it’s as or more effective than codeine for cough suppression. Oxycodone is not a cough suppressor.

Oxycodone maybe 50% more potent as a painkiller than hydrocodone. Oxycodone is thought to be 1.5 times as strong as morphine, while hydrocodone is about equal to morphine. This was backed up by a study that found it took 50% more hydrocodone to produce the same degree of pupil contraction (miosis, a side effect of opioids).^[8] 

However, other evidence suggests they have similar potency as pain relievers. In a study of people presenting at an emergency department with fractures, equal amounts of oxycodone and hydrocodone produced the same degree of pain relief.^[9]

Both drugs are abused, including by people who once had legitimate prescriptions for them, but may have different risk profiles. One study found that among previously opioid-naïve patients, the risk of developing chronic use was slightly higher with hydrocodone than with oxycodone. However, the risk of those patients overdosing was higher with oxycodone.^[10]

If you or a loved one has been affected by the opioid epidemic, then help is available. Visit our treatment directory today to see what opioid addiction treatment is available in your area.