Dihydrocodeine addiction is somewhat of a rarity in many countries around the world as this drug is not as freely prescribed as many other opioids, nor is it as popular with recreational users (which has more to do with its availability than its effects). But make no mistake about it, dihydrocodeine, or “DHC” as it is commonly known, is a very strong and very serious painkiller and dihydrocodeine addiction is equally serious and potentially as dangerous as addictions to other, more commonly prescribed, opiates.
What is Dihydrocodeine?
If you live in the UK and have any familiarity with opioids and opiates, then there’s good chance you will have heard of dihydrocodeine. This is not the case if you are in the US, however, because this drug is nowhere near as widely used Stateside. It is a semi-synthetic opioid that is used to treat pain and can be combined with other analgesic compounds such as paracetamol, also known as acetaminophen.
Users often compare dihydrocodeine to codeine and we have provided some comparisons below to give you an idea of how dihydrocodeine equates to codeine on a dose by dose basis. It is actually used as an alternative to codeine by many healthcare professionals, who see it as a stronger alternative to codeine and one that can treat a higher level of pain.
As with codeine, and unlike morphine and heroin, dihydrocodeine should not be taken intravenously and is best taken orally, often in the form of 15mg or 30mg tablets, but also in time-released tablets of between 60mg and 120 mg.
Dihydrocodeine Over the Counter
In the UK and a handful of other countries, dihydrocodeine is available in OTC preparations. This is very rare as the drug is stronger than codeine and there are more concerns about its potential to cause abuse and addiction, but these preparations do exist. In the UK, the main dihydrocodeine OTC product is Paramol, which contains 8mg of DHC per tablet and 500mg of paracetamol (acetaminophen).
It is also effective as a cough suppressant, but is very rarely prescribed for this reason and is not available in any kind of OTC cough syrup like codeine linctus.
Is Dihydrocodeine Addictive?
Dihydrocodeine is very addictive and it can lead to withdrawal symptoms that come on just as quickly and are just as severe as other opioids. If there was a scale of opiates that ranked from the weakest to the strongest (based on strength, abuse potential and withdrawal severity), with drugs like codeine at the lower end and heroin at the top, then dihydrocodeine would be somewhere in the middle, lower than morphine and oxycodone, but higher than tramadol and codeine.
Dihydrocodeine addiction can form very quickly, often before the patient realizes it. It is not uncommon for someone to unwittingly take addictive drug like DHC every day in order to cure a short-term pain problem such as a broken limb or post-surgery care, only to stop several weeks later when they feel better and to feel the onset of withdrawals.
This is why you need to be very careful when you have been prescribed drugs like this and to only take them when you absolutely need them. Of course, the more you use and the longer you use them for, the higher your chance of developing a DHC addiction will be. There are other factors at play as well, including genetics, psychological well-being, age, health and previous substance history.
Dihydrocodeine addiction presents in many of the same ways as other opioid addictions. Excessive use can lead to withdrawals once the user stops taking the drug and it can also lead to increased agitation, sedation and fatigue.
Just like codeine and tramadol, some of the side effects of increased dihydrocodeine use include itching, flushing, frustration and headaches. These side effects are often present in small doses but increase exponentially as the dosage increases. Many users find that there is a certain “sweet spot” which is to say a dose that provides the maximum amount of beneficial effects without many of the negative side effects. If they exceed this level, then they don’t feel anymore of the beneficial effects but the negative effects still increase in intensity.
Signs of Dihydrocodeine Addiction
There is no paraphernalia to look out for where DHC addiction is concerned, however, there may be blister packs and bottles of tablets lying around and there may also be powdery residue if they have crushed the tablets for what some believe provides a faster onset.
The main signs to look out for in someone who is suspected of being addicted to dihydrocodeine include:
- Pinpoint pupils
- Erratic sleeping schedule (insomnia one minute, sleeping a lot the next)
- Constant rubbing of the face
The speech may not necessarily be slurred, but you may notice that someone who is addicted to DHC is more agitated, more anxious, more sedate and more preoccupied, depending on the level of addiction, the stage they are at and the dose they have taken.
Dihydrocodeine vs Codeine
It has been said that dihydrocodeine is twice as strong as codeine, which means that 60mg of codeine will equate to 30mg of DHC. However, there is no easy way to make such a calculation and there are many variations on this equation out there. We have asked several experienced opioid users and they have informed us that while dihydrocodeine is easily at least twice as strong as codeine, it also has a different high and triggers different side effects, which makes it difficult to compare the two drugs directly.
Dihydrocodeine vs Oxycodone
From what we can gather, dihydrocodeine is weaker than oxycodone. However, these are two different opioids and they work in slightly different ways, so there is no easy way to decide how much dihydrocodeine relates to a dose of oxycodone.
You should definitely avoid taking the two together and you should always bear in mind that oxycodone is stronger than DHC. From there, you will need to consult with your doctor to get more information and if you are using recreationally, simply begin with very small amounts and stay on the safe side.
Dihydrocodeine vs Tramadol
Whole dihydrocodeine is generally considered to be a stronger drug than tramadol, many opioid users have told us that they get a longer and stronger high from tramadol, that it’s easier to take too much and ruin the pleasant feelings they would otherwise get from it, and that it also provides many psychological effects that you just don’t get with DHC.
This seems to be backed up by the literature out there on tramadol, which has more of an impact on serotonin levels in the brain. As a result, there is no real way to compare the two but what we can say is that they both slow your breathing, put strain on your respiratory system, reduce your blood pressure and heart-rate and should therefore not be taken together.
Dihydrocodeine vs Morphine
The users we have spoken to relate DHC more to the effects they get from morphine, saying it is somewhere between codeine and morphine in terms of the body feeling that it provides and the mental sedation that goes with it. DHC converts to morphine in the body and there is a lot of official literature out there that makes direct dose comparisons between morphine and dihydrocodeine.
These seem to suggest that 100mg of DHC is equivalent to 10mg of morphine, which is a comparison that rings true with the experience reports we have received from long-time and occasional users of these drugs.
How Common is Dihydrocodeine Addiction?
It is quite common in the UK and Europe. There are also stories of people becoming addicted to OTC preparations of DHC and paracetamol, such as drugs like Paramol. Some users will use a simple extraction technique that can remove most or all of the paracetamol so that only the opioid remains. However, there are many stories of addicts simply taking the medications as they are, consuming a very dangerous and occasionally lethal amount of acetaminophen to acquire a recreational dose of DHC.