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Dilaudid (Hydromorphone) Addiction

Dilaudid (hydromorphone) is a prescription opioid painkiller.[1] It’s one of the strongest medications in its class, used to treat pain that hasn’t responded to other therapies.

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Dilaudid’s strength makes it dangerous. It’s easy to take too much and trigger a life-threatening overdose.

How to Help During an Overdose

In high doses, hydromorphone can cause a person to experience dangerously shallow breathing. The body no longer takes in enough oxygen, which can be life-threatening.

Signs of a hydromorphone overdose (and an opioid overdose in general) include the following:[2]

  •       Unusually narrowed or widened pupils
  •       Shallow or slow breathing
  •       Trouble breathing (gasping for air)
  •       Significant drowsiness
  •       Confusion or unresponsiveness
  •       Cold, clammy skin
  •       Slowed or stopped heartbeat
  •       Dizziness
  •       Fainting
  •       Muscle weakness
  •       Seizure
  •       Unconsciousness

An opioid overdose should be treated as a medical emergency. If a person is exhibiting the above symptoms or any other symptoms that seem life-threatening, call 911.

If available, administer the drug naloxone, which can reverse the life-threatening effects of an opioid overdose.[2] Naloxone can restore breathing in minutes, but the person will still need medical care and monitoring to ensure they recover fully from the overdose.

When on the phone with a 911 operator, alert them of your location as accurately as possible. Tell them the condition of the person you believe is experiencing the overdose and answer any questions they ask as accurately as possible.

What Is Dilaudid (Hydromorphone)?

Dilaudid is the brand-name version of the drug hydromorphone. People in severe pain that can’t be treated with other opioids turn to hydromorphone for relief.[2]
This table can help you understand Dilaudid’s relative strength when compared to other opioid painkillers:

PainkillerPotency Compared to Morphine
Codeine1/10
Hydrocodone2/3
Oxycodone1.5 
Methadone5-10
Hydromorphone4-5 to 5-7.5
Fentanyl100
Source: [13]

Hydromorphone is a full opioid agonist that provides similar effects to heroin. People who use the drug feel euphoria mixed with significant relaxation. 

For those with cancer pain, the medication can be extremely helpful. For recreational users, Dilaudid can be incredibly damaging. 

Key Facts About Dilaudid

Key Facts

  • Dilaudid is approximately two to eight times stronger than morphine.[1]
  • Hydromorphone half-lives vary. Immediate-release formulations have a half-life of two to three hours. Extended-release formulations have a half-life ranging from eight to 15 hours.[2] Researchers say a drug is no longer active in the body after four to five half-lives.[11] That means some formulations of hydromorphone can stay in your system for 75 hours.
  • Dilaudid is an opioid medication that latches to the same receptors used by drugs like heroin. Researchers say prescription opioids like Dilaudid are chemically similar to heroin and can produce a similar high.[12]
  • Hydromorphone is used for severe acute and chronic pain. It’s only prescribed when other treatments have failed to bring relief.[2]

How Dilaudid Affects the Body 

Dilaudid is a full opioid agonist, meaning it can latch to receptors within your brain and body. That connection causes chemical changes, including dopamine release. 

In studies, people often can’t tell the difference between heroin and hydromorphone. The drugs produce the same sensations of euphoria and relaxation.[3] And with repeated doses, they can cause psychological and physical dependence. 

People may feel physically sick between doses, and they may experience overwhelming drug cravings. These sensations can keep people using drugs, even when they know they should quit. 

Opioid receptors in the gut can lead to unpleasant side effects, including constipation.[2] When people try to quit, they may experience severe diarrhea accompanied by vomiting. Dehydration, which can be life-threatening, can occur. 

Dilaudid Dangers & Drug Interactions 

Strong opioids like Dilaudid can cause euphoria, especially when taken in high doses. This trait can lead people to take more than prescribed for pain. Combining the drug with other substances increases the risks. 

Hydromorphone should not be taken with benzodiazepines and other central nervous system (CNS) depressants, including alcohol. These substances also slow breathing rates. Combining them with Dilaudid can quickly lead to an overdose. 

In some cases, taking hydromorphone with other drugs that affect a person’s serotonergic neurotransmitter system can induce what is called serotonin syndrome.[2] This condition can be life-threatening, so doctors generally avoid prescribing these types of drugs together unless necessary.

Hydromorphone can reduce the efficacy of diuretics. It can also cause complications if a person is taking anticholinergic drugs, as it can increase a person’s risk of urinary retention and/or constipation.

Alcohol, other opioids, and central nervous system depressants (sedative-hypnotics) can potentiate the respiratory depressant effects of Dilaudid, increasing the risk of respiratory depression that might result in death.

U.S. Food and Drug Administration[4]

Dilaudid Uses & Dosages

Dilaudid comes in multiple forms, including liquid, tablets, and injections. Some forms get started immediately and leave the body quickly. Others are made to stay in the body, providing long-lasting pain relief. 

Immediate-release oral Dilaudid comes in tablets ranging from 2 mg to 8 mg. Extended-release tablets range from 8 mg to 32 mg.[2] 

A doctor will usually begin a patient on the lowest dose they believe may provide the relief needed, raising it if required. 

People use Dilaudid to deal with the following issues:[2]

  • Postoperative pain
  • Traumatic injuries like broken bones or severe burns
  • Cancer-related pain
  • Chronic pain management where other treatments have failed

Doctors rarely (if ever) use Dilaudid first. Instead, they try other therapies to keep their patients comfortable. If those treatments don’t work, Dilaudid is the next option. 

Signs & Symptoms of Dilaudid Addiction 

Understanding what Dilaudid addiction looks like can help you reach out to someone in need. Symptoms can be split into three categories: physical, behavioral, and social.[2]

Physical 

Sedation and slurred speech are common in those new to Dilaudid abuse. But as the addiction deepens, people may seem calm and even “normal” when they’re high. If they try to limit or quit the drug, they develop flu-like symptoms accompanied by severe drug cravings. 

Behavioral 

An increasing need for privacy characterizes opioid addiction. People may spend long periods alone, either using or recovering from drugs. They may seem anxious and upset when their Dilaudid stash dwindles. And they may grow bitter and upset when asked about their drug use. 

Social 

It’s hard to sustain a Dilaudid addiction via prescriptions. People with a long history of abuse typically need dealers. They may spend time with other intoxicated people. Or they may have brief “visits” from people who are selling drugs. 

Physical Behavioral Social 
Sedation or intoxication Doctor shoppingSpending time with other drug users
Withdrawal symptoms between doses Asking friends and family for drugsConnecting with dealers 
Severe constipation Spending more time alone Withdrawing from friends and family 
Source: [2,8]

Risk Factors for Dilaudid Addiction 

Anyone who uses Dilaudid could abuse the drug in time. But your genetics, environment, and underlying mental health could all play a role in problematic Dilaudid use. 

Genetics 

Your genes play a role in how quickly organs process each Dilaudid dose. If you process the drug quickly, it produces a bigger high that fades fast. But if you process it slowly, it may persist for long periods and cause more damage.[5] 

Your height and weight may also be influenced by genes. These factors can also affect how quickly Dilaudid leaves your body and how high you feel in the interim. 

Environment 

Your doctor can influence your Dilaudid addiction risk. Accessing high drug doses for long periods is closely associated with problematic use. 

As many as one in four people getting opioids like Dilaudid from their doctors struggle with addiction.[6] If your doctor offers extended-release Dilaudid, the risks rise even more. 

Co-Occurring Mental Health Disorders

People with conditions like depression, anxiety, and post-traumatic stress disorder have a higher risk of opioid addiction.[6] You may lean on Dilaudid’s euphoric properties to help you deal with your mental health, and an addiction can quickly follow. 

Side Effects: How Dilaudid Affects the Body Over Time

Hydromorphone is powerful, and it can cause significant side effects. Even if you take the drug as directed, you can experience uncomfortable symptoms with each dose. The problems intensify with higher doses and long periods of drug use.

Short-Term Effects

Common side effects associated with Dilaudid include the following:[2]

  • Lightheadedness
  • Dizziness
  • Nausea or vomiting
  • Sweating or flushing
  • Euphoria
  • Dysphoria (a feeling of sadness or dissatisfaction; the opposite of euphoria)
  • Dry mouth
  • Sedation
  • Pruritus (itchy skin)

If the above symptoms don’t go away or seem severe, it is important to talk with a doctor. More serious symptoms include the following:[2]

  • Difficulty breathing
  • Cardiac problems
  • Tremors and other muscle control issues
  • Vision impairment, including blurred vision and excessive pupil constriction
  • Confusion

Long-Term Effects

With repeated use, tolerance develops. You will need larger doses to achieve euphoria, and eventually, you may need them to stave off symptoms of withdrawal. Those big amounts can increase overdose risks. 

Using opioids like Dilaudid can cause significant constipation. Some people develop bowel obstructions due to their sluggish bowel movements. Others develop laxative dependence, as this is the only way they can keep their systems moving.[2]

The way you use Dilaudid can cause long-term symptoms. People who inject the drug can develop collapsed veins and abscesses. Snorting the drug can lead to nasal and throat irritation. And smoking the drug can harm the lungs. 

Short-Term EffectsLong-Term Effects 
Sedation Tolerance 
DizzinessSickness between doses 
NauseaWithdrawal symptoms 
VomitingConstipation 
Headache Infections 
Source: [2,8]

Withdrawal & Detox From Dilaudid

Cells within your brain and body become accustomed to Dilaudid and won’t function properly without it. If you try to quit without help, you can become so sick that relapse seems inevitable. A supervised detox program is the best way to get sober without relapsing to drugs. 

Common Withdrawal Symptoms

People who quit taking Dilaudid abruptly can develop flu-like symptoms, including the following:[2]

  • Nausea
  • Vomiting
  • Goosebumps
  • Chills
  • Headache
  • Muscle aches 
  • Diarrhea 
  • Insomnia 
  • Agitation 
  • Restlessness

Supervised Medical Detox 

In a detox program, doctors use medications like buprenorphine or methadone to lessen withdrawal symptoms and cravings. Treatment helps your brain cells to function normally without Dilaudid, so you won’t be tempted to relapse to drugs to make uncomfortable symptoms stop. 

Quitting cold turkey may seem easier, but it’s rarely successful. It’s very easy to relapse to drugs to make yourself feel better. Medical detox ensures you get the help you need to get sober successfully.

Treatment for Dilaudid Addiction 

Addiction treatment programs are designed to help you get sober and preserve your sobriety for the rest of your life. Programs work best when they’re personalized. The help you need might be different from the approach that helps someone else.

But in general, people use these tools to combat Dilaudid addiction for treatment:

Inpatient Rehab 

People with Dilaudid addiction may be surrounded by dealers, drug stashes, and temptation at home. An inpatient rehab program allows people to step away from their triggers to focus on getting well.

You will move into the treatment facility and work with therapists, counselors, and peers every day. Teams can monitor your medications, provide therapy, and support your long-term recovery. 

Medication-Assisted Treatment 

A medication-assisted treatment (MAT) program combines prescription therapies with counseling. MAT is widely considered one of the best ways to combat opioid addiction.[9] 

Your doctors might choose from the following therapies:[10]

  • Buprenorphine: This mild opioid agonist latches to receptors used by Dilaudid, but its weak connection means you won’t feel high while using it. Instead, you’ll notice a decrease in withdrawal symptoms and cravings. 
  • Methadone: This opioid agonist is stronger than buprenorphine, and it could be a good choice if your Dilaudid addiction was long-lasting or involved high doses. You won’t feel high on this drug, but your withdrawal symptoms and cravings should lessen. 
  • Clonidine: While not typically considered an MAT therapy, clonidine can help with opioid withdrawal symptoms like a racing heartbeat. Your doctor might use it in the early days of your recovery. 
  • Naltrexone: This opioid antagonist will prevent you from getting high if you relapse to Dilaudid. A failed attempt could make your cravings less intense. 

Behavioral Therapy

Counseling can help you dive into the psychological and habitual triggers for Dilaudid abuse. Your sessions might focus on the thoughts and feelings that trigger drug cravings. Cognitive behavioral therapy (CBT) like this can help you change your life and make a relapse less likely. 

Researchers say that CBT is up to 26% more effective than no treatment at all.[7] Combining this approach with medications is one of the best ways to ensure you get sober and stay that way for life. 

Your team might also use motivational interviewing techniques to encourage you to participate in therapy and recovery. Family therapy could help you repair the damage done to important relationships during active addiction. 

Frequently Asked Questions About Dilaudid Addiction 

We’ve compiled some of the most frequent questions about Dilaudid use and abuse.

How long does Dilaudid stay in your system?

Yes. Researchers say Dilaudid is approximately two to eight times stronger than morphine.[1]

Is Dilaudid an opioid?

Yes. Dilaudid is an opioid painkiller.

What is Dilaudid used for?

Dilaudid treats severe pain that hasn’t responded to other forms of therapy.

Are Dilaudid and hydromorphone the same?

Yes. Dilaudid is the brand-name term for the medication hydromorphone.

Updated February 7, 2024
Resources
  1. Hydromorphone. United States Drug Enforcement Administration. Accessed July 17, 2023.
  2. Abi-Aad K, Derian A. Hydromorphone. Stat Pearls. Published July 11, 2022. Accessed July 17, 2023.
  3. Dunn, K.E., Brands, B., Marsh, D.C. et al. Characterizing the subjective, observer-rated, and physiological effects of hydromorphone relative to heroin in a human laboratory study. Psychopharmacology. 2018;235:971–981.
  4. Marcus H. Dilaudid-related morbidity and mortality from respiratory depression. The Doctors Company. Published December 2019. Accessed July 17, 2023.
  5. Smith HS. Opioid metabolism. Mayo Clin Proc. 2009;84(7):613-624. doi:10.1016/S0025-6196(11)60750-7
  6. Risk factors for opioid misuse, addiction, and overdose. Office of Workers’ Compensation Programs. Accessed July 17, 2023.
  7. Magill, M., Ray, L., Kiluk, B., Hoadley, A., Bernstein, M., Tonigan, J. S., & Carroll, K. (2019). A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: Treatment efficacy by contrast condition. Journal of Consulting and Clinical Psychology, 87(12), 1093–1105.
  8. Dydyk AM, Jain NK, Gupta M. Opioid use disorder. StatPearls Publishing. Published January 2023. Accessed July 17, 2023.
  9. Maglione MA, Laura R, Christine C, et al. Effects of medication-assisted treatment (MAT) for opioid use disorder on functional outcomes: A systematic review. Rand Health Q. 2020;8(4):RR-2108-OSD. Published 2020 Jun 15.
  10. Stotts AL, Dodrill CL, Kosten TR. Opioid dependence treatment: options in pharmacotherapy. Expert Opin Pharmacother. 2009;10(11):1727-1740. doi:10.1517/14656560903037168
  11. Half life. Hallare J, Gerriets V. StatPearls. Published June 20, 2023. Accessed February 2, 2024.
  12. Prescription opioids drug facts. National Institute on Drug Abuse. Published June 2021. Accessed February 2, 2024.
  13. WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents. World Health Organization. Published 2018. Accessed February 2, 2024.
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