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Dilaudid vs. Fentanyl: Comparing the Two Powerful Opioid Medications

Dilaudid and fentanyl are both Schedule II substances under the Controlled Substances Act, meaning they each have recognized medical uses. They are powerful and effective pain medications.

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In addition to relieving pain, both substances can also produce a high, for which they are frequently misused. Dilaudid is not as strong as fentanyl, but both are much stronger than morphine. Whether used for medical or recreational purposes, Dilaudid and fentanyl must be taken with caution, as addiction and overdose are possible.

What Is Dilaudid? 

Dilaudid is a prescription medication used for the treatment of moderate to severe pain. It is used to help manage pain in cancer patients, for example. It can also be effective in treating some types of coughs. 

Derived from morphine, Dilaudid binds to opioid pain receptors in the central nervous system, effectively blocking the sensation of pain. 

Additional names for Dilaudid include Exalgo, hydromorphone hydrochloride, and Hydrostat IR. Common street names for Dilaudid include D, Juice, Dillies, Smack, Dush, and Footballs. 

While it is legally manufactured and prescribed in the United States, Dilaudid is often misused by people who obtain multiple prescriptions from different doctors, steal from pharmacies, or acquire it from friends or family members. 

What Is Fentanyl? 

Fentanyl is a highly potent synthetic opioid. Fentanyl is similar to morphine but 100 times stronger. It is legally manufactured in labs and prescribed for the treatment of severe pain, such as pain following surgery or pain caused by advanced cancer. 

Pharmaceutical fentanyl and illegally manufactured fentanyl are two different types of the drug. While both are synthetic opioids, illegally manufactured fentanyl is an unregulated substance that is sold for the high it produces, which is similar to heroin. However, fentanyl is 50 times stronger than heroin. 

Due to its potency, fentanyl is often mixed into other drugs, such as heroin, cocaine, and methamphetamine, to create an increased high for the user. 

Fentanyl may commonly be referred to by slang names like Apache, Goodfellas, Jackpot, and Tango and Cash. 

Illegally manufactured fentanyl is highly addictive and dangerous. Many people are unaware it is present in the drugs they take, which results in accidental overdoses. 

Fentanyl is one of the most common drugs associated with fatal overdoses in the United States. Over 150 fatal overdoses occur each day to synthetic opioids like fentanyl. 

Similarities Between Fentanyl & Dilaudid

As they are both opioids, Dilaudid and fentanyl have many similarities. They can both be consumed as tablets, capsules, oral solutions, and injected. 

They both have similar effects on the body and mind, as well, explains the Drug Enforcement Administration (DEA). The effects of Dilaudid and fentanyl include the following: 

  • A sense of euphoria
  • Relaxation and sedation
  • Reduced anxiety
  • Mental clouding
  • Nervousness and restlessness
  • Changes in mood
  • Depression
  • Constipation
  • Reduced respiration, heartbeat, and blood pressure
  • Nausea and dizziness 
  • Impaired coordination
  • Urinary retention

Both types of opioids produce a rapid onset of effects and are considered addictive. Both are associated with psychological and physical dependence, even when used as prescribed by a doctor. When left untreated, dependence can lead to addiction, requiring proper substance abuse treatment. 

Key Differences Between Fentanyl & Dilaudid

One of the key differences between fentanyl and Dilaudid is the increased potency and risk of overdose associated with fentanyl. Dilaudid is two to eight times stronger than morphine, while fentanyl is 100 times more potent. As it is increasingly produced in illegal labs, fentanyl is also more frequently involved in fatal overdoses. 

In addition to being consumed as an oral pill, solution, or injectable, fentanyl can also be snorted from its powder form, taken as a patch or as gel extracted from a patch, smoked, or spiked onto blotter paper, explains the DEA. Illegally produced fentanyl is sold on its own or combined with other drugs. 

Risk of Overdose: Is One More Dangerous Than the Other?

Both Dilaudid and fentanyl have a high potential for abuse, warns the DEA. As they are both powerful opioids, each poses a risk of overdose. Signs of an overdose include the following: 

  • Respiratory depression 
  • Drowsiness that can lead to coma
  • Lack of muscle tone 
  • Cold and clammy skin
  • Constricted pupils 
  • Reduced blood pressure and heart rate

In severe cases, an opioid overdose can lead to death. Both Dilaudid and fentanyl can repress breathing to the point that the individual is no longer breathing. In such an instance, emergency medical intervention, such as administering naloxone, is necessary to reverse the overdose and save the person’s life. 

Due to its potency, fentanyl may be more dangerous than Dilaudid. It takes much less fentanyl to trigger an overdose, though both drugs should be used with extreme caution. 

Withdrawal Symptoms: Are They Comparable?

The withdrawal symptoms from Dilaudid and fentanyl dependence are comparable. The severity of symptoms depends on the individual’s history of substance abuse. Someone who infrequently consumed low doses of either opioid is likely to experience much less severe withdrawal symptoms than someone who has regularly consumed high doses of fentanyl or Dilaudid for an extended period. 

Withdrawal symptoms from opioids like fentanyl and Dilaudid include the following: 

  • Anxiety, agitation, and irritability
  • Body aches and pains 
  • Increased tearing and runny nose
  • Sweating and chills 
  • Difficulty sweating 
  • Stomach cramps
  • Nausea, vomiting, and diarrhea 

While the above symptoms can be physically, emotionally, and psychologically challenging, they are not typically life-threatening, especially with proper medical supervision. In rare cases, some of these symptoms can lead to life-threatening situations, however, so medical supervision is always recommended. 

With medical detox, medications can be administered to alleviate the worst of withdrawal symptoms. When proper care is given during withdrawal, it can prevent any complications, such as dehydration, and further damaging health effects.

Updated February 7, 2024
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