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Dilaudid (Hydromorphone) Abuse

In the late 1990s, prescribing practices around opioid painkillers began to relax, and newer versions of hydrocodone and oxycodone drugs became widely prescribed to treat moderate-to-severe pain after an injury or surgery. Although many people with serious physical pain need treatment, the wider availability of narcotic painkillers with less oversight meant that many people misused the drugs, began abusing them for nonmedical reasons, diverted them to friends or for sale, or mixed them other recreational substances.

During the early 2000s, opioid abuse through prescription painkillers became an epidemic, leading several local and state governments to tighten oversight and restrictions on access to these medications. Unfortunately, this led many people to turn to illicit narcotics, usually heroin. A 2008-2009 survey of injection drug users reported that 86 percent had abused prescription opioids recreationally before abusing heroin. Among those who began abusing opioid painkillers in the early 2000s, 75 percent reported that a prescription narcotic was their first drug of abuse.

The U.S. Centers for Disease Control and Prevention (CDC) found that, between 1999 and 2016, more than 630,000 people died from drug overdoses in the United States, of which 66 percent involved opioid abuse.

With the introduction of more potent narcotics like fentanyl into the drug supply, an average of 115 people die every day in the U.S. from opioid overdoses.

Although heroin and illicit fentanyl represent the leading problem opioids, prescription narcotics are still a serious issue, and they are still widely abused by many people. There is some concern that very potent painkillers like Dilaudid may be diverted more often or illicitly created and sold on the street. Fentanyl, for example, was developed as a potent opioid painkiller used to treat cancer-related pain in particular, but it is now illicitly produced and mixed into heroin.

If you have any concerns about opioid drugs like Dilaudid, here are answers to the most frequently asked questions.

What Is Dilaudid? Why Is It Abused?

Dilaudid is the brand name for a type of opioid painkiller called hydromorphone. This medication was approved for treatment of moderate-to-severe pain in 1984 by the U.S. Food and Drug Administration (FDA).

The prescription medication comes as an injectable with a regular-strength solution and a concentrated, extended-release version that contains more hydromorphone. There is also an extended-release tablet, which can be taken at home, but this is a rarer prescription. Either version may cause serious breathing suppression, other overdose symptoms, and even death in people who are not opioid-tolerant. Dilaudid was developed specifically to treat pain in people who had chronic pain problems and had taken opioid medication at increasing rates for years.

Dilaudid

The morphine milligram equivalents (MME) scale was created to help clinicians understand safe dosages for different opioid medications, using morphine as the basis for the scale. With morphine being 1 MME, hydrocodone also measuring 1 MME, and codeine measuring 0.15 MME, one dose of hydromorphone or Dilaudid measures 4 MME. Even in opioid-tolerant people, like those who may receive Dilaudid as pain treatment, taking more than 50 MME per day greatly increases the risk of overdose and chronic harm to health.

Hydromorphone is more chemically similar to morphine than some other pain medications. Often, people who take 10 mg (milligrams)  or more of morphine per day can be switched to 1 mg or 2 mg of hydromorphone or Dilaudid and receive the same lasting analgesic effects.

Is Dilaudid Dependence the Same as Addiction?

According to the National Institute on Drug Abuse (NIDA), dependence on a substance is not the same as addiction, although people who struggle with addiction to alcohol or drugs are likely also to have developed a physical dependence on the substance. Especially for potent drugs like opioid painkillers, including Dilaudid, physical tolerance to and dependence on the substance can occur even when you take the medication as directed. Essentially, your brain needs the presence of hydromorphone to manage neurotransmitters and feel normal.

If you quit taking a prescription opioid suddenly, you may feel sick, depressed, or in pain, which are withdrawal symptoms that indicate dependence. Addiction, in contrast, involves compulsive behaviors around a substance like Dilaudid — taking the drug to feel good, taking more than intended, and an inability to quit, among other symptoms.

What Are the Signs of Dilaudid Abuse?

Dilaudid abuse may share several side effects in common with taking Dilaudid as prescribed. Common side effects include:

  • Drowsiness or fatigue
  • Excessive sleeping
  • Stomach pain, cramps, and constipation
  • Dizziness
  • Headaches
  • Double vision or other vision changes
  • Euphoria
  • Appearing intoxicated
  • Loss of physical coordination

Is Illicit Dilaudid a Problem?

Unlike fentanyl, there are not illicit, inexpensive versions of Dilaudid that have infiltrated the illegal drug market. It is rare that Dilaudid is abused because it is rarely prescribed, and people who receive it typically need the pain treatment consistently for a long time.

However, it is diverted through sold or given prescriptions, forged prescriptions, doctor shopping, robberies, and theft from individuals, doctors’ offices, pharmacies, and nursing homes. A 2011 National Survey on Drug Use and Health (NSDUH) report found that about 1 million people aged 12 and older in the United States misused or abused Dilaudid that year.

There have been reports that Dilaudid has been abused for recreational reasons since the medication was approved. A CDC report dating from 1987 found that 12 people in the District of Columbia died that year from abusing intravenous Dilaudid alongside cocaine and quinine.

How Long Does Dilaudid Stay in the Body?

The immediate-release and extended-release formulas of Dilaudid will remain bioavailable for different amounts of time, but in general, intravenous hydromorphone’s dose has a half-life of 2.3 hours on average, depending on kidney health. This means the drug is metabolized out of a healthy adult within four to five hours.

While Dilaudid is active in the body, it is important not to take another dose of the drug, take other opioid painkillers unless a doctor specifically prescribes this, or take medications that may interact with Dilaudid. Misuse of this potent narcotic painkiller can lead to an overdose, which could be fatal.

Can I Drink Alcohol or Take Other Medications With Dilaudid?

No. Mixing Dilaudid with other drugs or alcohol can be extremely dangerous. Let your doctor know if you are taking other prescription medications, so they can understand how best to treat your pain while you take care of other health concerns.

Consuming other central nervous system (CNS) depressants like alcohol, benzodiazepines (Valium, Xanax, or Klonopin), other opioid painkillers, muscle relaxants, mental health medications like antidepressants or antipsychotics, sleeping pills, and tranquilizers can be very dangerous when combined with Dilaudid. These can compound the sedative effects of hydromorphone, which increases the risk of an overdose and death from oxygen deprivation.

Can I Safely Quit Dilaudid by Myself?

Dilaudid is prescribed to people who have developed a tolerance to other opioid medications, and it is more likely to be abused by people who have developed a tolerance to drugs like illicit hydrocodone or heroin. Since you are likely to have a dependence on and tolerance to opioid substances before taking Dilaudid, it is not a good idea to simply quit this potent medication without help.

If you take Dilaudid with a prescription from an overseeing doctor, and you do not want to take this painkiller anymore, work with your doctor to find a safe route to quitting. It is likely, because of how Dilaudid is prescribed, that you will need some form of pain treatment to replace Dilaudid, so tapering may or may not be part of your process.

If you struggle with opioid abuse, including addiction to Dilaudid, it is crucial to work with an evidence-based detox and rehabilitation program. You will likely need medication-assisted treatment (MAT), either buprenorphine or methadone, to ease your body off dependence on large doses of narcotics. This process could take months or years, but you will also receive counseling during this time to help you change behaviors related to drugs or alcohol.

Attempting to quit Dilaudid without help can cause withdrawal symptoms, listed below, which may be very uncomfortable.

  • Anxiety, agitation, restlessness, or mood swings
  • Watery eyes
  • Runny nose
  • Excessive yawning
  • Sweating and cold chills
  • Goosebumps
  • Insomnia or other sleep disturbances
  • Dilated pupils
  • Fast heartbeat and breathing rate
  • Muscle weakness
  • Nausea, vomiting, diarrhea, and stomach cramps
  • Appetite loss
  • Cravings
  • Relapse and overdose

If vomiting and diarrhea become serious, you could experience dehydration, which may be deadly if it is not treated for several days. It is rare that opioid withdrawal symptoms are deadly, but if you are not supervised during this process, cravings can lead to relapse, and that may cause an overdose.

What Happens If I Take Too Much Dilaudid?

Too much Dilaudid will cause an overdose. Signs of a Dilaudid overdose include:

  • Extreme confusion or delirium
  • Cold or sticky skin
  • Bluish tint to the fingernails, lips, or nose
  • Pinpoint pupils
  • Passing out and cannot be awakened
  • Slow heartbeat, weak pulse, and low blood pressure
  • Depressed breathing
  • Irregular breathing
  • Stopped breathing
  • Seizures
  • Coma

If someone near you is overdosing on an opioid drug like Dilaudid, call 911 immediately. There are other steps to take to help them, but this is the first and most important step. An overdose on Dilaudid may quickly become life-threatening.

What Should I Do in the Event of a Dilaudid Overdose?

Call 911 immediately if someone near you is overdosing on Dilaudid or another drug. They need emergency medical attention.

After you call for emergency medical services, stay with the person until help arrives. If they are conscious, prevent them from wandering away and potentially hurting themselves. If they are passed out, roll them onto their side so that they do not choke if they vomit. Try to keep them awake if possible so they will continue breathing. The 911 operator may guide you through rescue breathing if the person has stopped breathing and passed out.

spilled pill bottle

Naloxone is a medication that has no known side effects and is not addictive. It is carried by emergency medical professionals, law enforcement, and caregivers to temporarily stop an opioid overdose. This drug binds to opioid receptors in the brain, effectively kicking opioids off, so breathing and other functions can return to normal. However, naloxone has a shorter half-life than opioids, and more than one dose may be necessary for potent drugs like Dilaudid. It will not completely and permanently stop the opioid overdose in progress, but it will give you more time until EMS arrives.

As the opioid overdose epidemic gets worse around the world, more countries, states, and local pharmacies are making naloxone available with the help of Good Samaritan laws. The World Health Organization (WHO) advocates for wider availability of naloxone.

Where Can I Get Help Quitting Dilaudid?

If you abuse Dilaudid, you need help from evidence-based treatment starting with detox, moving into rehabilitation, and finishing with a long-term aftercare plan. Evidence-based treatment is a continuing commitment, and it works.