Dilaudid, also known generically as hydromorphone, is a prescription medication for severe pain.
It is typically reserved for people who are tolerant of more commonly used opioid medications. Its potency is a concern in the health care and addiction treatment communities.
Abuse of Dilaudid is not as common as the abuse of other prescription opioids, such as oxycodone and hydrocodone. However, between 2008 and 2012, emergency room visits due to this drug for nonmedical reasons increased by approximately 50 percent.
Of people who are prescribed prescription opioids by a doctor for a pain condition, approximately eight to 12 percent develop a substance use disorder related to opioids.
What Is Dilaudid?
Dilaudid is prescribed when someone requires pain control around the clock. It is typically considered when someone’s pain is severe despite using other opioids.
The oral tablets and capsules are usually prescribed in the extended-release form.
This medicine works on the central nervous system to alleviate pain. After taking an oral dose of the drug, it takes 30 to 60 minutes for its peak effects to occur. It alters a person’s response to pain by inhibiting ascending pain pathways. This synthetic opioid is a mu-opioid receptor agonist.
The more common side effects of this drug include the following:
- Trouble having bowel movements
- Joint pain
- Difficulty moving
- Muscle stiffness or pain
How Dilaudid Is Abused
People abuse Dilaudid to achieve its euphoric and calming effects. As someone continues to use this drug, it is possible to experience tolerance, dependence, and addiction. People crave the drug because it activates the brain’s reward center.
When someone takes opioids, the release of endorphins is triggered. These are a type of neurotransmitter that promotes pleasurable effects. Endorphins boost an overall sense of well-being, and they muffle pain perception. As the drug’s effects wear off, people take more of the drug so they can experience those feelings again.
As someone continues to take opioids, the production of endorphins in the body starts to slow. The person has to take more of the drug to keep getting the same effects. This is what leads to developing tolerance.
As someone keeps increasing their dose, they are at risk for developing an addiction to Dilaudid.
People abuse Dilaudid in several ways. Taking the pills orally is common since this is usually the form that is prescribed, and it is the easiest for people to get. Sometimes people mix the pills with water and inject the mixture. The pills can also be broken down into a powder form and snorted.
The risk of developing an addiction to opioids like Dilaudid is higher when someone uses an alternative method to use the drug. This means that injecting or snorting Dilaudid increases the risk of addiction. This can also increase the risk of accidental overdose.
Whether someone takes Dilaudid according to a doctor’s instructions or they are abusing it, there is the risk for short-term effects. When taking this drug under a doctor’s supervision and according to the instructions, these effects typically reduce with time. However, when someone is abusing this drug, these short-term effects may get worse over time.
The short-term effects of Dilaudid may include the following:
- Trouble sleeping
- Heavy sweating
- Stomach pain
- Dry mouth
- Back, joint, or muscle pain
It is possible to overdose on this drug. The following are symptoms of an overdose:
- Trouble breathing
- Excessive sleepiness
- Widened or narrowed pupils
- Stopped or slowed heartbeat
- Coma or loss of consciousness
- Stopped or slowed breathing
- Weak or limp muscles
- Clammy, cold skin
- Fingernails, skin, or lips that are bluish in color
On average, Dilaudid tablets are 2 to 4 mg per dose, taken every four to six hours. Exceeding this amount can lead to an overdose.
In some cases, even taking average doses can lead to overdose. This is more likely in people using Dilaudid with other drugs, especially other opioids.
Respiratory depression is another major concern with opioids like Dilaudid. This drug can slow down the breathing rate. It can result in not having enough oxygen throughout the body. If it is left untreated, it may progress to respiratory arrest or death. Initially, this issue may cause the following:
- Shortness of breath
- Shallow and slow breathing
- Daytime sleepiness
As the level of carbon dioxide in the body increases, the following symptoms may occur:
- Bluish fingers, toes, or lips
When someone is using this drug long term, there are additional effects that are possible. The biggest concern is experiencing withdrawal if the person stops using the drug.
The symptoms of withdrawal can be very uncomfortable.
- Craving the drug
- Chills or fever
- General pains and aches
- Rapid breathing
- High blood pressure
- Depression or anxiety
- Reduced appetite
- Rapid heartbeat
- Muscle spasms and tremors
- Agitation or restlessness
- Suicidal thoughts
- Trouble sleeping
Withdrawal effects can start 12 to 24 hours after the last dose of Dilaudid. The severity of these symptoms varies. Experiencing withdrawal often causes people to seek out more of the drug so they can alleviate the discomfort.
The half-life is 11 hours for the extended-release formulas and about two to three hours for the immediate-release formula.
There are certain behaviors that an addicted person might develop when the need for the drug becomes more intense. These may include:
- Putting a lot of focus on getting the next dose
- Falling behind on responsibilities due to the drug
- Ignoring loved ones in favor of drug use
- Buying the drug off the street or stealing it
- Spending a lot of money to always have the drug on hand
If someone overdoses on Dilaudid, this is a medical emergency. Immediately call 911.
Naloxone is an opioid overdose reversal drug, available as an injection and a nasal spray. If it is available, administer it according to the directions. This can quickly reverse the effects of an overdose, saving the person’s life.
Further medical care is needed since naloxone wears off faster than most opioids so that the overdose could return.
Keep an eye on the person’s pulse and breathing. If the person loses their pulse, start performing CPR. The 911 dispatcher can provide CPR instructions for those who are not trained to administer it.
Following emergency treatment for an overdose, there are treatment options to aid people in working toward recovery from their Dilaudid addiction.
There are medications that can be prescribed during the detox and recovery process. Options include methadone and a combination of buprenorphine and naloxone, known as Suboxone. This combination drug reduces withdrawal symptoms during detox, and it can also lessen cravings for Dilaudid.
Methadone essentially replaces Dilaudid without providing euphoria. This allows for a reduction in withdrawal symptoms without producing a high.
During the detox process, additional medications might be given to alleviate certain withdrawal symptoms. Clients may receive benzodiazepines to reduce insomnia, anxiety, and irritability that are common during withdrawal.
In some cases, antidepressant medications might be considered. They can help to balance mood during the detox and early recovery stages. When someone is undergoing withdrawal from opioids, their brain chemistry is altered. Antidepressants can help to rebalance these chemicals to promote better mood. Certain antidepressants, such as clonidine, may also help with sweating, cramps, muscle aches, and anxiety.
In fact, some research shows that people who get medications as part of their treatment plan are more likely to remain in treatment. The person will be thoroughly evaluated to determine which medications for opioid addiction may be most effective for them.
When undergoing medication-assisted treatment for Dilaudid addiction, it is important that these drugs are combined with different types of therapy. The following are therapy types that might be part of a comprehensive addiction treatment program:
- Contingency management rewards people for not using Dilaudid and for other positive behaviors that the person and their therapist identify.
- Motivational enhancement therapy helps people to remain in their treatment program by helping them increase their motivation to stay in recovery.
- Individual therapy allows people to talk one on one with an experienced therapist. Clients and therapists can get personal and dig into the issues that may have contributed to the person’s addiction.
- Family therapy allows people and their family members to discuss issues that may have developed as a result of addiction. This helps families to improve their relationships and open up lines of communication.
- Group therapy is another option. This type of therapy helps people know they are not alone while they are working to overcome their addiction. They can share in other people’s successes and discuss the challenges that are faced by individuals in the group. Group therapy can offer new perspectives about challenges.
Anyone misusing Dilaudid should seek assistance at a treatment facility. Abusing Dilaudid can have serious short-term and long-term effects on health and virtually every other area of life.
Care at an addiction treatment facility gives clients support during the withdrawal and recovery process. A solid aftercare plan provides them, a blueprint for how to thrive in the early stages of recovery post-treatment.