Dilaudid (hydromorphone hydrochloride) is a narcotic pain reliever that is classified as a full (or pure) opioid agonist. Dilaudid is similar to morphine, methadone, heroin, oxycodone, and other opioid drugs, though it is significantly stronger than many other opioid drugs.
Dilaudid acts in the same way that other narcotic medications act, by stimulating the neurons in the brain to increase the pain threshold (to increase the amount of stimulation required to feel pain) and to reduce one’s perception of pain.
Dilaudid is available in immediate-release tablets (2 mg, 4 mg, and 8 mg strengths), injectable solutions, high-potency injections (Dilaudid-HP), oral solutions (Dilaudid-5), and as a rectal suppository.
The United States Drug Enforcement Agency lists Dilaudid as a Schedule II controlled substance, indicating it has a high potential for abuse and addiction, and that it can only be legally purchased with a prescription from a physician.
After administration, the peak effects occur within 30-60 minutes. The half-life of Dilaudid is dependent on the mode of administration. The terminal elimination half-life of Dilaudid following intravenous dose is around 2.3 hours. For oral administration, the elimination half-life is about 4.1 hours.
Dilaudid is used for acute management of moderate to severe chronic pain in individuals when the use of an opioid drug is appropriate treatment consideration. Other uses for Dilaudid include postoperative pain and cough suppression.
How Dilaudid Works
Dilaudid is a pure opioid agonist. The specific action of pure opioid agonists is unknown; however, the brain has built-in receptors for endogenous neurotransmitters that have a chemical structure that is very similar to opioid drugs. Thus, the receptor sites for these neurotransmitters are particularly suited for binding with opioid drugs. These neurotransmitters are involved pain control, fatigue control, and feeling of pleasure. It is believed that pure opioid agonists bind to these sites, where they fit nearly perfectly and produce their effects.
When opiate drugs like Dilaudid bind to these receptors in the brain, they also increase the production of dopamine in the areas of the brain that are associated with reward or reinforcement for repeating a specific behavior, and this produces a state of euphoria and relaxation. The association of these feelings increases the desire to repeat the action in order to achieve this sensation.
The major action of Dilaudid is analgesia. One of the principal features of this analgesia is that it can occur without the person losing consciousness. Thus, at least in small doses, Dilaudid is an effective painkiller that does not render the person unconscious. This, of course, is useful on many levels, but it also opens up the potential for abuse.
Dilaudid has other central nervous system effects:
- It depresses the cough reflex through direct action on the cough center in medulla.
- It suppresses breathing (the respiratory reflex) by affecting the respiratory centers in the brainstem.
- The ability of Dilaudid to suppress respiration appears to act by a reduction in the responsiveness of the brainstem respiratory centers to increases in carbon dioxide in the system.
Dilaudid affects the cardiovascular system by causing veins and arteries to dilate.
It also releases histamine, which is a substance produced as an immune response to cause inflammation (it also has several other functions in the body, including acting as a neurotransmitter).
Dilaudid affects the gastrointestinal tract by decreasing gastric and pancreatic secretions, delaying food digestion in the small intestine, and decreasing tone in the intestines, leading to constipation.
The major cognitive effect of Dilaudid is a feeling of euphoria or extreme wellbeing.
Side Effects of Dilaudid Use
- The most commonly reported side effectsinclude:
- Other potential side effects (these are rare, but do occur):
- Changes in vision (blurred or double-vision)
- Lightheadedness or feeling faint
- Decrease in urination or a frequent urge to urinate
- Difficultly with or painful urination
- Changes in heart rate (e.g., slow, fast, or pounding heart rate)
- Dry mouth
- Irregular breathing, such as shortness of breath or wheezing
- Appetite loss
- Facial swelling
- Nausea and/or vomiting
- Skin rash
- Stomach cramps
- Trembling or uncontrolled muscle movements
- Nightmares or odd dreams
- Restlessness or excitement
- Other mental status changes
- Potential allergic reactions:
- Severe side effects that may be associated with an overdose or allergic reaction include:
- Breaking out in hives
- Confusion or other mental status changes
- Difficulty breathing
- Cold, clammy skin
- Sudden swelling of the face, throat, or tongue
- Fainting spells
- Decreased heartbeat
- Hallucinations or other psychotic behavior
- Depressed breathing
- Pinpoint pupils of eyes
- Seizures or convulsions
- Severe drowsiness
Because Dilaudid is a pure opioid agonist, it carries a high potential for both physical dependence and the development of a substance use disorder (an addiction).
How Does Dilaudid Addiction Begin?
Prescription drug abuse has been rapidly increasing in recent years. In a study published in the Journal of Drug and Alcohol Dependence, researchers identified three different subtypes of prescription drug users who use these drugs without having a prescription:
- Recreational subtypes typically used the drug for its euphoric effects, administered it in different ways including in pill form, snorting it, or injecting it. They were likely to use other drugs with their prescription drug of choice.
- Self-treatment subtypes were most often users who took the drug for reasons of pain control or other intended medical or therapeutic use. They most often only took it in pill form and did not mix the prescription medication with other drugs.
- Mixed subtypes, the largest of the three groups, displayed different combinations of drug administration and motives for usage.
The probability of being a prescription drug abuser, and therefore more prone to developing an addiction, was highest in the recreational and mixed subtypes. Based on this research, we can conclude that addiction to Dilaudid is far more likely to occur in individuals who use the drug for purposes other than its intended medical use (e.g., pain control). We could speculate that the aspects of tolerance and withdrawal, which are quite powerful with Dilaudid, contribute to the potential for the development of addiction in these individuals because using higher doses of drugs (a sign of abuse) more often will increase the probability of a potential for dependence. Moreover, experiencing withdrawal effects is a motivator to seek and continue drug usage even in the absence of wanting to “get high.”
Of course, a number of other factors contribute to the potential to develop an addiction to a drug, including such things as genetic makeup, environmental factors that could include things like relationship issues, the presence of trauma, and other psychological issues.
Currently, there are no specific identified causes for any kind of addiction. Rather, there are a number of influences most likely contribute to be development of substance use disorders in different individuals.
Withdrawal remains an important consideration in understanding addiction to any form of narcotic drug because the withdrawal syndrome that is common to these drugs is a potential motivator to keep using the drug. One of the surest ways to stop the symptoms of withdrawal is simply to take more of the drug. Therefore, understanding withdrawal is important in understanding addiction to any narcotic medication.
Factors Affecting Dilaudid Withdrawal
There are four major factors that have been identified to be important influences that determine both the severity of withdrawal symptoms and the length of time a person will experience these symptoms as a result of stopping use of an opioid drug. These factors include:
- Differences in individual physiology and psychological makeup: No two people are the same, and everyone who undergoes withdrawal will have different experiences. Some of these differences may be small and others large.
- How long the drug was used: The general principle here is that using a drug for longer period of time will result in increased severity and length of time in withdrawal.
- How much of the drug was typically used: Individuals who take higher doses or higher amounts of the drug habitually are more likely to experience more severe and lengthier withdrawal effects.
- Approach to quitting: Some attempt to quit immediately, whereas other people may try to slowly taper down the dosage and quit over a longer period of time. Quitting abruptly is associated with more severe and longer withdrawal effects. As Dilaudid is an opiate, medical detox is required; one should never attempt to stop taking the drug abruptly.
Tolerance and withdrawal develop relatively quickly with full opioid agonists. For Dilaudid use, physical dependence may occur as quickly as within 2-3 weeks. Due to its relatively short half-life, a person may begin experience withdrawal symptoms after as little as 10 hours of the last administration of Dilaudid.
Signs of Dilaudid Addiction
There are several different categories of signs and symptoms in addition to tolerance and withdrawal that are suggestive of a potential addiction to Dilaudid. These signs serve as indicators of the need for the individual to receive help. Behaviors that are signs that an individual has a problem include:
- Someone forging prescriptions
- Lying about one’s use of Dilaudid
- “Shopping” different doctors to get medication
- Frequent trips to the emergency room for vague complaints of pain
- Taking more of the medication or taking it more frequently than prescribed
- Social isolation
- Stealing or borrowing money to pay for Dilaudid
- Hiding Dilaudid in various places such as one’s car, home, at work, etc.
- Financial problems
- Issues at work due to one’s use of Dilaudid
- Legal problems associated with use of the drug
- Engaging in risky or reckless behaviors that one did not engage in before
Several other physical signs can also suggest an issue:
- Frequently getting sick (e.g., nausea, vomiting, feeling ill, etc.)
- Increase feelings of tension and anxiety
- Slurring words when talking
- Sweating or trembling
- Presenting as extremely lethargic or sleepy
- Psychiatric symptoms, such as depression, hallucinations, delusions, panic attacks, and extreme paranoia
- Difficulties with urination
- Mood swings or the presence of unexplained periods of agitation or irritability
- Cravings for Dilaudid
- Track marks on the arms and/or legs
- Disturbances in sleep
How to Choose a Treatment Program
The process for attempting to stop using any opioid drug is basically the same. Anyone attempting to stop using a powerful accounting medication like Dilaudid should do so under the supervision of a physician. It is never advisable to attempt to stop using Dilaudid without the assistance of a physician because there are several different complications such as withdrawal syndrome, the potential for individuals to experience pain they did not feel while on the drug, and other issues.
The discontinuation process for Dilaudid will typically begin with either a medical detox protocol to taper the dose slowly so the person can slowly adjust to discontinuing the drug or opioid replacement therapy (e.g., Suboxone) to assist with medical detox process.
Medical detox is not sufficient for full recovery. The person must engage in some type of therapy following medical detox to achieve recovery.
Inpatient or Outpatient?
Should one choose inpatient or outpatient treatment? From an effectiveness of therapy standpoint, research has indicated that inpatient and outpatient programs for treating addictions have similar success rates. Thus, there are other considerations that can help guide one in the choice of treatment.
An inpatient recovery program offers:
- A limited duration (most often 30-90 days but in special cases may be longer)
- Very close supervision (advantageous for initial treatment and medical detox)
- Daily therapy and the option for daily interactions with other people who have similar problems
- Very structured schedule
- No need to worry about life responsibilities, such as meal preparation, etc.
- An environment fully focused on recovery
Some advantages to an outpatient recovery program include:
- No need to disrupt one’s life
- Can change therapists/physicians easily if needed
- More overall independence
- The chance to immediately use the skills and techniques learned in rehab in other aspects of life
Often the choice of beginning an inpatient program is decided by a physician, family members, the judicial system, or due to other concerns (e.g., financial). If clients choose an inpatient program initially, they will eventually transition to some type of outpatient program. This may be group therapy, individual therapy, or both. Many people find local support groups, such as 12-Step programs, to be an available option for long-term outpatient treatment (although 12-Step meetings also occur in inpatient settings).
Things to Consider When Choosing a Treatment Program
Treatment for addiction works most efficiently when the person attends and engages in the process of recovery. Some things a person might want to consider include:
- Can one afford the particular program, or does insurance cover the treatment?
- Is there a way to determine how effective the program has been for others?
- Are there barriers to participating in the program?
- Can family members become involved or participate in therapy?
- How much interference with other important personal responsibilities will occur if one participates in the program?
- Is treatment customized to each client, and does it change throughout the recovery progress?
Taking the time to choose a treatment program that is a good fit for the individual will often result in better long-term outcomes for recovery.