Dilaudid (Hydromorphone)

Understanding Dilaudid (Hydromorphone)

Dilaudid, the brand name for Hydromorphone (also Exalgo, Palladone, and Dilaudid-hp), is a type of potent synthetic opioid prescribed to treat moderate to severe pain.^[1] The drug works by binding to mu-opioid receptors in the brain and central nervous system (CNS) which in turn dulls pain signals being sent to the brain. The drug also releases dopamine into the brain, the “feel good” chemical which creates sensations of pleasure and reward. 

Dilaudid often comes in tablet form of 2mg, 4mg, and 8mg doses and occasionally as a liquid. It is also used intravenously by hospitals for more immediate pain relief. The time it takes for Dilaudid to take effect varies depending on how it was ingested, with oral tablets typically taking around half an hour to begin relieving pain and intravenous administering taking effect almost immediately. 

Dilaudid is a Schedule II substance under the CSA meaning that despite its medical use it also holds a high potential for abuse. 

Effects of Dilaudid abuse

As taking Dilaudid intravenously offers immediate and more powerful effects, the drug is often injected when abused. This is also true of crushing pills and snorting them, another popular method of abuse. Taking Dilaudid in any method other than intended, as well as for longer or in higher doses than prescribed, is considered abuse. 

The effects of Dilaudid abuse are similar to other prescription and illicit opioids. The abuser will often feel an intense rush of euphoria before a sense of calm and relaxation. 

Dilaudid, like most opioid painkillers, is highly addictive and people who abuse the drug, as well as those who take the prescribed amount, can quickly form a dependence on the substance. This is why most doctors and medical professionals will not prescribe Dilaudid as a long-term solution.

Dilaudid overdose is also a common reaction to sustained abuse. Taking high doses of opioid painkillers, especially alongside other substances such as alcohol or other sedatives like benzodiazepines can cause slowed breathing and heart rate, as well as reduced blood pressure. This increases the risk of overdose and can lead to respiratory depression/failure, coma, seizures, and death.

Addiction to Dilaudid

Dilaudid is an extremely potent synthetic opioid and can cause tolerance and physical dependence to form in a manner of weeks. Tolerance occurs when the brain adjusts to the artificial chemical production of the drug, in this case dopamine, and cannot produce adequate levels on its own. Once tolerance is built up enough, users will often feel they need more of the substance to feel its effects and in some cases to feel normal. This is known as physical dependence and when the negative consequences of dependence build it can lead to addiction.

Like most forms of opioid use disorder, a person with a Dilaudid addiction will be diagnosed by a licensed professional using these 11 criteria, outlined by the DSM-5 to assess addiction: ^[2]

1. Hazardous use: You have used the substance in ways that are dangerous to yourself and/or others, i.e., overdosed, driven while under the influence, or blacked out.
2. Social or interpersonal problems related to use: Substance use has caused relationship problems or conflicts with others.
3. Neglected major roles to use: You have failed to meet your responsibilities at work, school, or home because of substance use.
4. Withdrawal: When you stop using the substance, you experience withdrawal symptoms.
5. Tolerance: You have built up a tolerance to the substance so that you have to use more to get the same effect.
6. Used larger amounts/longer: You have started to use larger amounts or use the substance for longer amounts of time.
7. Repeated attempts to control use or quit: You've tried to cut back or quit entirely, but haven't been successful.
8. Much time spent using: You spend a lot of your time using the substance.
9. Physical or psychological problems related to use: Your substance use has led to physical health problems, such as liver damage or lung cancer, or psychological issues, such as depression or anxiety.
10. Activities are given up to use: You have skipped activities or stopped doing activities you once enjoyed in order to use the substance.
11. Craving: You have experienced an intense craving for the substance.

These criteria are measured by the negative impact the substance has on a person's life; including physical, psychological, and behavioral measures, and are classified as mild, moderate, and severe. The criteria are measured against the previous 12 months of substance use and a score of 2-3 is considered mild, 3-5 moderate, and 6 or more severe. Even severe opioid addictions can be treated and overcome.^[2]

Symptoms of Withdrawal

Synthetic opioids such as Dilaudid have often severely uncomfortable withdrawal symptoms. These are often similar in symptoms to extreme flu and cause many who abuse Dilaudid to be incapable of stopping on their own.

Dilaudid Detox and addiction treatment

Detoxification from Dilaudid can be achieved in both an inpatient residential setting and as part of outpatient programs. These options not only offer medical monitoring to ensure opioid withdrawal symptoms are managed safely and in relative comfort, but they also greatly increase the chances of full recovery.

There is also the strong possibility that medication-assisted treatment will be used to help Dilaudid addicts taper off the drug and manage intense cravings. Common medications used in Dilaudid detox include:

• Buprenorphine: A commonly prescribed drug to help with opioid withdrawal symptoms that prevent withdrawals as well as help manage cravings. It is also often used in heroin withdrawal treatment
• Naltrexone: A medication that blocks the receptors in the brain that react to Dilaudid and other opioids. Over time it can reduce cravings and stops opioids from having any effect on the brain
• Suboxone: A combination of buprenorphine and naltrexone, suboxone relieves withdrawal pains such as muscle aches and abdominal cramps and inhibits the effects of opioids on the brain. 

Patients will often start the initial stages of ongoing Dilaudid addiction treatment during the detox process. This will often consist of a combination of therapies and other treatments (such as support groups and therapeutic recreational activities) with the goal of identifying the behaviors that lead to addiction, building coping mechanisms and strategies to deal with cravings (often through CBT or other behavioral therapies, identifying and treating any co-occurring mental disorders, and creating a treatment program to aid in the long term recovery process.

If you or someone you care about is suffering from Dilaudid or any other substance use disorder, then contact a treatment provider today to see what help is available.