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Hydromorphone Abuse, Addiction, And Treatment Options

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

March 21, 2019

Hydromorphone is a powerful synthetic opioid, derived from morphine. It carries a high risk for abuse and addiction, and when abused produces a ‘euphoria’ similar to heroin.

What Is Hydromorphone?

Hydromorphone belongs to the opioid family and is commonly known as Dilaudid, a brand name of the drug. Hydromorphone is used to treat intense, severe pain, and is only suggested for short periods of time, due to the high potential for abuse.

Hydromorphone is available as an IV injectable, tablets, or suppositories. Hydromorphone is approximately eight times stronger than morphine. This is why it is usually prescribed when pain is not responsive to other opioids, such as Vicodin, codeine, and morphine.

This drug is abused most often in suburban and rural populations, and some street names for hydromorphone include dillies, smack, dust, and juice.

Who Abuses Hydromorphone And Why

Many people begin taking opioids, like hydromorphone, due to an injury or trauma of some kind. The pain relieving properties of hydromorphone are fast acting, usually within 15 minutes, and intense. Pain relief typically lasts between 4 to 6 hours.

What begins as a treatment option for pain can easily lead to tolerance, dependence, abuse, and eventually, addiction. Anyone who takes prescription opioids can be at risk for opioid abuse, especially if they have developed a tolerance or dependence to hydromorphone.

Hydromorphone abuse occurs most often among young adults, ages 18 to 25. According to the Drug Enforcement Administration, illicit hydromorphone is usually obtained through illegal channels, like doctor shopping, fake prescriptions, theft, armed robberies, and illegal connections with doctors and pharmacies.

When hydromorphone is abused, a person experiences a high that results in euphoria, happiness, and elation. This happens due to the way that hydromorphone affects the brain. Hydromorphone is a full opioid agonist, which means that it attaches completely to opioid receptors in the brain. Once attached, it increases levels of other chemicals in the brain, like dopamine, creating the euphoric effect that keeps many people with opioid addiction coming back to the drug.

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Hydromorphone Abuse

Taking hydromorphone in a way that is not prescribed is considered substance abuse, whether they have a prescription or not. Some people abuse hydromorphone by taking more pills than prescribed, adding a dose before it is time, taking hydromorphone with other substances, or crushing and snorting or injecting the drug.

It may not be easy to recognize when a person is abusing hydromorphone. Because this medication is used to treat pain, a person who is using hydromorphone may become more active than when they do not have the medication in their body. It may not seem as though they are taking a central nervous system (CNS) depressant.

However, there are some effects of hydromorphone abuse, and they include:

  • dry mouth
  • sweating excessively
  • stomach pain
  • anxiety
  • headaches
  • insomnia
  • itching
  • flushed face/skin
  • depression

If a person is experiencing these effects, and they are also running out of their prescription of hydromorphone before it is to be refilled, this could indicate hydromorphone abuse.

Combining Hydromorphone With Other Drugs

Combining hydromorphone and other CNS depressants (alcohol, benzodiazepines, barbiturates) can be fatal. It can lead to many negative outcomes, including death. The combination can cause the body to slow down so much that it actually stops working at all, resulting in systems failure and potential fatalities.

Mixing hydromorphone with CNS stimulants (cocaine, methamphetamines, methylphenidate) can be equally catastrophic. When the body receives high doses of stimulants and depressants, it can cause heart dysrhythmia, dehydration, heart failure.

There are significant risks associated with mixing hydromorphone with any additional substances of abuse, at any dose. These include:

  • trouble breathing
  • stroke
  • coma
  • nausea
  • vomiting
  • collapsed veins
  • heart failure
  • seizures
  • death

Hydromorphone Addiction

Tolerance and dependence typically precede hydromorphone addiction. When a person does not feel the same effect from their prescribed dose of hydromorphone (ie, tolerance), they sometimes take more of the medication to get those effects.

Over time, a person may not feel normal if they are not taking hydromorphone (dependence). This can lead to a person engaging in behaviors that are considered addiction. Hydromorphone addiction can be indicated by a person having several of the following behaviors:

  • hydromorphone is taken in larger amounts or time periods than intended
  • failed attempts to regulate or quit taking hydromorphone
  • hydromorphone cravings
  • taking hydromorphone negatively affecting work, home, or family obligations
  • keep abusing hydromorphone after acknowledging negative effects on life.
  • continued hydromorphone use despite health issues directly related to substance abuse
  • avoiding social activities or hobbies in order to continue hydromorphone use
  • tolerance to hydromorphone
  • withdrawal when hydromorphone is not available

While these above behaviors occur with a person struggling with hydromorphone addiction, the body may also experience the following effects from high doses of hydromorphone:

  • rash/hives
  • a hoarse or gruff voice
  • difficulty breathing
  • trouble swallowing
  • nausea
  • sexual dysfunction
  • irregular menstrual cycle
  • low sex drive
  • sleeping in inappropriate situations
  • seizures

Hydromorphone Overdose

High doses of hydromorphone have a significant effect on both respiration and heart function. When a person overdoses on hydromorphone, a person’s breathing, and heart rate can slow so much that one or both systems fail completely, resulting in death.

When a person is overdosing from hydromorphone, the following symptoms are likely to occur:

  • pinpoint pupils
  • weak pulse
  • shallow breathing
  • disorientation
  • blue/grey lips or fingertips
  • clammy skin
  • vomiting
  • losing consciousness
  • dizziness
  • muscle spasms

Narcan is a medication that reverses the effects of an opioid overdose. This medication can be given to a person experiencing a hydromorphone overdose. It is important to seek emergency medical attention for an overdose, regardless if Narcan was administered or not.

Hydromorphone Statistics

  • 2.5 million hydromorphone prescriptions were written in 2016
  • A pharmaceutical company stopped making some US forms of hydromorphone in 2017, resulting in a shortage
  • More than 130 people die a day from opioid-related overdoses

Hydromorphone Treatment

When seeking treatment for hydromorphone abuse or addiction, it is important to locate facilities that are approved to treat opioid use disorders (OUD). These locations are equipped with medically supervised detoxification units that use evidence-based interventions to help a person withdrawal safely from opioids like hydromorphone.

It is common for medications to be prescribed to help ease the discomfort associated with opioid withdrawal. Medications, such as benzodiazepines, buprenorphine, and naltrexone, are prescribed to individuals who are struggling with withdrawal symptoms.

Once detox is completed, a person typically continues to a substance abuse treatment program in order to continue their sobriety. A number of evidence-based therapeutic interventions are offered to educate and help a person make positive changes and improvements to their life.

It is strongly encouraged that a person who struggles with opioid abuse or addiction attend an inpatient rehab, but it is not always an option for some people. There is no cookie-cutter solution for hydromorphone addiction. We can help find the right answer for you or your loved one. Reach out to us today so you can start your journey into sobriety right now.

Drug Enforcement Administration - Hydromorphone

American Society of Health-Systems Pharmacists - Drug Shortages-Hydromorphone Injection

Health and Human Services - National Opioid Crisis Information

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