Dilaudid Abuse, Side Effects, and Withdrawal

Dilaudid (hydromorphone hydrochloride) is a narcotic or opiate pain reliever that is a full (or pure) opioid agonist. This makes dilaudid similar to morphine, methadone, heroin, oxycodone, and other opioid drugs, but it is significantly stronger than many opioid drugs.

Dilaudid’s mechanism of action is the same as other narcotic medications. It stimulates certain neurons in the brain to increase the pain threshold (to increase the amount of stimulation required to feel pain), resulting in the reduction of a person’s perception of pain. It is most commonly used as a method to control postoperative pain.

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.

Dilaudid Abuse

According to the National Institute of Drug Abuse (NIDA), prescription medication abuse and overdose of prescription medications are increasing at alarming rates and are significant social concerns. Even though Dilaudid is a controlled substance, it has found its way into the graces of individuals who abuse opioid drugs. The Substance Abuse and Mental Health Services Administration and other sources such as the NIDA have reported that:

• Prescriptions for hydromorphone (the active ingredient in Dilaudid) increased sharply in the 2000s.
• Abuse of hydromorphone resulted in a substantial increase in ER visits in the years between 2004 and 2008. This trend remains relatively consistent.
• Hydromorphone overdose is an extremely serious matter, and it can be potentially fatal. For example, the drug has been approved for use in federal executions, although it is rarely used for that purpose.

Are Certain Groups More Likely to Abuse Drugs like Dilaudid?

There is quite a bit of research that investigates the different types of risk factors that are associated with abusing prescription medications and even with abusing medications such as heroin, Vicodin, and other opioid medications. Risk factors are not direct causes, but indicate that individuals who have one or more risk factors have an increased probability of developing a particular disorder or disease. According to professional organizations, like the American Society for Addiction Medicine(ASAM), risk factors for opioid drug abuse include having a first-degree relative with a history of a substance use disorder, being in a lower social economic status, having a coexisting psychological disorder, having a history of family strife especially when one is younger, and peer pressure, among others.

There is also some interesting research that directly looks at different subgroups of individuals who use medications like Dilaudid and the types of factors associated with individuals who eventually end up with Dilaudid use disorders (an umbrella term for Dilaudid abuse or addiction to Dilaudid). One particular factor associated with developing a substance use disorder, such as a Dilaudid use disorder, is obtaining and using Dilaudid without a prescription. Because the research indicates that individuals who use prescription medications under the supervision of a physician for medicinal uses, and only use them for the specified conditions and periods of their prescription, are far less
likely to develop substance use disorders than individuals who use prescription medications for
purposes other than their intended use or without a prescription. This type of research is
particularly important to understanding how individuals develop these types of substance
use disorders.

A particularly relevant study that was published in the Journal of Drug and Alcohol Dependence was able to specify different types of subgroups of prescription drug users who took these drugs without having a prescription for them. This research also indicated how the potential for the development of a prescription drug use disorder, such as a Dilaudid use disorder, might be related to the motivation for taking these medications. The groups were:

• People who use the medication for it psychoactive or euphoric effects: These individuals were labeled recreational subtype users. They would use the drugs in different ways, such as taking them in pill form, crushing and injecting them, or crushing and snorting them. These individuals were also far more likely to mix different types of drugs and use them in combination.
• Individuals who purchased narcotic medications without a prescription and only used them for their intended therapeutic purpose, such as the control of pain: These individuals were far more likely to take the drug only in pill form and not mix the drug with other types of drugs. This group was labeled the self treatment group.
• Those who displayed different combinations of motives regarding their use of the drug and different methods of administration: This is the largest of the different subtypes and termed the mixed subtype group.

The probability of developing a prescription drug use disorder was far higher in the recreational and mixed groups, indicating that individuals who use drugs like Dilaudid for reasons other than their intended purpose, whether they have a prescription for the drug or not, are far more likely to develop a substance use disorder. Thus, people who begin taking Dilaudid to get “high” or mix it with other drugs of abuse are more likely to develop a substance use disorder.

Withdrawal Timeline for Dilaudid

Opioid medications all have a high potential for the development of physical dependence. Physical dependence consists of the syndromes of tolerance (needing more of the drug to produce the effects produced at lower dosages) and withdrawal (a physical and psychological reaction that occurs when an individual stops using certain drugs that the person’s system has learned to rely on). Because the quickest way to stop withdrawal syndrome is to begin to take the drug again, anyone attempting to stop using Dilaudid will be at a high risk for relapse if they do not have some formalized medical detox plan in place.

The withdrawal process from Dilaudid will depend on how much Dilaudid the person was taking, how long they have been taking the drug, how they have been taking the drug (direct routes of administration, such as injecting or snorting Dilaudid, will produce lengthier and more severe withdrawal symptoms that taking it in pill form), what types of other drugs they may have been using with Dilaudid, and other factors, such as individual differences in metabolism and physiology. In general, withdrawal syndrome from Dilaudid will follow this timeline:

• Dilaudid has a relatively short half-life (the time that it takes for the drug’s concentration to be reduced by half in an individual’s system) that is dependent on how a person took the drug. If one were taking Dilaudid in pill form, the half-life is a little over 4 hours, whereas if one injected Dilaudid or snorted it, the half-life is a little over 2 hours. Thus, a person who has abused Dilaudid will start to experience signs of withdrawal in a few hours following discontinuation. Typically, after 4-8 hours, an individual will begin to experience feelings of anxiety, irritability, restlessness, and even mild gastrointestinal upset.
• Depending on the specific case, individuals will feel peak withdrawal symptoms anywhere between 12 and 24 hours after discontinuation, and these may continue to be significant for up to 48 hours. The symptoms will consist of muscle aches, muscle spasms, nausea, potential vomiting, headaches, sweating, chills, mild fever, issues with anxiety that can become quite severe and mimic panic attacks, confusion, and extreme cravings to take Dilaudid.
• Most individuals will find that the symptoms begin to decline significantly after 48 hours following discontinuation. For the next 2-4 days, there may be residual symptoms, such as muscle aches, nausea, mood swings that can include anxiety and depression, and periods of irritability.
• From day 5 to two weeks following discontinuation, people will typically feel mild residual symptoms that include mood swings, irritability, feeling as if one is just not quite in sync, occasional depression, occasional anxiety, and intermittent cravings to use the drug. In some cases, these feelings may continue intermittently for months and even years following discontinuation. People are still at risk for relapse following the acute withdrawal process, as mood swings and depression can trigger cravings for the drug.

Treatment for Withdrawal

Attempting to negotiate the withdrawal process by using a “cold turkey” approach is uncomfortable and has various potential dangers. While the withdrawal process from Dilaudid is not considered to be potentially physically harmful, individuals trying to endure the withdrawal syndrome on their own are risking a higher probability of relapse, potential mishaps due to accidents, or even in some cases the potential for self-harm (e.g., suicide attempts) due to the severe discomfort and depression that are associated with withdrawal. Given the advances in medicine, particularly in addiction medicine, it is not necessary for any individual to endure the full effect of the withdrawal symptoms from any opioid drugs like Dilaudid. Using medications and tapering strategies can eliminate most withdrawal issues. Approaches using herbs and other methods do not have sufficient empirical evidence to suggest that they are superior to a “cold turkey” approach or are even equivalent to a medically assisted detox approach.

In a medically assisted detox approach, a physician, such as a psychiatrist or addiction medication physician, supervises the individual going through withdrawal and administers medications to assist with the withdrawal syndrome.

The most common medications used are opioid replacement medications that can include methadone or Suboxone, which will minimize the withdrawal syndrome and trick the individual’s system so it will continue to function as if the addictive drug were still present. This avoids the severe aspects of withdrawal.

The physician will slowly taper down the dose of the opioid replacement medication (and other medications) on a declining schedule in order to help the individual to detox from Dilaudid and experience as few symptoms as possible. Other medications to counteract some of the symptoms of withdrawal, such as clonidine or baclofen, may also be used. The research indicates that this approach is far more successful than any other approach, although there is always an increased risk for relapse whenever anyone attempts to discontinue a drug that produces physical dependence.

One final word regarding recovery from a Dilaudid use disorder is needed. The choice to stop using a drug like Dilaudid should reflect an approach to attempting to remain drug-free and no longer engaging in substance abuse. The choice to detox from Dilaudid is only the initial stage in recovery from a Dilaudid use disorder. Just going through withdrawal or using a medical detox program will not “cure” one’s substance use disorder. In fact, there is no cure for addiction. Individuals will need to engage in long-term aftercare treatment that addresses many of the issues that drove the substance use disorder, teaches them new skills and coping methods, and assists them in developing a support system that is conducive to being drug-free over the long-term. Failure to engage in a comprehensive treatment program that includes aftercare is almost a sure sign that one will relapse in the near future.