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Dilaudid – The Opioid You Don’t Know Enough About

Dilaudid – The Opioid You Don’t Know Enough About

While it is one of the older approved opioid medications, Dilaudid is not nearly as well-known today as its newer cousins – Vicodin or OxyContin, for example. But in today’s climate, with the ongoing – and worsening – opioid epidemic, a lack of awareness can put your health at risk.

First Things First – What Is Dilaudid?

Dilaudid is the brand name for hydromorphone, a prescription opioid pain reliever. It is typically given for moderate-to-severe or chronic pain. It can also be used as an anesthetic adjunct, permitting the use of lower doses of anesthesia, and therefore, less side effects. Rarely, hydromorphone is used in a cough syrup. There are approximately 4 million hydrocodone prescriptions dispensed every year in the United States. Hydromorphone was first made in Germany, with the first patent being granted in 1922. In 1926, it became widely available under the brand name Dilaudid. Interestingly, the brand name has become so well-known that even generic formulations are often referred to as Dilaudid, rather than hydromorphone. Other brand names for hydrocodone include:

  • Dilaudid-HP
  • Exalgo – An extended-release tablet given for around-the-clock pain management.

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What is The Proper Dosage for Hydromorphone?

When given in an oral solution, the proper dosing range is between 2.5 mL and 10 mL every 3 to 6 hours, as necessary for pain relief. In tablet form, the dosing range is between 2 mg and 4 mg, every 4 to 6 hours. Chronic pain patients are allowed a supplemental dose of between 5% and 15% of their TOTAL daily use every two hours, as needed. With immediate-release formulations, Dilaudid’s onset of action when taken orally is usually approximately 30 minutes, with a duration of at least five hours. Hydrocodone is habit-forming, so when the drug must be discontinued, the dose should be gradually tapered, by 25%-50%, every 2 to 4 days. During this time, the patient should be monitored for signs of withdrawal. If withdrawal symptoms present, the dose should be increased slightly and then tapered again, albeit more slowly.

Comparison with Morphine

Morphine is the standard by which other opioids’ strength is measured. Compared to an oral dose of morphine, Dilaudid has a relative strength that is at between four and eight times greater. Hydromorphone’s potency sometimes creates a risk of accidental overdose. Because the names look and sound so similar, it is easy to mix up “hydromorphone” and “morphine”, creating a potential problem. For example, in 2004, an emergency room patient died after mistakenly being given a 10 mg dose of hydromorphone, when 10 mg of morphine was the correct medication. Hydrocodone is also more lipid-soluble than morphine, which means it is absorbed and takes effect faster. It also produces less itching and nausea than morphine.

What Are the Side Effects of Dilaudid?

Dilaudid use or abuse carries the same risk of side effects as other potent opioids, including:

  • Dizziness
  • Lightheadedness
  • Sedation
  • Headache
  • Itching
  • Nausea
  • Vomiting
  • Constipation
  • Profuse Sweating
  • Hallucinations
  • Urinary Difficulty
  • Hormonal Imbalance
  • The biggest danger of hydromorphone abuse is the risk of respiratory depression. This risk is dose-dependent, meaning the more of the drug that is taken, the greater effect it will have on the user’s breathing.

These risks are greatly magnified when Dilaudid is used in combination with other central nervous system depressants – other opioids, benzodiazepine tranquilizers, or alcohol. Of special relevance, 98% of all fatal drug overdoses involve more than one substance.

  • From 2008 through 2011, the number of ER visits involving the nonmedical use of hydromorphone rose significantly, from 12,142 to 18,224, an increase of 50%.
  • Between 2005 and 2011, there were almost 250,000 ER visits for opioid/benzodiazepine combinations.
  • When opioids, alcohol, and benzodiazepines were each involved, an additional 43,000 ER trips occurred.
  • Significantly, approximately 40% of those ER visits ended with a “serious outcome” – long-term hospitalization, permanent disability, or death.

This dangerous interaction played out in reality during 2004 and 2005. Purdue Pharma launched an extended-release hydromorphone formulation called Palladone. But taking this medication with alcohol led to a phenomenon known as “dose-dumping”. This is when the drug’s active ingredients are rapidly released into the bloodstream. When Palladone and alcohol were combined, even in small amounts, it triggered what the FDA referred to as “serious, or even fatal, adverse events in some patients.” In 2005, Purdue voluntarily pulled Palladone off the market.

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Why Is Dilaudid so Addictive?

Like other opioids, Dilaudid produces several “positive” effects that reinforce abuse:

  • Euphoria
  • Relaxation
  • Decreased anxiety

Taking hydromorphone triggers a surge in the production of dopamine – the body’s natural neurotransmitter associated with pleasure, reward, learning, and motivation. Dopamine is known as the “feel-good” hormone. This is how it works – FIRST, the person takes the Dilaudid medication, and experiences pleasurable sensations of euphoria and relaxation, triggered by the dopamine spike. THEN, the person’s brain learns to associate the action (taking Dilaudid) with a pleasurable reward (dopamine spike/euphoria/relaxation). This is what leads some people to misuse their pain medications recreationally – they simply like the way it makes them feel. OVER TIME, the brain stops producing dopamine naturally, instead relying on the artificial overstimulation caused by the narcotic use. This means that the person is completely unable to experience pleasure – or even feel normal – unless they are under the influence of hydromorphone. This process is accelerated when Dilaudid is taken non-medically, at higher recreational doses. This also means that when the drug is discontinued, the hydromorphone-dependent person goes into a kind of shock known as withdrawal – harshly uncomfortable and painful physical and mental symptoms that can manifest within just a few hours of the last dose. Withdrawal can be so agonizing as to cause compulsive drug-seeking behaviors in the person. They will act completely out of character in an attempt to obtain more drugs to relieve their suffering. Where once, they chose to take Dilaudid to feel GOOD, now they are forced to take it to keep from feeling BAD. Because of this, Dilaudid has a high dependence and abuse potential. In fact, before oxycodone and hydrocodone were introduced, products containing hydromorphone where the most-diverted and abused opioid products. On the street, hydromorphone/Dilaudid is known by several names:

  • D
  • Dillies
  • Dust
  • Footballs
  • Juice

According to the DEA, a 4 mg Dilaudid pill will sell on the black market for up to $100.

Withdrawal Symptoms

Within 12 to 24 hours following the last dose of hydromorphone, withdrawal symptoms begin to present. The symptoms typically last between 7 and 14 days, depending upon the person’s usage history. A heavy, chronic user will experience a withdrawal that is more severe and longer-lasting than someone with a shorter history of misuse.

  • Extreme anxiety, to the point of panic
  • Irritability
  • Deep depression
  • Loss of interest or enjoyment in daily activities
  • Irresistible drug cravings
  • Headache
  • Profuse sweating
  • Runny nose
  • Joint and muscle pain
  • Abdominal cramps
  • Goosebumps
  • Nausea
  • Vomiting
  • Diarrhea
  • Flulike symptoms – this is why an opioid addict in withdrawal will referred to themselves as “sick”.

While Dilaudid withdrawal is not particularly dangerous, it can be so unpleasant as to force a person engage in dysfunctional, drug-seeking behaviors.

Medications for Dilaudid Withdrawal

Opioid Replacement Therapy (ORT) is the best way to manage hydromorphone withdrawal.  ORT involves replacing the abused opioid – Dilaudid – with another longer-acting opioid that is not quite as euphoria-producing. This substitution allows the addict in recovery to regain a personal degree of stability while reducing drug cravings and other withdrawal symptoms. With the right ORT medication and supportive care, up to two-thirds of patients in hydromorphone recovery are able remain completely opioid-free, and up to 95% greatly reduce opioid use. Both the United Nations Office on Drugs and the World Health Organization endorse ORT. The most common ORT medications are:

  • Methadone– Methadone Maintenance Treatment (MMT) is a first-line option for those opioid addicts who have trouble staying sober. MMT grants them stability and productivity, while also protecting against infectious diseases such as hepatitis, HIV, and AIDS.

Ideally, the dosage can be gradually tapered over time, until the recovering opioid addict is able to maintain their sobriety on their own.

  • Buprenorphine– Like methadone, buprenorphine eases opioid cravings by interacting with the opioid receptors in the brain. But there is a key difference – methadone is a full opioid agonist, which means that although it displaces more harmful opioids like hydromorphone, it still carries a high potential for abuse and overdose. Buprenorphine is a partial opioid agonist. This means it has much less of an abuse potential than methadone.

Often, buprenorphine is combined with the overdose-reversal drug naltrexone, in a formulation called Suboxone. Not only does Suboxone ease opioid cravings, it also acts as a deterrent if the patient tries to misuse ANY opioid.

The Warning Signs of Dilaudid Abuse and Addiction

Drug addiction does not happen overnight, it is a gradual process. Along the way, there are definite warning signs that can serve as red flags of possible hydromorphone misuse and abuse.

  • Taking more of the medication than recommended.
  • Taking the medication more often than recommended.
  • Taking the hydromorphone in secret.
  • Lying to others about one’s hydrocodone use.
  • Faking or exaggerating symptom in order to obtain more medication.
  • “Doctor shopping” – visiting several providers to obtain multiple prescriptions.
  • Accepting, buying, or stealing Dilaudid from others.
  • Altering the hydromorphone medication or taking it in a manner not prescribed, in order to enhance its effects – crushing and snorting it, dissolving it in water and injecting it, etc.
  • Becoming anxious or irritable when the hydromorphone medication isn’t available.
  • Committing criminal acts to get more Dilaudid – embezzlement, fraud, stealing prescription pads, etc.
  • Unusual sleeping patterns – extreme drowsiness, nodding off, excessive sleeping
  • Injection marks

How Bad Is the US Opioid Crisis?

The US drug epidemic is being fueled by the opioid crisis. In 2017, an estimated 71,600 Americans died because of overdoses. That was the most drug deaths in a single year in this country’s history. But here’s the thing – in recent years, EVERY YEAR has set a tragic new “record”:

  • 2016: 64,070
  • 2015: 52,404
  • 2014: 47,055
  • 2013: 43,982

In fact, doing the math, we see that drug poisonings have increased by 63% within just the last five years. Opioid deaths account for approximately two-thirds of all fatal overdoses. That means that since 2013, there have been over 139,000 opioid-related deaths in America. According to the latest Vital Signs report released by the Centers for Disease Control and Prevention report, there was no part of the United States that did not experience an increase in opioid-related overdoses between 2016 and 2017. ER visits involving opioid overdoses increased by 30% in every part of the country. July 2016-September 2017:

  • The Midwest: +70%.
  • Large metropolitan areas: +54%
  • Large “fringe” metros: +21%
  • Medium metros: +43%
  • Smaller metros: +37%
  • Micropolitan areas: +24%
  • Non-core cities: +21%
  • Among males: +30%
  • Among females: +24%
  • 25-34-year-olds: +31%
  • 35-54-year-olds: +36%
  • 55 and up: +32%.

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What Does All of This Mean?

The most important take away from all of this information is that the opioid crisis is bigger and broader than most people realize. Although drugs other, more popular drugs get all the headlines, the truth is that there are literally dozens of opioid medications, in hundreds of formulations, all with a potential for abuse. This highlights the need for a better understanding of ALL opioids:

  • How they work
  • How they affect the brain
  • Regular side effects
  • Potential for tolerance, dependence, abuse, opioid addiction, and overdose
  • Warning signs of abuse
  • Responding to an opioid overdose emergency
  • How to manage pain without opioids
  • Talking with your doctor about concerns
  • Recovering from opioid dependency or addiction

The opioid epidemic is not going to end on its own. It is going to take a national paradigm shift that challenges the public perception about addictive disorders. From there, solving this public health crisis will take concerted efforts on every level—federal, state, city, community, and even individual families.