As a potent opioid analgesic, or pain reliever, Dilaudid is a prescription narcotic drug that the Drug Enforcement Administration (DEA) classifies as a Schedule II controlled substance. It may be used to treat moderate to severe pain and especially for those who may be tolerant to other opioids already. Schedule II drugs are the most regulated class of substances that still have medicinal purposes. The only drugs more tightly controlled are Schedule I substances, which are considered illegal.
The US Food and Drug Administration (FDA) publishes warnings in the prescription information for Dilaudid stating that hydromorphone (the active opioid in Dilaudid) along with other Schedule II opioid agonists have the highest potential for abuse. Dilaudid may be diverted through “doctor shopping,” which is when a person visits multiple doctors in an attempt to get more prescriptions for the drug; pharmacy, nursing home, and armed robberies; from physicians and pharmacists; and forged prescriptions, the DEA reports. Any use of a prescription drug without a legitimate and medically necessary prescription is considered abuse. The DEA further publishes that as of 2011, around 1 million Americans who were over the age of 11 had abused Dilaudid at least once in their lifetimes. Dilaudid is known by a variety of names on the street, such as dust, dillies, D, juice, smack, and footballs.
Dilaudid comes in a tablet, liquid, or injectable format, and it may be abused by swallowing, snorting, smoking, or injecting it. Hydromorphone is a pure opioid agonist, according to the FDA, which works to suppress pain sensations and the cough reflex. Opioid agonists bind to opioid receptor sites in the brain, causing a flood of some of the neurotransmitters affecting moods and cognition. As a result, it can produce euphoria, or a “high.” Opioid drugs also act as central nervous system depressants, slowing down respiration rates and other autonomic body functions necessary for life.
These drugs are considered extremely addictive and habit-forming if used for a long period of time. The National Survey on Drug Use and Health (NSDUH) reports that close to 4.5 million people over the age of 11 in the United States in 2014 were currently abusing prescription painkillers.
The American Society of Addiction Medicine (ASAM) publishes that around 2 million American adults battled a substance abuse disorder involving prescription pain relievers in 2014. Young adults and adolescents may be at the highest risk for abusing prescription painkillers, as those between the ages of 18 and 25 abuse them at the highest rates (according to the 2014 NSDUH).
Dilaudid Overdose and Other Potential Hazards of Abuse
The DEA reports that hydromorphone is 2-8 times more potent than morphine, with greater pain-relieving results, more sedative effects, and a shorter length of action. When someone is under the influence of Dilaudid, they are likely drowsy, mellow, and happy. They may suffer from impaired coordination and motor functions, have slurred speech, and not be able to think clearly enough to make good decisions. They may engage in potentially dangerous behaviors, get into accidents, or get into legal trouble.
Hydromorphone can also cause nausea, vomiting, and constipation, and it may result in a loss of appetite and potential weight loss and malnutrition. Chest pain, dizziness, headache, lightheadedness, difficulties sleeping, short-term memory lapses, irregular blood pressure and heart rate, agitation, dry mouth, skin issues, and urination problems may also be side effects of hydromorphone use or abuse. If an individual injects Dilaudid, they may be at risk for contracting an infectious disease, such as HIV/AIDS or hepatitis, as well as for skin infections, collapsed veins, and the buildup of “track marks” or scarring at the injection site. Snorting the drug can cause irreversible damage to the sinus and nasal cavities, causing nosebleeds and a runny nose. Smoking it may lead to respiratory infections, burns on the hands or face, and a chronic cough. The Drug Abuse Warning Network (DAWN) reports that more than 18,000 people obtained emergency department (ED) care for some kind of negative reaction to the abuse of hydrocodone in 2011.
Hydromorphone can overwhelm a person’s system and lead to a toxic overdose as well, particularly when taken in high doses in a manner other than as intended. The Centers for Disease Control and Prevention (CDC) calls drug overdose fatalities an epidemic in the United States, as close to 50,000 people died from one in 2014. This includes a 200 percent increase in opioid overdose fatalities since the year 2000. More than 60 percent of drug overdose deaths in America in 2014 involved an opioid drug, and semisynthetic and natural opioids (which includes hydrocodone) were involved most frequently in opioid overdose fatalities, the CDC publishes.
An overdose on hydromorphone slows down heart rate, blood pressure, body temperature, and respiration rates, and generally, an individual will stop breathing. Cold skin, mental confusion, nausea and vomiting, pinpoint pupils, weak pulse, extreme drowsiness, loss of consciousness, significantly decreased alertness, and trouble breathing are all signs of a hydrocodone overdose. Mixing other central nervous system depressants like alcohol or prescription tranquilizers (benzodiazepines) can increase the possible side effects and risk for overdose, as these substances also slow down autonomic life-sustaining functions.
Dilaudid Withdrawal Timeline
One of the major side effects of physical dependence on a drug such as Dilaudid is the onset of the withdrawal syndrome when the drug is stopped suddenly or removed from the body. The National Library of Medicine (NLM) publishes that the side effects related to opioid withdrawal generally start within about 12 hours of the last dose of an opioid drug. According to the labeling information on Dilaudid by the manufacturer, Purdue Pharma, hydrocodone may stop being active in the body 3-6 hours after it is taken, depending on the method. This means that it is a relatively short-acting opioid, and withdrawal symptoms may therefore start a little sooner than with other opioids.
These withdrawal symptoms can be both physical and psychological. Typically, they will peak within a day or two, with physical symptoms lasting about a week, on average, and emotional ones potentially lingering a little longer. In general, opioid withdrawal symptoms are broken down into two main stages: early and late withdrawal.
Early withdrawal symptoms
- Tearing up
- Runny nose
- Achy muscles
Late withdrawal symptoms
- Stomach pain
- Nausea and vomiting
- Chills and goosebumps
- Dilated pupils
- Joint and back pain
- Difficulty feeling pleasure
- Trouble concentrating
- Muscle weakness
- Hypertension (high blood pressure)
- Tachycardia (irregular heart rate)
- Respiratory distress
- Drug cravings
The withdrawal timeline, and the intensity and duration of symptoms, can be directly correlated to how physically dependent on Dilaudid a person is. Longer time periods taking the drug and higher doses of Dilaudid will result in higher levels of dependence. Co-occurring medical or mental health issues can also complicate dependence and withdrawal, and environmental factors can play a role as well.
Detox and Comprehensive Care Options
Addiction is considered a chronic and relapsing disease of the brain that impacts a person’s relationships, emotional state, physical wellbeing, and many other parts of everyday life. In this sense, treatment must be comprehensive in order to help a person to heal and work toward recovery. Often, the first stage of an addiction treatment program is to safely process drugs from the body through detox. In the case of an opioid drug like Dilaudid, medical detox is the most beneficial, as it can provide the highest level of care. Medical and mental health professionals can monitor vital signs, offer support and encouragement, and administer aid when needed. Withdrawal symptoms can be managed and minimized with the help of medications and supportive care during medical detox.
The FDA approves of three types of medications for the treatment of opioid dependence, according to the White House. These include methadone, buprenorphine, and naltrexone. Methadone and buprenorphine may be useful during medical detox, as they act as replacement opioid agonists for Dilaudid. These drugs still activate opioid receptors, but in the case of methadone, for longer and with fewer doses, and for buprenorphine, only partially.
Buprenorphine is also often combined with naloxone, which is an opioid antagonist. Opioid antagonists block opioid receptors and keep the drugs from making a person “high.” In buprenorphine combination products (e.g., Zubsolv, Suboxone, and Bunavail), the antagonist remains dormant unless a person tries to abuse and inject the drug or add other opioids to the mix. Then, it will precipitate difficult withdrawal symptoms. In this way, these products can be helpful in preventing relapse and ensuring treatment compliance. Opioid antagonist medications may therefore be useful later on in opioid addiction treatment. Antidepressants, medications that control irregular autonomic nervous system functions, sleep aids, and medications for gastrointestinal upset may also be helpful during medical detox, as they work on some of the specific symptoms that may accompany Dilaudid withdrawal.
The main goal of medical detox is to re-establish physical balance before entering into a more complete treatment program. Detox usually lasts 5-7 days, although some circumstances may require less or more time. A complete assessment and drug screening are done upon admission in an attempt to best understand the particular needs of each individual person and to provide the optimal treatment methods.
After detox, individuals may choose between outpatient or inpatient treatment programs. Both likely offer a wide range of options and services, including:
- Behavioral therapies to improve self-esteem, teach stress management techniques, and positively modify negative thought patterns to therefore change behaviors for the better
- Counseling sessions provided in both group and individual formats as well as family counseling options to improve communication skills and the family unit as a whole
- Educational programs to help individuals and families to better understand the disease of addiction and how treatment and recovery work
- Integrated treatment for co-occurring mental health disorders so both disorders can be managed concurrently and completely
- Support groups and 12-Step programs may be initiated in treatment to provide long-term support and relapse prevention tools
Inpatient, or residential, treatment programs likely offer holistic services in addition to traditional recovery methods, such as nutritional meal planning; set sleeping, waking and eating times; yoga; mindfulness meditation; fitness programs; art therapy; and massage therapy. These complementary techniques can aid in recovery by promoting overall wellbeing during treatment.
The National Institute on Drug Abuse (NIDA) recommends no less than 90 days in a substance abuse treatment program to allow the brain time to heal and for new healthy habits to become second nature. Transitional housing and aftercare services may provide additional support beyond a residential treatment program to assist individuals in reintegrating back into everyday life while helping to sustain abstinence and enhance long-term recovery.