Understanding Dilaudid Abuse

An opioid narcotic medication 5-10 times more potent than morphine, according to the British Journal of Anesthesia (BJA), Dilaudid is the brand name for the drug hydromorphone, an analgesic available legally only through prescription.
Hydromorphone is a pain reliever prescribed for severe pain, to treat chronic pain, or for those who are tolerant to other opioid drugs. It is not intended to be used for the short-term relief of pain symptoms, Mayo Clinic reports.

Dilaudid comes in tablet form, oral solutions, injectable forms, and rectal suppositories. The Drug Enforcement Administration (DEA) classifies Dilaudid (hydromorphone) as a Schedule II controlled substance, a status reserved for drugs with accepted medicinal uses but also extremely high potential for diversion, abuse, and dependence. Schedule II control status is the highest level of regulation for prescription medications, with only Schedule I illegal drugs that have no accepted medical use in the United States being more tightly regulated or controlled.

Abuse of Dilaudid

Pills In Pill Bottle On White BackgroundOpioid drugs act on the central nervous system, suppressing cough symptoms and pain sensations as well as lowering blood pressure, heart rate, and respiration levels. Opioids enhance calm and relaxation, and when abused, they can produce a euphoric “high.”

Prescription opioid drugs are heavily abused around the world, as the World Health Organization (WHO) reports that an estimated 15 million people around the globe battle opioid addiction. In the United States, the National Survey on Drug Use and Health (NSDUH) estimated that 4.3 million Americans aged 12 and older were considered current abusers of prescription painkillers at the time of the 2014 survey, meaning that they had used one for nonmedical reasons in the month prior. The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that close to 2 million people in the United States suffered from a substance use disorder related to prescription pain reliever abuse in the year leading up to the 2014 national survey.

Prescription drug abuse and addiction are often treated with behavioral therapies and pharmacological methods in specialized facilities where individuals can receive education, tools for stress management, help removing the drug safely from the body via medical detox, and support throughout treatment and into to recovery. Both residential and outpatient programs offer a range of services and treatment methods that can help an individual recover from opioid addiction and sustain long-term abstinence through relapse prevention, aftercare, and support services.

The NSDUH of 2014 found that the highest percentage of people abusing prescription opioids were between the ages of 18 and 25. The DEA reports that suburban and rural populations are more likely to abuse hydromorphone specifically, and that diversion occurs most often through forged prescriptions, going to multiple doctors for prescriptions, pharmacy robberies, thefts of the medication from nursing homes, armed robberies, and through direct and illegal diversion from pharmacists and physicians.

On the street, Dilaudid is known as footballs, dust, smack, dillies, juice, and D. Opioid drugs like Dilaudid are popular with recreational users, likely because of the way the drugs interact with opioid receptors in the brain and along the central nervous system. They disrupt the flow of some of the brain’s natural messengers, signaling pleasure and dispelling anxiety and stress.

Dilaudid is a full opioid agonist, meaning that it fills opioid receptors completely and mimics some of the brain’s normal functions, including how these natural chemicals are reabsorbed. This can create a kind of backlog of some of the brain’s messengers like dopamine and its natural endorphins. Endorphins work to regulate emotions, and dopamine is the brain’s chemical messenger that tells a person when to feel happy. When this drug floods the brain due to the inability to be reabsorbed naturally, or through artificial stimulation of its production, it can cause an unnatural spike in euphoria, or a “high” that recreational drug users may strive for.

Being a more potent opioid than many others, Dilaudid is commonly sought by people wishing to feel this intense high. Dilaudid has a short onset of action of 10-15 minutes, which is desirable to users as well.

Dilaudid may be abused by swallowing the tablets, chewing them, crushing and snorting or smoking them, or by injecting the crushed tablets after mixing them with liquid. The DEA published that as of 2011, 1 million people aged 12 and older had used Dilaudid recreationally, or for nonmedical purposes, at least once in their lives.

Individuals who have a history of substance abuse or recreational drug use may abuse Dilaudid; however, this is not the only population to do so. Dilaudid abuse may start out with a legitimate prescription for pain relief. When Dilaudid is taken regularly for a period of time, a tolerance to the drug may develop, meaning that the individual will need to take higher doses in order for it to continue to be effective. As a person takes more Dilaudid regularly, a physical dependence can form over time.

The U.S. Food and Drug Administration (FDA) publishes that like other opioids, Dilaudid can cause dependence, which is manifested by withdrawal symptoms when the drug is removed or leaves the bloodstream. Dilaudid withdrawal can cause a person to suffer from the following effects: restlessness, anxiety, yawning, chills, irritability, depression, nausea, abdominal cramps, weakness, joint and back pain, insomnia, diarrhea, hypertension, fever, increased heart rate and respiration levels, sweating, tearing, and a runny nose within several hours of the last dose. Withdrawal symptoms may encourage people to keep taking Dilaudid even when their prescription runs out or when they may no longer need the medication for pain relief. The way the brain’s chemical pathways are altered through chronic Dilaudid use can make it desirable to keep taking the drug in order to keep feeling good.

Physical dependence and the presence of withdrawal symptoms do not always indicate addiction, although they are both potential signs. Addiction is considered a brain disease that affects the parts of the brain responsible for impulse control, mood regulation, and reward processing. When people battle drug addiction, they are unable to control how much of the drug they take at one time and how often they take it.

Individuals suffering from addiction may be prone to erratic, risk-taking, and unpredictable behaviors as well as mood swings. Socially, they may become secretive and withdrawn, and stop participating in things they used to take great pleasure in. Drug-seeking behaviors and drug usage may dominate life, and work production is likely to be negatively impacted. Someone battling addiction to Dilaudid may sleep at strange times and may change eating habits, resulting in weight fluctuations that may be significant. Money problems and criminal activity may be signs of addiction even in people who had no legal troubles or financial difficulties before using Dilaudid. Those who suffer from an addiction to Dilaudid cannot control their drug abuse and may continue to use the drug even when they are fully aware of the multitude of physical, emotional, social, financial, and other negative consequences.

Due to the nature of the withdrawal side effects and drug cravings that may begin when a person stops taking Dilaudid, it is not recommended to try and stop taking this powerful opioid without professional help. Opioid dependence and addiction must be treated first through medical detox in order to safely remove the drug from the body and minimize potential withdrawal symptoms. Therapeutic methods and counseling sessions, as a part of a comprehensive treatment program, should follow detox.

Overdose Dangers

Every single day in the United States 44 people die from a prescription opioid painkiller overdose, the Centers for Disease Control and Prevention (CDC) reports. Powerful narcotics such as Dilaudid slow down some of the necessary bodily functions like breathing, heart rate, body temperature, and blood pressure. An opioid overdose is usually the result of respiration levels dropping too low and breathing stops. The FDA cites the following as signs of a Dilaudid overdose:

  • Shallow, slow breaths or trouble breathing
  • Drowsiness
  • Possible loss of consciousness or falling into a coma
  • Lack of muscle tone or flaccid skeletal musculature
  • Cold or clammy skin
  • Constricted pupils
  • Low blood pressure
  • Weak pulse or slow heart rate
Anytime too much of the drug is introduced into the bloodstream at once, an overdose is possible; however, the method in which a person takes Dilaudid can impact overdose. Snorting, smoking, or injecting it sends the full dosage of the drug very quickly across the barrier between a person’s blood and brain and can raise the risk for overdose. Injecting Dilaudid may increase the risk for suffering from an overdose by resulting in a collapse of the circulatory system, cardiac arrest, or apnea, the FDA warns.

A Dilaudid overdose is potentially fatal, and immediate medical attention should be sought if one is suspected. The Drug Abuse Warning Network (DAWN) reported almost 20,000 emergency department (ED) visits involving the nonmedical use of hydromorphone in 2011.

An overdose from hydromorphone can be reversed with the introduction of an opioid antagonist like naloxone.

Taking additional drugs or alcohol in combination with Dilaudid also heightens the potential hazards and the possibility of suffering from a life-threatening overdose. The DAWN Report in 2014 published that mixing opioid pain relievers such as Dilaudid with benzodiazepines or alcohol greatly increased the risk of a more serious negative interaction. Benzodiazepine medications are sedatives and tranquilizers, and they also suppress the central nervous system. Since alcohol, benzodiazepines, and Dilaudid all function to lower these vital life functions, combining them can have disastrous consequences.

Overdose is also a concern for individuals who have detoxed from Dilaudid and then suffer a relapse. A return to using Dilaudid after the body has purged it completely can be dangerous as the person may return to using the drug at previous levels only to discover that tolerance has changed. This can increase the chances that the person will suffer an overdose. Comprehensive substance abuse treatment programs can help to prevent relapse, and offer support and continuing care for those struggling with opiate addiction.

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