Hydromorphone (Dilaudid) Addiction: Signs, Effects, and Treatment

What Is Hydromorphone (Dilaudid)?

Hydromorphone is a semi-synthetic opioid analgesic prescribed to provide relief from severe pain. As an opioid, it interacts with opioid receptors in the brain and influence the body’s perception of pain.¹

Hydromorphone is a Schedule II substance under the Controlled Substances Act. Other Schedule II opioids include morphine, oxycodone, oxymorphone, and fentanyl. While these substances, including hydromorphone, can be useful for pain management, they can also be addictive.¹

When prescribed, hydromorphone—marketed under the brand name Dilaudid as well as generic formulations—comes as tablets, capsules, and liquids to be taken orally or injected.³

Effects of Hydromorphone

Hydromorphone, prescribed for pain relief, may come with side effects. Some of the most commonly reported effects include.⁴

• Light-headedness.
• Dizziness.
• Sedation.
• Nausea.
• Vomiting.
• Sweating.
• Flushing.
• Euphoria.
• A state of general dissatisfaction with life (dysphoria).
• Dry mouth.
• Itchiness.

More dangerous adverse effects associated with hydromorphone use include misuse, addiction, and severe respiratory depression (i.e., slowed or stopped breathing).⁴

Though hydromorphone and other opioids are generally considered to be safe when taken as directed and under the supervision of a doctor, even taking them as prescribed can lead to tolerance and physiological dependence. Tolerance occurs when an individual’s body adapts to having the drug present and requires higher or more frequent doses to feel the same effects the drug had previously produced.^4,5 Physiological dependence means that because of regular use, the body has become so used to having hydromorphone in its system that abrupt discontinuation of the drug or significant reduction in dose results in withdrawal symptoms.^3,4

Hydromorphone Misuse

Individuals who misuse hydromorphone may do so to produce the feelings of euphoria, relaxation, or reduced anxiety or pain relief.³ Misuse can occur in several ways, including:^4,6

• Taking a hydromorphone prescription that is not prescribed to you.
• Taking a higher dose than is prescribed to you.
• Using the prescription in a way other than prescribed. For instance, individuals who misuse hydromorphone may crush the tablets or break open the capsules to snort the powder or dissolve it in water and inject it into the vein.
• Shopping doctors to obtain multiple opioid prescriptions.

Signs of Hydromorphone Addiction

Addiction is a treatable, chronic medical disease marked by compulsive or uncontrollable substance use that continues despite harmful consequences.⁷ Doctors, psychiatrists and psychologists use the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5^th edition, to diagnose a hydromorphone addiction, clinically referred to as an opioid use disorder. Knowing the diagnostic criteria can be helpful in recognizing whether your hydromorphone use or that of a loved one should be a cause for concern.

The diagnostic criteria for an opioid use disorder includes:⁸

• Taking hydromorphone in larger quantities or over a longer period than was intended.
• Having an ongoing desire or making unsuccessful attempts to stop hydromorphone use.
• Spending a lot of time acquiring, using, or recovering from the effects of hydromorphone.
• Craving hydromorphone.
• Having a hard time fulfilling obligations at work, school, or home due to hydromorphone use.
• Continuing to use hydromorphone despite it causing or worsening problems in social or interpersonal relationships.
• Giving up activities once enjoyed to use hydromorphone.
• Using hydromorphone in physically dangerous situations, such as while driving.
• Continuing to use hydromorphone despite it causing or exacerbating a physical health issue or mental health condition.
• Developing tolerance to hydromorphone. (This criterion is not considered to be met for those taking opioids solely as directed by a physician.)
• Experiencing withdrawal symptoms when hydromorphone use suddenly stops or is drastically reduced. (This criterion, too, is not considered to be met for those taking opioids solely as directed by a physician.)

To receive an opioid use disorder diagnosis, at least 2 of the above criteria must be present within a 12-month period.⁸

Mixing Hydromorphone with Other Substances

Mixing hydromorphone with other opioids or central nervous system depressants—like benzodiazepines, sleep aids (or Z-drugs, like Ambien or Lunesta), barbiturates, or alcohol—for instance, can potentiate the respiratory depressant effects of hydromorphone, thereby, increasing the risk of a potentially fatal overdose.⁴ .

Hydromorphone Overdose

In 2020, an average of 44 individuals died each day in the United States from overdoses involving prescription opioids.⁹

Hydromorphone overdose occurs when there is more hydromorphone in the body than it can handle, or when hydromorphone has been combined with other substances mentioned above—such as other opioids, benzodiazepines, or alcohol—all of which can increase hydromorphone’s respiratory depressant effects.⁴

When an individual overdoses on hydromorphone or other opioids, they typically show signs of being over-sedated and their breathing slows or stops, which decreases the amount of oxygen that reaches the brain and can result in coma or death.⁶

Symptoms of a hydromorphone (or other opioid) overdose include:^4,10

• Shallow, slowed, or stopped breathing.
• Profound sedation.
• Vomiting or making gurgling noises.
• A body that goes limp.
• Cold, clammy, pale skin.
• Blue or purple lips or fingernails.
• Pinpoint pupils.

Opioid overdose is life-threatening and requires immediate emergency attention. If you suspect that you or someone else is experiencing an opioid overdose, act quickly and do the following:¹¹

1. Call 911 immediately.
2. Administer naloxone (Narcan) if available.
3. Try to keep the person awake and breathing.
4. Lay the person on their side to prevent choking.
5. Stay with the person until paramedics arrive.

Naloxone is a medication that can temporarily reverse an opioid overdose and restore an individual’s breathing by blocking the effects of opioids in the system.^6,11 Narcan, a pre-dosed nasal spray form of naloxone, is available for purchase over the counter at pharmacies without a prescription.¹¹

Treatment for Hydromorphone Addiction

If you or someone you love struggle with hydromorphone or other opioid addiction—or any other substance use disorder—treatment can help. Addiction is a treatable disease, and long-term recovery is possible.

Treatment for opioid use disorder may take place in an inpatient or outpatient setting. Inpatient or residential programs provide round-the-clock care and require you to remain at the treatment facility for the duration of the program. Outpatient programs, which vary in intensity, allow you to live at home or in a sober living facility while participating in treatment.

The inventions commonly used in the treatment for hydromorphone addiction or other opioid use disorder include:

Medically supervised detox. While not typically life-threatening, the withdrawal symptoms that occur when stopping hydromorphone use can be intensely uncomfortable. Detox treatment may include starting medications to treat opioid use disorder, such as buprenorphine or methadone, or other medications to help alleviate withdrawal symptoms.^6,12-14.

Behavioral therapies. Treatment for addiction typically includes behavioral therapy and counseling. One common behavioral therapy approach in prescription opioid addiction and other substance use disorder treatment is cognitive-behavioral therapy (CBT). CBT helps a person explore how their thoughts, feelings, and behaviors that lead to substance use and how to change these thoughts and behaviors to avoid drug use in the future.^6,13,14

Medications. Hydromorphone addiction and other opioid use disorders are treated with a combination of behavioral therapies and medications.^6,13 Medications that may be prescribed for opioid use disorder may continue after formal treatment is completed to support your recovery, reduce the risk of relapse and overdose, and control drug cravings.¹⁵

Effective addiction treatment looks different for everyone and is tailored to meet your individual needs in all areas of your life impacted by addiction, including your physical and mental health as well as addressing your legal, vocational, and social issues.¹³

If you or someone you care about is ready to get help for hydromorphone addiction, call American Addiction Centers (AAC) at today. Our compassionate and knowledgeable admissions navigators are available 24/7 to listen to your story, answer your questions, explain your options, and help you start your path to recovery. It’s never too late, and the decision to start treatment can save your life.