Author: Ruben Bermea, LPC

Hydromorphone, sold under the brand name Dilaudid, is approved by the U.S. Food and Drug Administration to treat pain.² Hydromorphone is classified as a Schedule 2 narcotic by the U.S. Drug Enforcement Agency (DEA) because, while it has valid medical uses, it is also considered to have a high potential for addiction and harmful effects when misused.

In This Article:

• What Is Hydromorphone?
• What Are Hydromorphone Side Effects?
• What Are the Risks of Hydromorphone Use?

What Is Hydromorphone?

Hydromorphone belongs to a class of pain-relieving substances known as opioids.¹ Doctors prescribe hydromorphone to manage severe, long-term, and chronic pain.³ This medication comes in several different forms, including:¹

• Solutions taken by mouth
• Formulas for injection
• Capsules or tablets
• Rectal suppositories

People who misuse hydromorphone or any other Schedule 2 opioid run the risk of developing a substance use disorder. Misuse of opioids occurs when a person uses more than the prescribed amount or uses the opioid for longer than prescribed.⁴ Misuse also includes altering the form of the medication to increase its potency, such as crushing or dissolving hydromorphone pills into a powder for injection purposes.

What Are Hydromorphone Side Effects?

Hydromorphone side effects may include:¹

• Difficulty getting to sleep
• Difficulty remaining asleep
• Excessive sleepiness
• Headaches
• Joint pain
• Muscle pain
• Back pain
• Stomach pain
• Flushed or reddening skin
• Itchiness
• Increased sweating
• Anxious mood
• Depressed mood

You may experience some of these side effects even while taking the medication as prescribed. Talk to your doctor about any concerns you have while taking this medication. If you experience unpleasant side effects, your doctor can lower the dose of your prescription, combine hydromorphone with another pain medication, or prescribe a different medication. If these or any other uncomfortable symptoms persist or worsen over time,  tell your doctor or seek medical support.³

Hydromorphone’s side effects can range from uncomfortable to life-threatening, depending on its use.³ Individuals who misuse this medication by taking it in higher doses and without the guidance of a prescribing medical professional may be at greater risk of developing severe side effects.

What Are the Risks of Hydromorphone Use?

Even when taken as directed, hydromorphone can cause you to develop side effects.³ In the first three days of treatment, or following an increase in the prescribed dose, this medication can affect your breathing.³ Certain factors may also increase your risk of hydromorphone side effects while using this medication.

These include:^3,7

• Mixing hydromorphone with other medications or alcohol
• Using more of the medication than prescribed
• Any history of overdose on any substance
• A history of mental health conditions as depression or anxiety

The potential for overdose is one of the most serious risks of misusing hydromorphone.³ Hydromorphone overdose can occur if you take more than the prescribed amount or if you mix it with alcohol or other drugs.⁵ A toxic amount of hydromorphone can overwhelm important functions in your body.

Signs of opioid overdose include:^{2, 3, 5}

• Pale face
• Clammy skin
• Vomiting or gurgling noises
• Inability to wake or speak
• Fainting of extreme dizziness
• Muscles going limp
• Changes in pupil size
• Unusual snoring
• Blue or purple lips or fingernails
• Reduced or ceased heartbeat
• Slowed or stopped breathing

Overdose may become fatal if a person’s breathing slows or stops completely. Signs of opioid overdose require immediate medical attention.³ Naloxone, an opioid overdose antidote, can help a person’s breathing return to safe levels while they wait to get emergency treatment. Talk with your doctor about accessing naloxone for at-home administration.

Hydromorphone Withdrawal, Dependence, and Addiction

Taking hydromorphone pills, or using the medication in any other form, on a chronic or long-term basis can result in symptoms of tolerance and dependence.^2,4 Tolerance occurs when your body adapts to the dose you are taking, requiring larger or more frequent doses to achieve the desired effect.

Many individuals who develop a tolerance to an opioid medication also develop a physical dependence on it, meaning they begin to need the medication to sleep, concentrate, manage pain, and perform other daily tasks. Developing a dependence on hydromorphone also means that you may experience withdrawal symptoms if you suddenly stop using it or significantly lower your dosage. ²

The length and severity of hydromorphone withdrawal depends on your personal health and how you have used the medication.⁶ Symptoms of hydromorphone withdrawal include:^2,6

• Anxiety
• Difficulty sleeping
• Agitation
• Sweating
• Runny nose
• Tearfulness
• Yawning
• Diarrhea
• Goosebumps
• Stomach cramps
• Vomiting
• Uncontrollable pain
• Nausea
• Suicidal ideation

If you experience hydromorphone withdrawal symptoms and find it hard to stop using the medication, you may be at risk for an opioid use disorder (OUD)—the clinical diagnosis of addiction to opioids.⁴ The severity of an OUD can range from mild to severe depending on how many symptoms you experience and how they impact your life. Some symptoms of hydromorphone addiction, as well as other OUD diagnoses, include:⁴

• Taking more of the medication than you originally meant to
• Using it longer than you intended
• Using it in situations that could put you at risk
• Giving up important hobbies, responsibilities, or relationships because of hydromorphone use
• Having challenges in relationships, school, or work associated with hydromorphone use
• Spending a lot of time trying to obtain the drug or recover from its use
• Continuing to take it despite negative effects on your health
• Developing tolerance or symptoms of withdrawal associated with hydromorphone misuse
• Using hydromorphone for intoxication instead of, or in addition to, taking it for pain relief
• Exaggerating or lying about your pain symptoms to acquire hydromorphone from a medical provider

If you experience symptoms of an OUD, substance use treatment programs can help you recover from hydromorphone addiction.⁷

Substance use treatment normally starts with withdrawal management to allow you to safely detox from opioids. ⁷ This process can occur in an inpatient or outpatient setting, depending on the nature of your symptoms.

Once you complete the withdrawal process, which typically lasts 4-7 days for opioids, you can begin recovery.⁷ Treatment typically includes medication to manage cravings and behavioral therapy. Other services may include:⁷

• Care for co-occurring mental health disorders, such as anxiety or depression
• Stress management skills
• Holistic activities such as yoga and meditation
• Access to supportive relationships
• Long-term planning for recovery

If you would like support in exploring your recovery options, call 800-934-1582(Who Answers?) today to speak with a treatment specialist.

References

1. S. Drug Enforcement Administration. Hydromorphone.
2. S. Food and Drug Administration (2016). Medication Guide, Dilaudid.
3. (2021, January 15). Hydromorphone. U.S. National Library of Medicine.
4. American Psychiatric Association. (2013). Substance-related and addictive disorders. In: Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
5. (2021, June 3). Opioid Overdose. U.S. National Library of Medicine.
6. (2021, May 25). Opiate and opioid withdrawal. U.S. National Library of Medicine.
7. Miller, W. R., Forcehimes, A. A., & Zweben, A. (2019). Treating addiction: A guide for professionals. The Guilford Press.