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Hydromorphone Addiction: Understand the Signs & Treatment

Hydromorphone is a pain-relieving medication that should only be used for short periods of time.

Individuals who abuse hydromorphone can develop multiple physical, psychological, and social issues associated with their use of the drug. Addiction can form quickly.

Hydromorphone

Hydromorphone is an opioid medication that is primarily prescribed as a pain reliever. Its primary use is to control pain and discomfort in individuals who have recently undergone surgery, although it can be used in other instances to relieve chronic pain.

Extended or long-term use of hydromorphone or other any opioid as a pain reliever should be monitored very closely by prescribing physicians due to abuse potential.

Forms of Hydromorphone

Hydromorphone products are available by prescription only. The products can be obtained in a tablet immediate-release form, a tablet extended-release form, and a liquid. 

Some of the more common brand names of hydromorphone products in the United States include Dilaudid, Exalgo (an extended-release form), and Palladone (which has been removed from the market).

Restrictions Regarding Use

Products containing hydrocodone are controlled substances that are listed by the U.S. Drug Enforcement Administration (DEA) in the Schedule II category. All the medications in this category have an extremely high potential to be abused and to produce physical dependence in people who take them for extended periods, even though they do have important medical uses.

Products containing hydrocodone are available only under a restricted distribution program (the Opioid Analgesic Risk Evaluation and Mitigation Strategy Program). This essentially means that the prescription of hydromorphone products is closely monitored. Refills cannot be automatically obtained, as they require a new prescription from a physician.

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Pain Control

pain control

Hydromorphone products are primarily used to relieve pain while someone is under the supervision of a physician. This medication is not designed to address the aches and pains that occur in everyday circumstances. Instead, this medication is used to address severe pain associated with surgery, a serious injury, or a very severe chronic disorder that produces intense pain.

The immediate-release tablets address postsurgical pain quickly. The extended-release capsules address pain in people who may have developed a tolerance to opioids or who need around-the-clock pain relief.

Hydromorphone is a strong medication estimated to be between two to eight times more potent than morphine, making it an effective pain reliever for people who have tolerance to other opioids. Its potency also results in a higher potential for abuse.

Considerations for Use

Whenever any prescription medication is considered for any patient, the physician and patient must weigh the costs and benefits of using the medication. There are many considerations when it comes to hydromorphone.

  • If the person has experienced any unusual reactions or allergic reactions to similar medications in the past, it should not be used.
  • The medications the person is already taking may have adverse reactions with hydromorphone products. There is a laundry list of medications that can have potential untoward interactions with hydromorphone. 
  • The age of the patient should be a concern. Younger and older individuals should be prescribed this medication with caution.
  • Pregnant women should not use the medication unless there is an extreme need.
  • Certain medical conditions may rule out the use of hydromorphone products. These include dementia, a previous history of substance dependence, or an existing mental health disorder.
  • Some individuals may be more prone to developing unpleasant side effects from the medication.
  • Opioid medications can produce physical dependence in individuals who use them for lengthy periods of time.

The medication should only be used for its prescribed purposes, such as for severe postsurgical pain, for individuals who have developed some tolerance to other opioids, and sparingly in individuals with chronic pain.

Side Effects

All medications carry a side effect profile that can complicate their medical use. The following are some of the side effects associated with the use of hydromorphone products:

Side Effects

  • Constipation or decreased urination
  • Bloating
  • Blurred vision
  • Dry mouth
  • Dizziness or lightheadedness
  • Nausea, stomach cramps, or vomiting
  • Significant lethargy or sedation
  • Appetite loss
  • Insomnia or hypersomnia
  • Issues with motor coordination or walking
  • Effects on cognition similar to those that occur with alcohol intoxication, such as slurred speech, poor judgment, memory problems, and other similar symptoms
  • Significantly reduced blood pressure, breathing rate, or heart rate
  • Confusion and disorientation
  • The development of tolerance, physical dependence, and potential abuse

Side Effects and Abuse

Side effects are relatively rare in individuals who use the medication as prescribed. If they do occur, they will typically resolve over time, or they can be addressed by the physician who prescribed the medication.

Those who abuse opioids like hydromorphone tend to experience more intense and more varied side effects along with a significant increase in tolerance and the potential to severe develop a physical dependence on the drug. Thus, one of the potential signs that someone is abusing hydrocodone is that they experience significant and lingering side effects that are associated with the drug, high tolerance to it, and significant withdrawal symptoms when they do not use the drug.

Abuse of Hydromorphone

Hydromorphone products are extremely potent drugs that are primarily designed for use in a hospital or clinic, for individuals who have significant postsurgical pain (for short periods of time), or for individuals who have developed tolerance to other opioids. Long-term use of hydromorphone is never recommended.

According to the National Institute on Drug Abuse (NIDA), abuse of prescription medications is a significant problem in the U.S. Opioid abuse has become so prevalent that it has been labeled an epidemic.

In the early 2000s, prescriptions to hydromorphone began to increase at an alarming rate. Due to recent controls on prescribing opioids, the number of individuals reporting using and misusing hydromorphone products is declining. 

High-Risk Groups for Abuse

SAMHSA and NIDA report that use and abuse of prescription medications are highest among individuals between the ages of 18 and 35, but it occurs across all age groups.

Other individuals at risk for abusing hydrocodone include those with previous histories of substance abuse problems, those who have some other form of mental illness, and those who have a family history of substance abuse or mental illness.

Effects of Abuse

Those who abuse prescription opioids may take the pills orally, but they are also likely to grind up the pills and snort them or mix them with a liquid and inject the solution.

Long-term abuse of hydromorphone can lead to many physical, psychological, and social issues.

  • Increased risk for diseases and infections associated with poor self-care or needle sharing, such as hepatitis, HIV, and others
  • Poor judgment and reckless behaviors associated with the effects of drug abuse
  • Financial issues or poverty associated with problems at work or job loss, and attempts to get the drug illicitly, and other issues
  • Legal issues associated with using controlled substances
  • Increased risk for injury and higher mortality rates
  • Impaired personal relationships, social isolation, and family issues
  • Psychological problems, such as anxiety, depression, and a greater potential to be diagnosed with some form of mental illness
  • A transition to other forms of illicit drugs, such as heroin
  • An increased risk for overdose

Physical dependence on opioids is typically not a concern for individuals who use them under the supervision of their physician and according to their intended purpose. However, physical dependence is a significant problem for those who abuse opioids. It complicates a person’s cycle of drug abuse since they are compelled to keep taking the drug.

Other Signs of Abuse

Using hydromorphone for reasons other than its intended purpose is a sign of misuse. Those who use the drug to experience euphoria or relieve stress are abusing the drug.

There are other signs of hydromorphone abuse.

  • Chronic or intense presentation of hydromorphone’s side effects 
  • Significant tolerance to hydromorphone 
  • Frequently mixing hydromorphone with other substance of abuse, including alcohol, other opioids, benzodiazepines, cannabis products, stimulants, and other drugs 
  • Issues with controlling use of hydromorphone, such as spending a lot of time using it, using it in large amounts, using it when it is not safe to do so, and similar issues
  • Problems at work, in personal relationships, at school, or in other important areas of life due to drug use
  • Continuing to use hydromorphone even though it is causing significant distress, problems with functioning, issues in personal relationships, or physical or emotional health issues
  • Frequently trying to get hydromorphone products illicitly

Treatment for Abuse

treatment

People using hydromorphone products under the supervision of a physician will generally not have issues discontinuing use of the drug when it is time to do so. It’s still a good idea to talk to the prescribing physician about the best way to stop use.

Those who have been abusing hydromorphone need medical detox to stop safely. The withdrawal process from opioids can be incredibly uncomfortable, and relapse is likely without professional help.

Detox should be followed by therapy to address issues related to substance abuse. Usually, a comprehensive addiction treatment program is the best approach to recovery.

Treatment will generally include the following:

  • Physician-assisted medical detox or withdrawal management that uses medications like methadone, buprenorphine, or clonidine to control withdrawal symptoms 
  • Substance use disorder therapy to help the individual discover and deal with their underlying issues, including triggers for drug use and the development of beliefs and habits that support sober living
  • Groups like Narcotics Anonymous that offer ongoing support for maintaining long-term abstinence
  • Additional services, such as case management services, vocational rehabilitation, tutoring for school, family therapy, and others that are appropriate for the individual’s situation

While hydromorphone is a potent drug that can lead to serious issues with addiction, recovery is possible. 

Sources

(2013). Opioid Analgesics: Chemistry and Receptors. Springer Science & Business Media. from

DEA: (N.D.) Drug Scheduling. U.S. Drug Enforcement Administration. Retrieved January 2019 from https://www.dea.gov/drug-scheduling

(February 2019). Hydromorphone (RX). MedlinePlus. Retrieved February 2019 from https://reference.medscape.com/drug/dilaudid-hydromorphone-343313

(2017). Complete Guide to Prescription and Nonprescription Drugs 2018-2019. Penguin Press. from https://books.google.com/books?id=nBYcDgAAQBAJ&printsec=frontcover&dq=Complete+Guide+to+Prescription+%26+Nonprescription+Drugs,+2018-2019&hl=en&sa=X&ved=0ahUKEwjm0sWOre7YAhUSgK0KHUz9Bx4Q6AEIKTAA#v=onepage&q=Complete%20Guide%20to%20Prescription%20%26%20Nonp&f=false

(December 2018). Misuse of Prescription Drugs. National Institute on Drug Abuse. Retrieved February 2019 from https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/what-scope-prescription-drug-misuse

(October 2018). National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration. Retrieved January 2019 from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf

(2007). Addiction and the Medical Complications of Drug Abuse. CRC Press. from

(July 2016). Treatment of Opioid-Use Disorders. New England Journal of Medicine. Retrieved February 2019 from http://unmhospitalist.pbworks.com/w/file/fetch/115878559/treatment%20of%20opioid%20use%20disorders%20NEJM.pdf

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