No, it is never safe to shoot hydromorphone.

What is Hydromorphone?

Hydromorphone is an opioid medication found in prescription drugs like Dilaudid.  Injecting hydromorphone is dangerous due to a number of factors.

It is highly potent, meaning that it is effective in very small amounts, and it is a controlled substance, meaning that it can only be obtained legally with a prescription from a physician.

Like the majority of the prescription opioids, it has significant potential for abuse. Its primary medicinal use is for the treatment of severe pain, most often following surgery, but it can be used to address chronic pain as well.

Individuals who abuse hydromorphone products will most often grind up the pills and snort them, mix the powder from the pills with water and inject it, or even smoke the powder. These modes of administration result in a quicker effect from the drug.

Individuals who inject drugs can experience significant health risks.

Injection Type

The injection of medications can occur via several different routes.

  • Subcutaneous injections are administered in the layer of fat underneath the skin.
  • Intramuscular injections are delivered directly into muscle tissue.
  • Intradermal injections are delivered into the skin layer underneath the upper layer of skin (the epidermis).
  • Intravenous injections occur when the individual injects a substance directly into a vein.

Most drug abusers who inject drugs prefer intravenous or intramuscular injections to other methods, as the effects of the substance will typically occur more quickly.

The health risks associated with injecting illicit drugs remain the same regardless of how they are injected. Injecting a drug promotes a more effective delivery of the substance and also translates into a more rapid onset of potential negative effects.

Risk of Infections

One of the major concerns associated with individuals who inject drugs is an increased risk for infections.

Individuals who often inject drugs will usually not sanitize their instruments very well or may share needles with others. This leads to an increased risk to develop the following:

  • HIV
  • Hepatitis
  • Tuberculosis
  • Tetanus (lockjaw), which can lead to problems swallowing, stiffness in the neck, and rigid muscles
  • Abscesses on the skin, which can become very serious and infected
  • Wound botulism, which can lead to paralysis and even be fatal
  • Gangrene, which can lead to serious tissue damage and can be fatal
  • Necrotizing fasciitis, which can lead to significant tissue loss and even loss of limbs
  • Other infections that can affect different organs, including the heart and brain, such as bacterial meningitis (a serious infection of the protective tissues surrounding the brain)

Problems with the Cardiovascular System

Drug abusers who inject drugs are at significant risk to develop cardiovascular issues. This can include problems with:

  • Peripheral blood flow, which can lead to swelling of the ankles or feet
  • Endocarditis, an inflammation of the inner layer of the heart
  • Scarring, blockages, and collapses of the veins and arteries
  • Chronic high blood pressure, which can lead to increased risk for heart attack
  • An increased risk to develop a stroke

Neurological Problems

Because the drug crosses the blood-brain barrier and enters the brain more quickly and in a larger amount when it is injected, continuing to inject hydromorphone can lead to changes in the brain that can affect cognitive and emotional functioning.

These changes can alter certain neural pathways that are associated with the experience of pleasure, such that individuals with difficulty receiving pleasure from everyday activities will derive more pleasure from drug use.

Other neural pathways can be altered that can affect the ability to learn new information, focus or concentrate, and even make rational decisions.

Individuals with chronic drug abuse issues are often noted for having problems with emotional control or for being impulsive. These issues may also reflect changes to the brain that may not fully remit if the person completely stops using drugs.

Other Organ Damage

The kidneys and liver are other organs that are especially susceptible to the effects of injecting drugs like hydromorphone. Structural damage to the liver and/or kidneys can occur from chronic injection of hydromorphone in addition to the damage that can occur as a result of infections like hepatitis or HIV.

Increased Risk of Overdose

Because the drug is delivered more efficiently in the brain, those who inject hydromorphone, which is already very potent, are at an increased risk for an overdose.

The Symptoms of an Overdose on Hydromorphone Include:

  • Pinpoint pupils of the eyes
  • Cold and clammy skin
  • Extreme lethargy or drowsiness
  • Slurring of word
  • Confusion or a lack of emotional control
  • Significantly reduced heart rate and blood pressure
  • Drastically reduced breathing
  • Seizures or trembling
  • A comatose state

An overdose of hydromorphone can be fatal. Individuals who are overdosing require immediate medical attention.

Narcan (naloxone), a powerful opioid antagonist, can reverse the effects of opioid overdose if the drug is administered quickly enough.

The Development of a Substance Use Disorder

When a person begins to inject drugs like hydromorphone, they have developed a serious issue with drug abuse.

Repeatedly injecting hydromorphone products will inevitably lead to the development of a significant opioid use disorder, a substance use disorder that represents a form of mental illness (a psychiatric disorder).  The symptoms of an opioid use disorder in individuals who inject drugs are often much more intense. There is a more rapid progression of physical dependence on hydromorphone in this group.

By definition, these individuals are experiencing significant problems associated with their drug use that leads to major dysfunction in other areas of life and substantial distress. The ramifications of a substance use disorder can be quite severe, including serious problems with work, educational goals, personal relationships, physical and mental health, and even freedom.

Long-Term Issues

Chronic abusers of hydromorphone who inject the drug are most likely to experience numerous long-term issues. These include:

  • Higher rates of divorce and a lower overall quality of personal relationships
  • Significant problems with unemployment
  • The diagnosis of some other mental health disorder in addition to a substance use disorder
  • Lower levels of life achievement
  • Greater chance of being a victim of a crime or being charged with criminal behavior
  • Lesser levels of self-reported life satisfaction
  • Poorer levels of overall physical health
  • Higher rates of early mortality

Is Injecting Hydromorphone Safe?

Injecting hydromorphone is not safe under any circumstances. The only time injecting an opioid is safe is when the procedure is performed by a medical professional for the treatment of a legitimate medical condition.

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