Hydromorphone Addiction: Signs, Effects, and Treatment

Hydromorphone is a prescription opioid drug used to treat both chronic and acute pain that ranges from moderate to severe.^{1, 2} Like other opioids, this medication has a high potential for misuse and can lead to physiological dependence. Anyone taking prescription opioids is at risk for unintentional overdose or death and can develop a hydromorphone addiction.^{1, 2} This article will provide information about hydromorphone, signs of hydromorphone addiction, hydromorphone side effects and how to find treatment.

What is Hydromorphone?

Hydromorphone is an opioid analgesic prescribed to provide relief from moderate to severe pain and can also depress the cough reflex.² It is listed as a Schedule II substance under the Controlled Substances Act, which means it has a medical use; however, it also has a high potential for misuse.^2,3 Other opioids that are Schedule II substances include morphine, codeine and fentanyl.³

Hydromorphone can come in several forms including tablets, capsules, oral solutions, and injectable forms.² Common brand names for hydromorphone include Dilaudid, though it is also prescribed in generic forms.⁵

Hydromorphone is often used illicitly for its ability to produce feelings of euphoria and sedation, and to reduce anxiety.^{2, 5} Misuse or illicit use occurs when a person:²

• Takes more hydromorphone (i.e., a higher dose) than prescribed.
• Takes hydromorphone for longer than prescribed.
• Takes someone else’s prescription for hydromorphone.
• Forges prescriptions for hydromorphone.
• Obtains prescriptions from multiple doctors to misuse medication.

Hydromorphone is commonly misused by ingesting, crushing, chewing, snorting or injecting the tablets after dissolving them in water.^{2, 3}

Is Hydromorphone Addictive?

Yes, people taking hydromorphone, or any other type of opioid, are at increased risk of addiction, as well as an opioid overdose.^{2, 3}

When taken under the supervision of a doctor, opioids are generally safe. However, even when taking hydromorphone as prescribed, a person may experience tolerance. Tolerance occurs when a person’s body adapts to the presence of the drug in their system. To feel the same effects they did previously requires that they take the drug more frequently or in higher doses.^{2, 4}

Someone who regularly takes hydromorphone may also experience dependence. Dependence is when the body adapts to a drug in a way that a person will experience withdrawal symptoms if they abruptly stop taking the drug or significantly reduce their dose.

Both tolerance and dependence can occur in someone who takes the drug regularly as prescribed by their doctor. Experiencing tolerance and dependence does not mean a person is necessarily addicted to hydromorphone, although both can contribute to developing a substance use disorder.⁷

A substance use disorder (the clinical term for addiction) is a chronic condition in which a person continually seeks and uses substances despite negative consequences.⁶ A person who is addicted to opioids specifically has an opioid use disorder.

Signs of Hydromorphone Addiction

The Diagnostic and Statistical Manual of Mental Disorders outlines the criteria to diagnose opioid use disorder (OUD), which is characterized by compulsive drug-seeking and drug-taking, despite the negative effects on their life and daily functioning.⁷ Oftentimes, Hydromorphone addiction is categorized as an OUD.

Only a medical professional can diagnose an OUD; however, knowing the signs of OUD may help you identify when to seek help. A person may have an OUD if they display at least 2 of the following signs within a period of 12 months:⁷

• Taking more opioids or taking opioids for longer than intended
• A desire to quit or inability to cut back on opioids
• Significant time and effort are spent trying to obtain opioids
• An intense craving or urge to use opioids
• The use of opioids results in difficulty fulfilling obligations at work, school, or within relationships.
• Continuing to use opioids even when it has caused or worsened recurrent social or interpersonal problems
• Activities once enjoyed are given up so you can take opioids.
• Use of opioids in physically dangerous situations like driving
• Continuing to use opioids even though you can acknowledge that it is a problem
• Developing tolerance to opioids.
• Symptoms of withdrawal are experienced when you stop or significantly reduce your opioid use.

It is worth noting that, generally speaking, criteria 10 and 11 (development of tolerance and the presence of withdrawal upon cessation of use) are generally not factored into an OUD diagnosis if one is engaging in prescription use.

Health Effects and Risks of Hydromorphone Misuse

Hydromorphone is prescribed for pain relief and to suppress cough. Side effects of hydromorphone include:^{2, 3}

• Euphoria.
• Feeling light-headed.
• Dizziness.
• Sedation.
• Nausea and vomiting.
• Constipation.
• Sweating.
• Flushing of the skin.
• Feeling uneasy or distressed.
• Dry mouth.
• Itchiness.

In addition to the risk of developing an opioid use disorder, other potentially serious health effects can include:¹

• Hypotension.
• A loss of consciousness due to an insufficient amount of blood reaching the brain.
• Respiratory depression.
• Raised intracranial pressure.
• Seizures.
• Suicidal thoughts.
• Coma.

Regular opioid use in pregnant women can lead to neonatal abstinence syndrome.⁹ This means that the child is born with a dependence to opioids and will experience withdrawal symptoms. Supportive medical care is typically required to manage withdrawal symptoms.⁹

Hydromorphone Withdrawal

If one stops using hydromorphone, they may experience hydromorphone withdrawal.⁷ Considered an opioid withdrawal, hydromorphone withdrawal occurs when somebody dependent on the drug stops taking it, resulting in a variety of withdrawal symptoms ranging from mild to severe in intensity. Oftentimes, medical detox is used as an option to manage opioid withdrawal symptoms and help a patient prepare for a comprehensive addiction treatment program. There is no set timeline for hydromorphone withdrawal, with symptoms potentially ranging for over a week.⁷

Hydromorphone Withdrawal Symptoms

Some of the symptoms of hydromorphone (opioid) withdrawal may include:⁷

• Dysphoric mood.
• Nausea or vomiting.
• Muscle aches.
• Lacrimation or rhinorrhea.
• sweating.
• Diarreha.
• Insomnia.
• Fever.

Risks of Mixing Hydromorphone and Other Drugs

Taking hydromorphone at the same time as certain other substances (i.e., polysubstance use) can be dangerous and potentially deadly.¹⁰

Hydromorphone is a powerful opioid, which means it slows breathing. Taking it with other opioids, or with other CNS depressant drugs (e.g., benzodiazepines, alcohol, Ambien), increases the risk of a
life-threatening overdose because it heightens the respiratory depressant effects. This can lead to
over-sedation, coma, or death.³

It’s important to talk with your doctor about all substances or medications you are taking if you are being prescribed hydromorphone to assess whether there are any potentially harmful drug interactions.

Hydromorphone Overdose

An opioid overdose can happen when you take too much hydromorphone or combine it with other opioids or substances that increases hydromorphone’s respiratory depressant effects. In 2019, more than 14,000 people died from a prescription opioid overdose.¹¹

When someone overdoses on hydromorphone or other opioids, their breathing slows or stops, and they may lose consciousness. If their breathing is not restored, the brain does not get enough oxygen, and this can lead to coma or even death.⁹

Symptoms of an Hydromorphone (opioid) overdose include:³

• Slowed or stopped breathing.
• Profound sedation, or a complete loss of consciousness.
• Cold and clammy skin.
• Constricted pupils.
• Slowed heart rate or pulse.
• Low blood pressure.

Treating Hydromorphone Overdose

If you or someone you know is experiencing the signs of an Hydromorphone (opioid) overdose:

• Call 9-1-1 immediately. Opioid overdose can slow or stop a person’s breathing. When a person isn’t getting enough oxygen to the brain, damage, coma, or death can occur.⁹
• Administer naloxone, if available. Naloxone is often co-prescribed with opioids, as it can reverse the effects of a life-threatening opioid overdose and restore a person’s breathing by blocking the effects of the opioid drug that’s still in their system. In most states, naloxone is available for purchase at a pharmacy without a prescription. Should the overdose be reversed, and normal breathing is restored, know that the effects may only be temporary, and additional medical support is still required. ⁹
• Keep the person awake and breathing. If a single dose of naloxone did not awaken the person or restore their breathing, administer a second dose, if available.
• Lay the person on their side. This is to prevent accidental choking from vomiting.¹³
• Stay with them. Wait until emergency medical professionals are on site.¹³

Risk Factors for Overdose

Hydromorphone (opioid) overdose can happen to anyone who uses opioids.¹² Certain factors that may increase the risk of overdose include:¹²

• Taking alcohol and opioids together (i.e., polysubstance use).
• Daily consumption of high dosages of opioids.
• Taking more opioids than prescribed.
• Using illegal opioids (i.e., heroin or illicitly manufactured synthetic opioids, like fentanyl).
• Having a medical condition like sleep apnea.
• Being older than 65.

Treatment for Hydromorphone Addiction

If you or a loved one are struggling with opioid or hydromorphone addiction, or any other substance use disorder, it can feel overwhelming to try and find help. Addiction is a treatable disease and finding treatment that’s tailored to your individual needs can be an important step in recovering from hydromorphone addiction.¹⁴

Both inpatient and outpatient treatment are available to treat OUD.⁸ Inpatient, or residential, programs are those where you live on-site for the duration of treatment. Outpatient programs are those in which a person visits the facility for treatment and can continue living at home.

Common treatment interventions for OUD can include:

• Severe withdrawal symptoms can happen to people who stop using hydromorphone. Getting support during the detox phase can help ease cravings and the discomfort of withdrawal symptoms in a safe environment. Treatment medications such as buprenorphine or methadone may be used to reduce the severity or eliminate certain withdrawal symptoms.^{8, 9}
• Inpatient treatment (also known as residential treatment) is a treatment setting where a patient lives at a facility and receives care 24/7. An intensive form of treatment, inpatient can occur in hospital or residential settings.
• . Outpatient treatment is a type of treatment that allows a patient to live and work at home while still receiving addiction care. There are three types of outpatient treatment that vary in intensity: standard outpatient, partial hospitalization programs, and intensive outpatient programs.
• Behavioral therapies like cognitive behavioral therapy (CBT) are often used in treating prescription opioid addiction. These can help a person learn to avoid drug use in the future while increasing their motivation for change.^{9, 14}
• Medications for opioid use disorder may be prescribed during treatment and are often continued once formal rehab treatment is completed. These medications help to support your recovery by reducing the risk of relapse and overdose, as well as controlling drug cravings.⁹

No single treatment is right for everyone. When you enter treatment, an individual treatment plan will be developed to address your needs in multiple areas of life affected by addiction: physical and mental health, legal, vocational, and social.¹⁴

Get Help for Hydromorphone Addiction

If you are ready to seek help for yourself or someone else, it’s important to remember that you are not alone. While hydromorphone addiction can be devastating, evidence-based addiction treatment can lead to positive health outcomes. If you’re prepared to start looking for rehab, consider visiting the recovery.org treatment directory. This powerful online resource can allow you to search across the country for hydromorphone treatment programs.