Pennsylvania Dilaudid Addiction Treatment

Drug abuse presents a significant public health issue around the globe. In the United States, the problem is worsened by the misuse of prescription opioids.

Opioids account for a significant percentage of harmful incidents. However, the issue of opioids misuse is exacerbated by illegal distribution, together with increased accessibility.

Dilaudid refers to an uncontaminated opioid prescribed for mild to short-term serious pain, as well as serious prolonged pain.​1 Given the drug’s great power, overdose threat, and misuse possibility, it is only prescribed in a situation when the first-line of medications fail. The generic Dilaudid costs less, and can sometimes be lesser in form and potency.

History

In the 1920s, Germany was the first country to produce hydromorphone, which is the generic form of Dilaudid. During the time while Germany was evaluating pain management methods, Dilaudid was perceived effective as it posed limited side effects and health threats. The drug was first sold in 1926 under the name Dilaudid.

Dilaudid Side Effects

Opioids are typically used to control chronic pain that affects patients of noncancerous and cancer complications. In the United States, about 20% of the patients seeking physicians’ assistance with pain receives opioid prescriptions.6 Nevertheless, the adverse effects of the drugs worsens the patient’s condition by impacting the quality of life.

  • Pain Patients that Receive Opioid Prescriptions 20% 20%

Opioid-Induced Constipation

Opioid constipation is a common complication for medications such as Dilaudid. Like other opioids, Dilaudid reduces the function of the central nervous system (CNS) impacting reflex movements that include food movement through the digestive system, thus contributing to constipation. It’s estimated that about 21-90 percent of individuals using opioids struggle with constipation.2 Opioid-induced constipation could contribute to complications that include rectal prolapse and hemorrhoids.

Nausea

Nausea includes stomach uneasiness and could result in the forcible emptying of the stomach. Prolonged use of Dilaudid or its abuse can increase nausea due to effects associated with the nervous system or irritation of the stomach lining.6

Loss of Appetite

Typically, pain affects eating habits due to a dull burning sensation. The drugs used for the treatment of pain, including Dilaudid, disrupt eating habits even more.6 For example, Dilaudid causes vomiting and nausea, which inhibit the maintenance of a healthy diet due to reduced appetite. The use of Dilaudid also lowers metabolic rates resulting in reduced appetite.

Dizziness

Prolonged use of Dilaudid impacts the body structures responsible for enabling balance, resulting in dizziness and vertigo. 1 Indicators of dizziness include increased sensitivity to sounds or light, trouble with balancing, uncontrolled eye movement, headaches, facial weakness, and hearing loss.

Slowed Breathing

Slowed breathing may be seen within the first 24-72 hours of Dilaudid use. Breathing complications pose as a dangerous side effect of Dilaudid.1 Like other opioids, Dilaudid affects the brain section responsible for regulating breathing, contributing to slow breathing. In severity, slowed breathing contributes to hypoxia: a condition that occurs when too little oxygen is reaching the brain. Breathing problems are commonly experienced during the first day to the third day of treatment and after the dose is increased.

Itching

Itching is also identified as a common problem that affects opioid users, including those of Dilaudid. It is estimated that about 2-100% of opioid users struggle with itching depending on how its taken. Oral administration accounts for 2-20%, 10-50% from intravenous administration, while 30-100 percent experienced itching after epidural/spinal administration.4 Dilaudid itching effects are more common among ambulatory patients, together with those experiencing moderate pain.

Overdose

Incidents with medications represent a large rate of unintentional harm. Generally, hospitals use opioids to relieve pain. Although effective, opioids have a constricted therapeutic gap that depends on tolerance and comorbidities, as well as use with other drugs.5 Depending on the medical situation and the prescriber, patients receive various formulations that could result in an overdose. Again, considering that opioids have been accessible, its misuse rates are high. Overdose effects can be fatal.

Cold and Clammy Skin

Clammy skin describes wet skin resulting from sweating. Overdose of Dilaudid contributes to cold and clammy skin, and unlike normal sweating, Dilaudid users experience sweating even if their bodies are not necessarily hot. Basically, cold and clammy skin is due to the failure of the body’s mechanisms.1

Constricted Pupils

Overdosing of opioids, such as Dilaudid causes constricted pupils. 1 Dilaudid excites the parasympathetic part of the autonomic nervous system causing the constriction of the pupils. Normally, constriction of pupils is uncommon, and its occurrence is an indicator of opiate use.

Impaired Coordination

Dilaudid use affects the central nervous system disrupting different parts of the brain. The disruptions affect the ability to maintain voluntary coordination and balance. Complications associated with coordination result from cerebellum malfunction, which is the brain section responsible for managing voluntary movements and controlling balance. 8

Changes in Blood Pressure

Scholars associate the prolonged use of hydromorphone to issues in the central nervous system, primarily the blood control centers.8 The functioning of the control centers is disrupted, resulting in fluctuations in blood pressure.

Rapid Heartbeat

There is significant evidence opioids are linked with high risks of developing irregular heartbeats. The use of drugs to depress the central nervous system contributes to the malfunction of the cardiac system, resulting in irregular and mostly rapid heartbeats.

Coma

The possibility of Dilaudid overdose depends on the amount taken, together with the method of introduction. For instance, overdose risks are high if the drug is introduced through smoking, snorting, and injecting since the full dose penetrates the hurdle between the brain and the blood quickly. Dilaudid injection is significantly associated with the effects of coma as an overdose contributes to dangerous complications such as apnea, cardiac arrest, and failure of the circulatory system.

Death

There has been a notable increase of opioid-associated overdoses in recent years. Partially, the surge is linked to the rising use of opioids in managing both cancer and non-cancer pain.7 For example, within the United States, about 63,632 persons are estimated to have died from a drug overdose in 2016, representing a rise of 21 percent from the past years. The surge was significantly linked to opioid prescription. In 2016, opioid-related deaths contributed about 19,413 deaths in the US, doubling the 2015 figures. With Dilaudid, death is linked to different effects that include the collapse of the circulatory system, reduced breathing, and cardiac arrest.

Forms of Dilaudid

Exalgo: Extended-Release Pill

Exalgo extended-release pills are tablets that contain hydromorphone. It has a long-acting formula applicable for around-the-clock management of moderate to severe continuing pain, usually due to cancer. Normally, hydromorphone works by modifying the brain to reverse how the body responds to and feels pain. The extended-release forms have a commencement action of 6 hours peaking at 9 hours and lasting for about 13 hours.1 The half-life is estimated to be about 11 hours, but fluctuates between 8-15 hours.

Dilaudid: Immediate-Release Pill, Injection, Liquid

Immediate-release Dilaudid forms accessible in the US are prescribed for pain management between 4 to 6 hours. Unlike extended-release Dilaudid, immediate-release hydromorphone is significantly misused and abused.9 Immediate-release tablet forms have a commencement action of about 15 to 30 minutes that climaxes at 30 to 60 minutes and only persists for 3 to 4 hours.1 The half-life is relatively shorter, usually fluctuating between 2 to 3 hours.

Dilaudid HP: Injection

Dilaudid-HP injections are only used for those who are opioid-tolerant. Opioid tolerant patients refer to those that take not less 60 mg oral morphine/daily, 30 mg oral oxycodone/daily, 25 mg oral oxymorphone/daily, 25 mcg transdermal fentanyl/hourly, 8 mg oral hydromorphone/daily, or another analgesic opioid does for seven days or longer. Other than hydromorphone, Dilaudid-HP injection contains a Schedule II controlled substance that is likely to be misused the same way as opioid analgesics.

Generic: Extended-Release Pill, Immediate-Release Pill, Injection, Liquid

Both extended-release and immediate-release Dilaudid forms are available in generic forms. Generic drugs are relatively cheaper compared to other forms, increasing the likelihood of misuse and abuse. Nevertheless, the available generic drugs differ in both strength and form while compared to other brand-name forms.

Palladone: Extended-Release Pill (Discontinued)

Palladone must only be prescribed by a physician with significant expertise on the application of powerful opioids in controlling chronic pain. The drug presents high risks of respiratory depression and is only prescribed to those that are opioid-tolerant. Before beginning a palladone dose, one is expected to discontinue the use of other extended-release opioids. Physicians are advised to ensure the use of palladone therapy on opioid-tolerant patients and strictly avoid their prescription as the first opioid. Users are advised to take the capsule wholly as other methods such as chewing, dissolving, or crushing increases its bioavailability and could result in an overdose and death.

Detox

Normally, Dilaudid is traded in immediate-release pills, intravenous injections, and oral solutions. The available hydromorphone element is classified as a Schedule II controlled substance, implying high abuse possibility as well as increased risks for users to become dependent.3 Dilaudid interacts with the brain sections responsible for managing pain as well as those in charge of happiness and motivation. The increased misuse of Dilaudid is the result of the drug overwhelming the pleasure centers of the brain.

The continuous use of Dilaudid could result in opioid addiction. Addiction is ongoing use of a specific drug even when it contributes to negative outcomes. Continuing to use Dilaudid after a prescription runs out or taking Dilaudid when not in pain are indicators of addiction. Chances of addiction are equally higher when the drug is injected or snorted. Individuals seeking to detox from Dilaudid face significant challenges.

Restlessness

Opioid detox is challenging in different ways, including emotionally, mentally, and physically. Efforts to eliminate Dilaudid from the system might trigger restlessness.

Sweating

Sweating is common during Dilaudid withdrawal. Commonly, during opioid detox, excessive sweating is evidenced at night. This is usually a primary indicator of Dilaudid withdrawal.

Muscle or Joint Pain

Withdrawal from Dilaudid and all opioids causes pain in both or either the joints and muscles. The pain during detox is triggered by the fact that the body does not receive the same amount of Dilaudid.

Anxiety

Anxiety during the withdrawal of Dilaudid is common. It is usually the result of psychological and physical health effects.

Insomnia

It’s also very common to experience restlessness, night sweats, and anxiety as a result of the body detoxing from Dilaudid.

Nausea and Vomiting

During withdrawal, nausea and vomiting are common and nasty side effects experienced by individuals trying to detox from Dilaudid without medical assistance.

Rapid Breathing

While the use of Dilaudid causes slow breathing, withdrawal contributes to rapid breathing. Rapid breathing is associated with anxiety and restlessness experienced during this time.

Rapid Heartbeat

Rapid heartbeat is largely experienced during Dilaudid withdrawal. The increase in heart rates could be associated with factors such as anxiety and rapid breathing.

Treating Dilaudid Addiction

The treatment of Dilaudid addiction is relatively challenging as some become discouraged by the withdrawal symptoms. 3   However, treatment is critical to successful recovery from substance use disorders. Treatment institutions provide support throughout withdrawal via medical guidance and therapies. For instance, prescription medications that include buprenorphine and methadone can make withdrawal symptoms more manageable. Treatment centers can advise the use of naltrexone to minimize relapse threats.

Rehabilitation centers are critical in providing therapy and counseling sessions that target substance abuse and co-occurring disorders. Therapy sessions teach concepts related to ending drug use and understanding thought and behavior patterns. Support groups after treatment are also found to be beneficial is supporting enjoining successful recovery.

Finding Help with Dilaudid Detox

Typically, the positive effects of Dilaudid in managing moderate acute pain and severe chronic pain for cancer and non-cancer complications have been evidenced. However, the drug is highly addictive and poses significant threats to public health. Dilaudid addiction can be avoided if its sale is strictly maintained at hospitals and through prescriptions. Physicians can equally train Dilaudid users on the primary addiction indicators to enable early addiction interventions.

In conclusion, Dilaudid is an effective and safe opioid used in relieving both moderate and severe chronic pain among cancer/non-cancer patients. Nevertheless, Dilaudid contains hydromorphone which is a Schedule II controlled substance with high addiction risks. Seeking assistance during detox, especially from rehab facilities and after treatment from support groups supports the maintenance of complete sobriety.


Resources:

  1. Abi-Aad K. R., & Derian A. (2019 ). Hydromorphone. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
  2. Carter, A. (2018). Opioid-induced constipation (OIC): Causes. Retrieved from https://www.medicalnewstoday.com/articles/323418.php
  3. Elkins, C. (2018). Dilaudid addiction. Retrieved from https://www.drugrehab.com/addiction/prescription-drugs/hydromorphone/
  4. Golembiewski, J. (2013). Opioid-Induced pruritus. Journal of PeriAnesthesia Nursing, 28(4), 247 – 249
  5. Lowe, A., Hamilton, M., Greenall BScPhm MHSc, J., Ma, J., Dhalla, I., & Persaud, N. (2017). Fatal overdoses involving hydromorphone and morphine among inpatients: a case series. CMAJ open5(1), E184–E189. doi:10.9778/cmajo.20160013
  6. Nelson, A. D., & Camilleri, M. (2016). Opioid-induced constipation: advances and clinical guidance. Therapeutic advances in chronic disease7(2), 121–134. doi:10.1177/2040622315627801
  7. Scholl, L., Seth, P., Kariisa, M., Wilson, N., & Baldwin, G. (2018). Drug and opioid-involved overdose deaths — United States, 2013–2017. Retrieved from https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm
  8. Shanazari, A. A., Aslani, Z., Ramshini, E., & Alaei, H. (2011). Acute and chronic effects of morphine on cardiovascular system and the baroreflexes sensitivity during severe increase in blood pressure in rats. ARYA atherosclerosis7(3), 111–117.
  9. Shram, M., Sathyan, G., Khanna, S., Tudor, I., Nath, R., Thipphawong, J., & Sellers, E. (2010). Evaluation of the abuse potential of extended release hydromorphone versus immediate release hydromorphone. Journal of Clinical Psychopharmacology30(1), 25-33. doi: 10.1097/jcp.0b013e3181c8f088