Hydromorphone/Dilaudid - One More Drug to Add to the Opioid Crisis
There is a crisis happening in the US today. Opioids have ravaged the lives of many in the most rural areas and the populated cities. The opioid crisis in Colorado or Minnesota for example, come with overdose deaths and a spike in crime. Teenagers are starting to abuse prescription opioids and heroin. This is no longer just a "junkie" sort of drug.
There has been an increase in opioids like hydrocodone and oxycodone being prescribed for pain in rural parts of the US. They don't have the kind of services a city has to rehabilitate after injury. The easiest way to ease pain was to prescribe people opioid pain killers. This caused the average guy to start using heroin because his prescription of pain killer ran out. You have more people doing heroin than ever. Then the drug dealers start adding fentanyl or carfentanil which causes sudden death overdoses.
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In 2017 alone, there were over 500 opioid overdose deaths in Colorado.
This was from either heroin or a painkiller prescribed by a doctor. The population of the US makes up for 5% of the world's total population. Americans are using 80% of the total consumption of prescription opioids. Across the country, nearly 12 million people have been misusing opioids as of 2016. The cost of the epidemic is in the billions.
Dilaudid is just another prescription painkiller that is a powerful opioid. It's even nicknamed "heroin at home." Find out how it's contributing to the opioid problem that's occurring around the country.
What is Dilaudid?
Dilaudid is the name brand of the drug hydromorphone, which is also known as dihydromorphinone. Made from morphine, the drug class is an opioid analgesic. A strong painkiller, it is prescribed to relieve moderate to severe pain. It works on certain centers in the brain to block the pain you're experiencing. It's often been dubbed, "drug store heroin" because it's properties are so similar to morphine with the kind of euphoria that occurs when you take codeine. It differs in potency however, as it's about eight times more potent than morphine. It only takes about 15 minutes before you feel the effect of the drug. Depending on the dosage option, it can last from 5-12 hours.
As it has a high potential for addiction or dependence, Dilaudid will not be used for more than 4 weeks. The addiction is physical and psychological and abuse is common because of the rush that comes with the medication. Much of the time, this drug is used to treat pain for the terminally ill. They require constant relief of pain, which is why there's an intravenous alternative. When someone is dying from an illness, they will use Dilaudid long-term. Otherwise, it's prescribed with extreme caution.
It's a schedule II controlled substance due to the risks of abuse and addiction. It comes in a variety of dosages:
Tablet: Schedule II
Tablet, extended-release: Schedule II (adult only)
What are Opioids?
When you understand what opioids are and how they work in the body, you'll have a greater understanding of addiction to it. The epidemic and addiction that you're seeing in places like Colorado is not from a lack of willpower. The addiction to it is a disease. Many times, a doctor was responsible for creating the disease within the patient. When you take prescription drugs, you assume they're safe because they're legal and your doctor gives them to you.
It turns out that opioids take over how the brain functions. When you stop using the opioids, you are unable to feel pleasure and don't feel good about anything. The depression and cravings to feel good again and not suffer from pain can cause people to start abusing opioids. They are a class of drugs that come from the opium poppy plant. Some of the prescriptions will be made from the plant while others will be created from a similar structure. This gives you the same effect, but it's a synthetic version.
Why are opioids being used in prescription medications? They relax the body and relieve the pain that people experience. It is the feeling of euphoria and relaxation that can often cause patients to abuse the drug and build a tolerance to it. It's important to know all of this because you've probably been affected by someone who has a problem with opioids. It's important to know the risks of opioid use and how it can turn into heroin addiction. Maybe it starts with your prescription of Dilaudid but it can become far more risky and dangerous.
Prescription pain killer drug abuse has become a major problem. So how does Dilaudid weigh in? As of 1984, it was FDA approved as a painkiller. It is primarily used when other painkillers stop working due to tolerance patients will experience from using opioids. The liquid form can be taken every 3-4 hours while the tablet can be taken every 4-6 hours. There is an extended-release version of the drug too which needs to be taken once per day. It relieves pain for 12 hours.
Not all prescription painkillers have the amount of options that Dilaudid has. It differs too because people who are allergic to certain painkillers won't have a reaction to Dilaudid. For those in need of a painkiller and experience allergies to other opioids, it may be the only resource they have.
There are similar issues that occur with it when compared to other painkillers. Respiratory depression and abuse potential is high. Using it with certain substances can make it even harder to breathe and can lead to death. As an opioid, Dilaudid stimulates receptors in the brain to increase your threshold to pain and reduce pain perception.
An epidemic is a word that is not thrown around loosely. It's not a scare tactic that opioids are causing major problems all over America. There are over two million Americans that have been reported as having a dependency on, or abusing prescription opioid painkillers and street drugs. Yes, whether opioids are legal or illicit, they are causing similar issues such as tolerance, dependency, addiction, and overdose.
There were over 63,000 overdose deaths in 2016. Over 42,000 of those deaths occurred from opioids. When you put a daily average on that stat, that's over 100 people per day that are dying in the US from either prescription pain killers of street opioids. When Fentanyl hit the scene, this increased overdose deaths because of it's potency.
To create a cheaper product, drug manufacturers will add Fentanyl to heroin because it requires so little of the drug to create the same high. The problem is, it's not measured so one might get the whole segment of the drug that was thrown into the heroin. The respiratory system becomes so depressed, you can't breathe.
In the state of Colorado, they saw more deaths from drug overdose than any year in the history of the state in 2017. When heroin users in Colorado were interviewed, 70% of them say that their opioid addiction began with prescription medications. Although Colorado is trying to stop the growth of opioid abuse and addiction, the game keeps changing. A report put out explains that while there has been a decline of opioid prescription medication addiction, there has been a rise in heroin abuse and addiction.
The figures for 2017 showed that 959 people have died in Colorado from drug poisoning. This would make up for suicide overdoses and mistaken overdoses. In 2016, 912 people died. The true toll of the death count is probably higher. There have been many drugs in the state where people have died from drugs that can't be specified.
The medical care in 2013 for treatment of substance abuse and addiction cost about $78 billion. In 2016, there was an act passed that gave $1 billion over two years to aid in the opioid crisis. The funding is going to make it possible for more people to get treatment. Prevention programs are also being put into place. There has been money given to states that are affected by the opioid epidemic. It is not yet known what the outcome is as it's too soon to tell.
As a prescription painkiller medication, it still has abuse potential. The DEA classified Dilaudid as a Schedule II controlled substance. This categorizes it as an extremely risky drug to use for diversion, abuse, dependence, and addiction. This causes it to be highly regulated in the effort to prevent abuse of Dilaudid. When prescribed to someone that isn't terminally ill, it will be for a short time use only. The patient will be heavily monitored, ensuring they haven't developed dependency.
Despite the tight control of how the drug is prescribed, it can get into the wrong hands. Dilaudid can be found on the streets. A study found that people aged between 18 and 25 were the most prominent group abusing prescription opioids. Abuse for this drug is most widely seen in rural areas. The diversions of Dilaudid are occurring from forged prescriptions. Also, there will be those that doctor shop. If all of this fails, they will rob nursing homes and pharmacies. Dilaudid even has street names such as footballs, smack, dillies, or juice. It is popular amongst recreational users.
Abuse will occur through swallowing tablets that weren't prescribed to them, chewing, crushing, snorting, and smoking them. Some will even crush the tablets, mix in a liquid and inject the drug. The DEA has said that over 1 million people aged 12 or older had at one point abused Dilaudid recreationally.
Opioid Use and Abuse
This video explains why we sometimes need opioid painkillers, how they work in the body and why it can cause addiction.
It may seem like Dilaudid is a far cry from heroin but sadly, it isn't. Hydromorphone, which is the generic drug in Dilaudid, is from the opioid family. A prescription opioid pain medication works on the brain and body in the same way as heroin. Both can be used recreationally and when you crush up prescription opioids, they become more potent. Many times, these prescription painkillers end up being the gateway drug to street drugs that are far more powerful and risky.
We have opioid receptors in our bodies to protect us. They let you know when you're in pain by sending messages to the brain. This allows you to react appropriately by getting the help you need. The perception of your pain has to do with the neurons that receive pain signals.
Opioids drugs bind to your opioid receptors, which are protein molecules on your nerve cells. They are found in the central nervous system and in the gastrointestinal tract. Morphine, methadone, Demerol, and heroin are opioids. When the opioids attach to your receptors, they send signals to the brain. This blocks pain, breathing slows down, you feel no sense of depression, and calmness in the mind/body will occur. As the body is not able to produce enough opioids itself to stop severe pain, it sometimes requires opioid drugs to do the job.
There is a feeling of intoxication when you use low to moderate doses. Patients and users feel joy and a sense of comfort. The feeling is similar to how the brain responds to accomplishments in life or achievements you've experienced. At higher doses, breathing can become so suppressed; it can cause breathing to slow down to the point of death. Respiratory depression is the cause of most opioid overdose deaths. It is especially risky when you mix other substances with it. Not only are you more likely to depress your respiratory system but you risk developing a co-occurring disorder.
This is when you suffer from two addictions at the same time. Abusing opioids enough can quickly cause tolerance, where it takes more of the drug to get you high. You then begin to feel abnormal if opioids are not in your system. The brain has a hard time trying to function without the drug. The rise of endorphins that you get when using heroin or Dilaudid causes you to feel extremely depressed when it wears off. On top of that, your brain has a hard time producing the "feel good" chemicals.
How Someone Gets Addicted to Dilaudid
Dilaudid has a similar addiction risk to methadone. It is a good tool for managing pain as long as you stick to the prescription. Physicians are well aware of the risks of this drug so they're going to give you no more than necessary. When your doctor consciously gives you a prescription and you follow it, you're likely safe from gaining tolerance, dependency, or addiction.
When someone is injured, it may be challenging to handle the pain on your own. As discussed, our own natural opioid receptors can't fight off intense, chronic pain. Therefore, if someone breaks their leg, the body does release natural painkillers in the beginning. These are known as endorphins. Serious injuries like a broken arm will often require painkillers. Experiencing constant pain changes the way you feel and causes you to feel depressed.
The person with the broken leg is mending but still, they're in pain all the time as the body heals. The doctor gives them a prescription painkiller like Dilaudid. When this patient starts taking the opioid prescription, it causes levels of dopamine to spike. This is what makes you feel happy and it is noticeable from the very first dose. When something good happens, dopamine is released in the brain which gives the patient pleasure.
When the patient with the broken leg is taking painkillers, they feel good. They feel no anxiety or depression and will likely experience euphoria. The patient will probably feel worse. The brain continues to work properly but when Dilaudid continues to be used, it can no longer produce it's own endorphins. The patient needs the drug to feel good. On top of that, the tolerance of the drug may be building.
The patient with the broken leg finds that he needs to increase his dosage of Dilaudid to get the same effects he had before. This is tolerance. The pills run out and the inhibitory neurons in the brain will then shut down the opioid neurons. This means there's an increase of emotional and physical pain. In fact, depression and anxiety will be quite common because the brain isn't producing any "happy" chemicals like dopamine.
The patient will also feel flu-like symptoms (withdrawal symptoms). The patient is going through withdrawal and it's not comfortable to manage. Emotional issues that the patient is dealing with are more challenging than before. Some people will experience a little bit of withdrawal when they stop using opioids. Then there are patients with a family history of addiction or mood disorders that are more likely to become addicted to Dilaudid.
It can often be too much for a person to handle. The withdrawal symptoms can be overwhelming and cause a person to seek out more opioids. This is how the cycle towards addiction occurs. For a greater understanding of prescription painkiller addiction, this Harvard short story will explain exactly what occurs in the cycle.
Dependence will usually refer to a physical dependence, characterized by symptoms of how the body reacts to withdrawal efforts. Dependence is a step towards addiction. When you have a dependency to Dilaudid, you'll have a hard time feeling happy without it in your system. The pain you began using the prescription for will often come back. There's still a chance you can abstain without too much suffering but if you continue once you have dependency, addiction is not far off.
Addicted is when your behavior actually changes. This is due to the biochemical changes that happen in the brain. The drug will have you hooked in so all you want to do is find and use opioids to feel normal. It's not so easy to get a prescription to Dilaudid and if you do, your doctor won't continue to give you additional prescriptions. Having a black box warning of abuse and addiction risks, people would have better luck finding heroin on the streets. This is what many have done.
Addiction causes someone to do irrational things that aren't in their character. They go through a lot of mental and physical pain when they don't have opioids in their system. Sometimes, their only way of getting the fix they need is through hard street drugs. They become easier to get the prescription of opioids that jumpstarted addiction in the first place.
When someone begins to see that there's a problem brewing in their life from Dilaudid, they may try to stop using the prescription. It's not always that easy. The brain is trying to regain balance and this causes a myriad of physical and mental problems. Many people, especially those with an addiction, won't admit they have a problem. Often, it takes a family member to intervene, otherwise there's a legal intervention.
Trying to Come Off Dilaudid
Treatments can retrain the brain. Medication and therapy can help a patient to find pleasure in their life again. It is best to seek out professional addiction treatment when abstaining from this potent opioid also known as "heroin at home".
Withdrawal symptoms are extremely uncomfortable when withdrawing from opioids. Sweating, cramps, depression, and anxiety are hard to manage on your own. You don't know how long it will all last and you may succumb to using again. This is where you put yourself at risk because your tolerance has reduced. You'll likely take the same amount you did before you tried to withdraw. This is where most of the opioid overdoses occur.
You also need the support that medical supervision gives you. There are complications that can occur. You may have trouble breathing and vomiting may occur. It's important that you don't try to go off such a potent opioid "cold turkey" on your own. The withdrawal symptoms can be reduced through various measures in a professional setting.
There are stories about people using all sorts of at-home detox kits for Dilaudid. Some people are even using kratom to get off opioids at home. The thing is, addiction is a complex web that isn't just about the withdrawal symptoms. Many will need emotional support as they come clean and should be monitored until stable.
If someone is going through withdrawal from Dilaudid, they may have flu-like symptoms. Most people will say that their symptoms feel far worse than any flu they've ever had. The symptoms of withdrawal are very similar to that of heroin. Here are some of the withdrawal symptoms that people may experience:
- Pain in the body (muscles and bones)
- Intense cravings.
- Body cramps.
- Blood pressure lowers.
- Anxious feelings.
There are many variables when it comes to symptoms and the withdrawal timeline. It depends on how severe the addiction became. How much the person abused Dilaudid such as frequency and amount is one of the main factors of duration. Mixing substances can be cause for a longer withdrawal period than normal. Also, how the drug was abused is a factor. Someone injecting or snorting this opioid will likely experience longer symptoms.
One woman who detoxed at a hospital said the physical withdrawal was horrendous. She didn't start getting sick until the 4th day. All the flu like symptoms including vomiting occurred at that point. The mental withdrawal was just as bad for her as the physical withdrawal. She got to the point where she was praying to God to get rid of her obsession of craving the drug.
There is a general withdrawal timeline from Dilaudid. The half-life of the drug is fairly short. If someone has extensive opiate use, they will experience the following symptoms within 4-8 hours from abstaining:
- Mild nausea.
- Anxious feelings.
- Fever and cold sweats.
- Cravings will kick in.
Symptoms will get more intense and will peak within 12-48 hours. Many reports from Dilaudid abusers and addiction practitioners say that the distressing symptoms will last for up to 72 hours. Primary symptoms in these three days include:
- Flu-like symptoms such as; nausea, vomiting, diarrhea, sweating, fever, chills, body aches, and headaches.
- Severe cravings.
- A decrease in appetite.
- Inability to sleep.
- Extreme confusion.
- Suicidal thoughts.
When symptoms are at their worst, addicts are more likely to use again and make poor choices. This is where overdose is prevalent. This is because their tolerance is down but they take the same amount as they would have before. Cognitive problems can ensue because of their physical symptoms. They have a hard time paying attention, solving problems, and remembering things.
Symptoms decrease between 48-72 hours depending on each individual and their history with Dilaudid. Once this time passes, addicts are capable of becoming more focused on their recovery and getting through the detox phase. Cravings and moodiness may still occur but many of the symptoms subside or reduce. The withdrawal phase is about 5-7 days after abstaining from the drug.
The detox is one part of recovery but there is more to endure when it comes to managing life without Dilaudid. There are reasons that you started abusing an opioid drug and you may need therapy to understand why. Emotional breakthroughs can change an addict's life and this is why rehab, which includes therapy, shouldn't be skipped.
The emotional issues can last much longer. It can be weeks and months.Therapy and support groups are highly recommended as part of the full recovery solution. An addict needs more support after they've detoxed. Anxiety, depression, and apathy, along with cravings can make even the smallest everyday challenges a huge mountain. The reminder of drugs may be around the addict once they get back to their normal life. This is why it's essential to plan out strategies and educate an addict on what addiction truly is. Rehab benefits give the addict all the tools they need to move forward with their life and not go back to using.
For example, Neurofeedback Therapy retrains your brain to reduce chances of relapse. This powerful, new form of therapy creates willingness in a patient to participate in rehabilitation. The brain needs to be rewired so it will function normally again. This helps decision making, memory, and general cognitive functioning that allows someone to live a normal life after addiction.
It may be helpful to use medication-assisted therapy. Suboxone is a drug that helps someone taper from opioids. It's just one of the commonly used medications used to reduce withdrawal symptoms. Methadone is also used and helps addicts taper off opioids. Methadone is addictive so doctors will heavily monitor how much you're getting. It will often mean having to visit a clinic daily to get a dose. Suboxone is easier to take in this way, especially if you can afford the monthly injection Vivitrol. Suboxone is addictive also and can be abused by crushing pills and injecting or snorting them. This is why the slow-release version puts you at an advantage.
Medications that are used to help with addiction should be just a part of the whole program. Exercise, a nutrient-rich diet, behavioral therapy, group therapy, and other holistic activities should also be incorporated.
What to do if You Can't Afford Professional Help from a Rehab Facility?
If you don't have the money for professional help in a rehab facility, you might want to consider intensive outpatient therapy. Your insurance may be more willing to pay for IOP. This can help you maintain your responsibilities and it costs less money than being in a rehab facility. If you have no insurance and no money to put forth, there are many government programs in every state. You can get free rehabilitation, which will include certain types of therapy and other proven methods to help you stop using opioids.
Dilaudid addiction is just another opioid problem in the US. It's a powerful drug that should be used sparingly for good reason. Opioids quickly create a tolerance which can then lead to dependency and the disease of addiction. It's not something you can just decide to stop once it's become addiction. Luckily, there has been proven results to manage addiction properly. You have to commit and it does take time. With the help of addiction specialists, you will have the hope you need to get past the challenges of recovery.