Emergency department visits associated with the nonmedical use of Dilaudid (hydromorphone hydrochloride) are increasing. The U.S. Department of Justice and Substance Abuse & Mental Health Data Archive (SAMSHA) reported that emergency rooms visits for Dilaudid went from about 12,000 in 2008 to about 18,000 in 2011. 1

SAMSHA also reports that low doses of Dilaudid (at 2 mg and 4 mg) were a leading opioid product for abuse. This was for immediate release hydromorphone formulations of Dilaudid and before the current popularity of oxycodone and hydrocodone, which have become the most abused prescription drugs. Abuse of Dilaudid is primarily in suburban and rural locations.

Abuse of this powerful and potent drug has become a continuing problem in the United States. Dilaudid is one of the most powerful synthetic narcotics in the opioid class of drug. Someone who is regularly taking Dilaudid can build up a tolerance. This can mean higher and more frequent doses of the drug to get the desired effect leading to rapid addiction.

Other Names

Dilaudid (with the generic name of hydromorphone) also goes by the street names of:

Dilaudid AKA
Big D

Hydromorphone brand names:

Statistics About Dilaudid Use

In 2012, almost 4 million prescriptions were filled for hydromorphone drugs like Dilaudid in the United States, as reported by the Drug Enforcement Agency (DEA).

Every day in the United States, more than 130 people die after overdosing on opioids. About 25 percent of patients prescribed opioids for chronic pain misuse them. About 10 percent develop an opioid use disorder. 2

25% of people prescribed dilaudid misuses their medication
Over 1 million people reported having used Dilaudid for recreational purposes at some point in their lives according to a study in 2011. 3

The Centers for Disease Control and Prevention (CDC) reports that the number of prescriptions filled for opioid painkillers increased fourfold from 1999 to 2014. This is despite no significant increase in the amount of pain people reported experiencing. In this same period, about 200,000 people died from an opioid overdose.


A tolerance to Dilaudid can occur within two or three weeks. If a user finds the tolerance takes hold, they may take more pills than prescribed, resulting in the prescription running out early.

If a person has Dilaudid tolerance, the person can experience symptoms of withdrawal if the drug wears off. If a person wants to stop taking Dilaudid but is not able to, they may have an addiction.

Signs of Dilaudid addiction include:

Spending great sums of money on the drug
Being obsessed with the next dose
Ignoring responsibilities such as school or work
Neglecting family in favor of drug use
Needing larger doses to feel a high
Forging prescriptions
Purchasing Dilaudid off the street or online
Attempting to “doctor shop” for new prescriptions
Visiting many doctors with complaints of pain
Getting more drugs through criminal activity


Dilaudid is typically prescribed for moderate to severe pain. It attaches to receptors in the central nervous system and brain. This dulls pain and triggers the release of a large quantity of dopamine. This release of dopamine in the brain creates a pleasurable feeling. As this activates the reward center of the brain, the user interprets this as something they should repeat. As this happens more and more, the brain produces less dopamine, and the user becomes more reliant on Dilaudid.

How Is the Drug Taken?
Administration of Dilaudid can be orally, intranasally, and intravenously. The time for the drug to take effect depends on how you take it.

When taken orally, the drug takes effect within 30 minutes to an hour
When taken intranasally, the drug takes effect within 5 minutes
When taken intravenously, the drug takes effect almost immediately
The pain relief that comes from taking the drug lasts between four and six hours. The dose is typically small at 2 mg or 4 mg. The pills can have a triangular or round shape. Dilaudid can also come in liquid form. Intravenous administration can take place in a hospital setting.

Effects and Risks

The use of opioids and Dilaudid can cause adverse side effects. (4) If someone experiences an unusual side effect when taking Dilaudid, they should contact a medical professional immediately.

Side effects can include:
•Dry mouth
•Heavy sweating
•Stomach pain
•Difficulty falling or staying asleep
•Joint pain

Health Risks

Depressed Body Functions
One health risk can come when a user abuses Dilaudid recreationally by mixing it with other substances. These substances include alcohol or benzodiazepines. The drugs are mixed to get a stronger effect. Dilaudid and these other substances depress the central nervous system. Mixing amplifies the effect. Mixing also dangerously slows breathing and heart rates. Medication cocktails can lead to coma, seizure, respiratory failure, and even a fatal overdose.

Gateway to Harder Drugs
Some addicted to Dilaudid may want to feel euphoric and relaxed as they initially did when they started taking the substance. They try to feel the high again. This can lead to abuse of harder drugs such as heroin.

Physical Dependence

Physical dependence means having symptoms of tolerance and withdrawal. If someone gets Dilaudid for pain in the hospital after surgery or injury, there is little chance of addiction. The doses are medically supervised and end when the patient leaves the hospital.
The biggest problem is when Dilaudid is prescribed for long-term use. This can be for control of ongoing pain, like cancer. When prescribed long-term, there is more opportunity for addiction and abuse.

The physical dependence on an opiate such as Dilaudid can cause great discomfort, leading to drug dependence. If a person has a physical dependence on Dilaudid, withdrawal symptoms can cause the person to abuse the drug.
A person suffering from Dilaudid withdrawal may take more Dilaudid to control the discomfort. This can cause continued drug abuse and lead to a downward spiral.

Dilaudid Withdrawal
There can be withdrawal symptoms after taking Dilaudid. Remember that Dilaudid is an opioid; classified as a potent Schedule II controlled substance. It works in a way that is similar to heroin or morphine and is more potent. Addiction to Dilaudid can cause severe physical discomfort while in recovery.

Withdrawal Symptoms
Symptoms of withdrawal from Dilaudid can vary from person to person. The symptoms can depend on how much of the drug a person took. Symptoms can also depend on how long the person took the drug and the method of administration. With injection or snorting, withdrawal symptoms can be longer and more severe. Other factors affecting symptoms can include individual differences in metabolism.

4-8 Hours

Within 4-8 hours after discontinuing use of Dilaudid for someone with a severe opiate use disorder, withdrawal symptoms can include:

•Craving for the drug

12-48 Hours

In the next 12-48 hours, withdrawal symptoms can intensify and peak. Symptoms can include:

•Profuse sweating
•Muscle spasms
•Aches and pains
•Decreased appetite
•Severe craving for the drug
•Confusion and depression

Some individuals can become suicidal. When symptoms are at their peak, a person can make poor decisions and relapse. There can be cognitive issues such as problems with memory, problem-solving, and attention.

48-72 Hours

After 48 to 72 hours, an individual can find they can be more focused on an attempt to get through the symptoms of withdrawal. A person can still have the following symptoms.

•Appetite loss

5-7 Days

Within five to seven days after discontinuing the use of Dilaudid, the symptoms of withdrawal resolve in most cases. However, some people can continue to have issues for weeks. These issues can include:

Intermittent cravings

Chance of

During all stages of the withdrawal process, relapse potential can be high. It can be especially high as symptoms of withdrawal intensify.
Those going through withdrawal should reduce triggers that cause a craving for the drug. Triggers can include stressful situations, meetings with people, memories, feeling tired, or feeling hungry. Relapse triggers are part of the important education and therapy done by a professional rehab facility.

Treating Dilaudid Addiction

In a treatment program, doctors will create an addiction treatment plan for you. Part of the plan will be withdrawal management, which can require medication-assisted treatment or MAT. Medical professionals supervise the steps of your plan and make adjustments as necessary. During treatment, medical professionals will also educate you and your family on ways to prevent relapse.
If you need medication-assisted treatment, the following outline may be followed by your doctor:
Opioid replacement with medications such as methadone or Suboxone (buprenorphine and naloxone) is often used.
The medications used in the process will help reduce the unpleasant withdrawal symptoms and make your recovery more likely to succeed.
Physicians can slowly taper off the dosage of the opioid replacement, making recovery easier.
If complications or other symptoms develop during withdrawal, a physician can use medicines or other interventions as needed to help with mental health problems or other medical conditions.
When compared to going cold turkey, withdrawal with a managed process lasts longer, but the possibility of relapse and major complications is reduced

Misconceptions About Dilaudid Use

Dilaudid Use Always Results in Addiction
A misconception about the use of opioids for pain is that if you take an opioid such as Dilaudid, you will get addicted. You will not always get addicted, but some factors can make a patient more likely to misuse opioids and become addicted. If a patient is young and has a history of depression, smoking, anxiety, alcohol, or drug abuse, the person is more likely to misuse prescribed opioids such as Dilaudid. 5

One tool used to identify patients who are at a higher risk of using prescribed opioids is the Screener and Opioid Assessment for Patients with Pain (known as the SOAPP). If the person is at high risk as determined by the SOAPP questionnaire, the person can receive education about addiction as this can help. There may also be a frequent follow-up schedule. Getting a small supply of medication can also help.

An Increase in Dose Indicates Addiction
Another misconception is that if a person needs an increase in dosage of a drug such as Dilaudid, this means the person is addicted. As the body can develop a tolerance for the opioid, the drug can become less effective over time and does not mean addiction. For some patients, a change in the medication dosage is needed for pain management. Increased dosage by itself does not indicate addiction.

Dealing with Dilaudid Addiction

When used correctly, Dilaudid and other prescription pain medications are helpful. Misuse of the drugs can lead to addiction and dependence because Dilaudid is a powerful opioid. Opioids are a class of drugs that include both synthetic opioids such as fentanyl and Dilaudid and the illegal drug heroin. The initial decision to take a drug is voluntary, but even proper use of the drug can lead to changes to the brain and addiction.

Signs of addiction include:

•Medication craving
•Using a drug beyond its prescription
•Taking a drug for the “high” and not just pain relief
•Taking a larger dose than prescribed
•Taking a drug more frequently than prescribed
•Mixing an opioid with recreational drugs or alcohol

An addiction treatment center can create a plan that will make recovery on you easier and reduce the chances of relapse. Medication-assisted treatment may also be needed as you wean of physical dependence on Dilaudid.

An addiction treatment center can create a plan that will make recovery on you easier and reduce the chances of relapse. Medication-assisted treatment may also be needed as you wean of physical dependence on Dilaudid.


  • https://www.deadiversion.usdoj.gov/drug_chem_info/hydromorphone.pdf
  • https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
  • https://www.cdc.gov/drugoverdose/data/prescribing.html
  • https://medlineplus.gov/druginfo/meds/a682013.html
  • https://www.mdanderson.org/publications/cancerwise/opioids-for-cancer-pain-relief–myths-and-facts.h00-159222567.html