What Is Hydromorphone Used For?

Hydromorphone (brand names: Dilaudid, Exalgo) is a powerful semi-synthetic opioid painkiller used in both hospital settings and as part of a long-term treatment regimen for significant pain in opioid-tolerant individuals.

Depending on the needs of the individual, the substance is prescribed in various forms, including as immediate- and extended-release tablets, liquids, suppositories, and injectable solutions.^1,2

Is Hydromorphone Harmful?

Like other opioids, hydromorphone can be quite harmful when misused. The substance can negatively impact the mental and physical health of the person using it.

The potential dangers of this drug are so pronounced that hydromorphone is classified as a schedule II controlled substance in the U.S. This indicates that while the drug has medical benefit, it also carries a high risk for abuse.² In fact, the Drug Enforcement Administration (DEA) reports that as many as 1 million people have abused hydromorphone at some point in their lifetimes.²

Hydromorphone, like other opioid painkillers, has a high prevalence of abuse. This is a major public health concern because of the multitude of medical issues associated with abusing opioids, as well as the risk of fatal overdoses. The DEA reports that more than 18,000 people were treated in emergency departments for problems associated with hydromorphone abuse in 2011.² There were 19,000 deaths due to opioid-related overdose in 2014 alone.⁵

While the drug has some inherent dangers (possible side effects) even when used as directed, the risk of harm significantly increases when:

It is taken in higher amounts than prescribed.
It is taken more often than recommended.
It is used for reasons other than pain relief.
It is used without a prescription.
It is combined with other substances like alcohol.

NOTE: Extended-release tablets carry an increased risk of harm when abused because the extended-release mechanisms may malfunction when the pills are tampered with (e.g. crushed), allowing the full effects to be experienced at once.^1,2 The overwhelming highs that result from such misuse can easily result in lethal overdoses and further drive the development of addiction.

Short-Term Effects of Hydromorphone Use

The mechanism behind the short-term physiological effects of hydromorphone is similar to that of many other opioids (such as morphine and heroin).³

When the substance enters the system, it interacts with opioid receptors to not only alter pain perception, but also to release an accompanying surge of a neurotransmitter called dopamine. Dopamine is a vital neural signaling molecule involved in a number of brain processes, including motivation, movement, emotion, and pleasure.^2,3,6 Dopamine normally gets released when a person engages in healthy activities like exercising or eating, and it produces a feeling of reward that promotes repetition of the action. Because hydromorphone induces a large release of dopamine, a user can easily become addicted to the feeling and use it over and over again in order to reproduce this rewarding, pleasurable sensation.

Many people who use or abuse this drug will report a range of pleasurable effects produced by hydromorphone soon after it is consumed. Injections and oral administration will trigger effects that begin within 30 minutes and last for more than 5 hours.² These effects include:^2,6

Euphoric high.
Decreased feelings of pain.
Increased physical relaxation.
Decreased stress and anxiety.
Drowsiness.

People experiencing a hydromorphone high will often appear subdued, with slow speech and movements.

Learn more about the signs and symptoms of hydromorphone abuse.

Hydromorphone Side Effects

Even when used as prescribed, hydromorphone has a long list of unwanted and potentially dangerous side effects. In fact, it is known to cause life-threatening problems with breathing if taken in excess or in combination with other depressant substances.

Other hydromorphone side effects include:^1,2,5

Headaches.
Pinpoint pupils.
Dizziness/lightheadedness.
Fainting.
Feeling weak.
Trouble sleeping.
Dry mouth.
Trouble swallowing.
Gastrointestinal problems (nausea, vomiting, constipation).
Sweating.
Pain in muscles or joints.
Skin problems including rash, hives, and itching.
Difficult, slowed breathing.
Chest pain.
Swelling of the face or extremities.
Reproductive symptoms, such as irregular menstruation, decreased sexual interest, and erectile dysfunction.
Extreme sedation.
Seizures.

The medication also produces several side effects that impact the mental health of the user, including:^1,5

Increased anxiety.
Feelings of depression.
Anger and agitation.
Confusion.
Auditory or visual hallucinations.

Long-Term Effects of Hydromorphone Abuse

The continued use and abuse of hydromorphone can culminate in a higher number of more intense side effects. For example, someone who experiences symptoms of anxiety as a side effect of the substance could develop worsening symptoms of an anxiety disorder as use continues. Also, people who use substances as a form of self-medication will only conceal their underlying mental health concerns.

Use of hydromorphone, especially at high doses, can cause respiratory depression. When breathing is affected, less oxygen is available to the brain. Over time, the cumulative harm sustained during periods of reduced oxygen can result in lasting brain damage and/or coma.³

Long-term opioid abuse is also potentially linked to impaired:³

Decision-making skills.
Behavior regulation.
Response to stress.

Tolerance

Another long-term effect that may be very dangerous for an opioid user is the development of tolerance. Tolerance occurs when the body begins to require more and more of a drug to produce the same effects.³ Tolerance compels users to flirt with ever-increasing, dangerous amounts of drugs, which can easily lead to overdose.

Dependence and Withdrawal

Over time and often after taking increased doses, users will become dependent on hydromorphone, meaning they must have it to feel and function normally.³ While this can happen to any hydromorphone user—even someone who takes the drug exactly as prescribed—it is a more common development among those who abuse it. An opioid-dependent person will experience withdrawal symptoms when they stop or decrease their use. Due to the severe discomfort of opioid withdrawal, many users keep taking opiate drugs even when they want to quit.

Hydromorphone withdrawal symptoms are similar to other opioid withdrawal symptoms and include:¹

Insomnia.
Restlessness.
Teary eyes and runny nose.
Sweating.
Chills.
High levels of pain.
Weakness.
Cramps.
Nausea.
Vomiting.
Diarrhea.
Elevated blood pressure and heart rate.
Rapid breathing.
Mental health complaints, such as irritability and anxiety.

These symptoms can begin a few hours or a few days after last use, depending on how the substance was used.

Symptoms of Hydromorphone Addiction

Arguably, the most damaging long-term effect of hydromorphone abuse is the development of addiction. Addiction is the compulsion to obtain and continue using hydromorphone without concern for possible negative outcomes.

Someone struggling with an addiction to painkillers like hydromorphone may experience:⁶

Declining interpersonal relationships.
Decreased performance at work and school.
Inability to reduce or end drug use successfully.
Problems with law enforcement.
New or worsening mental and physical health complaints.
Problems maintaining and attending to typical priorities.
Lower levels of happiness in life.

Hydromorphone Withdrawal and Addiction Treatment

Hydromorphone withdrawal will not usually be medically dangerous, but it will be very uncomfortable. Someone who is withdrawing without professional treatment may be more likely to seek out more opioids to relieve symptoms during this time in which the body is processing and removing hydromorphone—known as detoxification.

Medically supervised detoxification services can help reduce this risk while:^7,8

Monitoring vital signs.
Providing a safe, structured environment.

Medical detox programs can also manage symptoms, with various medications used to ease the process, such as:

Clonidine, which reduces some symptoms of withdrawal without producing an intoxicating effect.
Methadone, a full opioid agonist that alleviates withdrawal without producing a high.
Buprenorphine, a partial opioid agonist that also relieves withdrawal discomfort and reduces cravings.
Probuphine, a buprenorphine implant that steadily releases the drug over a period of 6 months.

Another medication—naltrexone—will block the effects of opioids, but it should only be administered after detox. If it is prescribed too soon after last use, it may intensify symptoms of withdrawal.^7,8

Once detoxification is complete, an individual may benefit from different levels of treatment based on their current needs, including:

Inpatient assistance—Typically short-term, relatively intense hospital-based programs to stabilize the individual medically and psychiatrically.
Outpatient therapy—Various forms of treatment allowing the person to attend treatment and return home.
Residential recovery assistance—Longer-term treatment to foster a period of abstinence from substances in a safe and comfortable environment.
Recovery housing—Less rigid, recovery-focused housing where the person can transition back to independent living.

Find Addiction Treatment Programs

If you or a loved one is struggling with hydromorphone addiction, help is available and recovery is possible. A professional addiction treatment program can start anyone battling a substance use problem on the path to a happier and healthier life. Rehab programs are located throughout the U.S., and many offer specialized treatment that can cater to individual needs. You can use SAMHSA’s Find Treatment tool to search for rehabs. Many state government websites will also provide local drug and alcohol resources to those in need. To find your state government’s website, do a web search for your state name and ‘.gov.’ Once your state website is located, substance use resources shouldn’t be hard to find, and they should provide further phone contacts for your assistance.

American Addiction Centers (AAC) is a leading treatment provider and has trusted rehab facilities across the country. If you are interested in seeking treatment with us, or to receive helpful advice and information, please call AAC free at to begin the process of starting over without hydromorphone.

Effects of Hydromorphone Abuse: Short-Term, Long-Term, Side Effects, and Treatment