What Is Hydromorphone?
Hydromorphone is an opioid, and opioids are indispensable tools when it comes to the treatment of pain. However, they are also some of the most addictive drugs. Many medicinal opioids – including hydromorphone – are abused across the country.
Available Forms of Hydromorphone
Hydromorphone – also known as dihydromorphinone – is a drug that acts on opioid receptors in the brain to produce morphine-like effects. It has the chemical formula C17H20ClNO3. Primarily used medicinally, many also abuse it recreationally, available either having been diverted from legitimate medical use or imported illegally (for example, via the dark web). When taken as a tablet, hydromorphone’s effects typically begin within half an hour, and can last five hours or more. That is, unless you have developed a tolerance to the drug.
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Medical uses of hydromorphone
Hydromorphone is usually provided in tablet form for oral consumption. However, it can also be administered as an injection, either into a vein, into a muscle, or under the skin. The medical uses of this medication can work only if prescribed by a medical professional and if it is not abused.
Hydromorphone Brand and Street Names
Hydromorphone is best known by the brand name Dilaudid. It is sold around the world under various other brand names including Hydal, Dimorphone, Sophidone LP, Hydrostat, Hydromorfan, Hydromorphan, Hymorphan, Laudicon, Opidol, Palladone, and Hydromorph Contin.
Legal status (UK)
In the UK, hydromorphone is a class-A controlled substance (the most restricted category) with serious penalties for unlawful possession and supply.
Pharmacological actions of hydromorphone
Hydromorphone is technically described as a “semi-synthetic μ-opioid agonist”, acting on opioid receptors in the brain and central nervous system and the gastrointestinal tract to produce depressant effects which include sedation and analgesia, but which can also have euphoric qualities.
Hydromorphone Addiction and How It Develops
Addiction is primarily a disorder of the brain’s reward system which drives repeated engagement in rewarding behaviour despite the knowledge of the negative consequences of such engagement. The more someone engages in the behaviour in question – in this case, consuming hydromorphone – the more the reward centres of the brain adjust to their production of chemicals including dopamine which create a positive feeling when the behaviour is repeated – while decreased levels of such chemicals in the absence of such behaviour causes negative psychological responses.
In the case of hydromorphone, a physical dependence can also result from repeated consumption over time. Dependence occurs when an individual’s system becomes used to the presence of certain levels of a substance, and becomes reliant upon those levels to function normally. If a dependent individual suddenly stops taking the substance in question, their brain and body may start functioning abnormally – with various symptoms manifesting, collectively known as withdrawal syndrome – until the system has re-normalised after a period of time.
Addiction and dependence are closely related. However, this does not mean they are the same thing. While you may be psychologically addicted to a specific drug or a behaviour, you could be physically independent of it. At the same time, you can be physically dependent but emotionally and psychologically non-addicted.
Why is hydromorphone addictive?
Hydromorphone is addictive for two main reasons. Firstly, the pleasant effects of taking hydromorphone – including its euphoric “high” – drive repeated consumption as the individual taking it desires to enjoy those effects over and over again, leading to a psychological addiction.
Secondly, hydromorphone – like all opioids – has a high dependence liability: it can create a strong physical dependence in the user, leading them to consume it again and agai
How addictive is hydromorphone?
It is difficult to grade opioids by how addictive they are, partly because each individual’s response to any given substance can differ from another’s; however, hydromorphone is considered to be between five and eight times as potent as morphine on a per-milligram basis, and while that does not necessarily translate into being five to eight times as addictive, it is certainly considered one of the opioids with the highest dependence liability.
Causes & Risks factors in Hydromorphone Addiction
Addiction is still not a completely understood phenomenon in terms of what exactly drives it in any given individual. We do not yet know why one person may develop an addiction while someone else, in very similar circumstances, may not. However, it is known that both genetic and environmental factors can play a role in the development of addiction.
The two primary causes of hydromorphone addiction are the regular consumption of hydromorphone as a result of being given it in a medical setting; and taking hydromorphone repeatedly as a recreational substance. Someone taking hydromorphone for medical reasons who stops being provided with it after developing an addiction and dependence may go on to take it – or other opioids – illicitly as a means of staving off withdrawal.
Fundamentally, no one who never takes hydromorphone will become addicted to it, and the more – and more frequently – someone takes it, the greater the likelihood that they will develop a hydromorphone addiction. With those caveats borne in mind, some of the leading risk factors for hydromorphone addiction include:
- being given hydromorphone repeatedly in a medical setting
- a previous personal history of substance abuse (especially opioid abuse)
- a family history of substance abuse
- associating with a peer group within which hydromorphone abuse is common
- easy access to hydromorphone
- low socio-economic status
- pre-existing mental health conditions
- chronic pain
- a partner who abuses hydromorphone
Common Drug Combinations
Because hydromorphone is an opioid, it may be taken by opioid addicts who cannot obtain their opioids of choice (such as heroin) and indeed may be cut into other opioids by suppliers.
Signs and Symptoms of Hydromorphone Addiction
It is important to note that someone suffering from any form of addiction may strive to hide the signs of their condition, because of the stigma associated with it; therefore, it may not be obvious that someone has a hydromorphone addiction.
Nevertheless, various signs may indicate the presence of addiction (though it must be borne in mind that there could be other reasons for the signs), including (but not limited to):
- frequent intoxication
- financial troubles
- engagement in criminal activity
- mental and physical health issues
- a preoccupation with obtaining substances of abuse
- a disinterest in previously enjoyed activities
- changes in sex drive and sexual preferences
- altered peer group
- decreased attention to appearance and hygiene
- altered sleep pattern
- altered eating pattern
- an abandonment of personal and professional responsibilities
- a decrease in professional and/or academic performance
- frequent tiredness
- mood swings
Someone addicted hydromorphone specifically may well display withdrawal symptoms after they stop taking hydromorphone or other opioids for 12 hours or more (for example, if they are unable to get hold of opioids). Some of the most prominent withdrawal symptoms include:
- decreased appetite
- feeling lightheaded or dizzy
- increased sweating
- hyperalgesia, or worsening pain
- rash or hives
- new and unexplained swelling
- trouble breathing
- difficulty swallowing
- chest pain
- extreme drowsiness
Co-Occurring Disorders with Hydromorphone Addiction
Substance abuse sometimes occurs with other mental health disorders. It can both result from such disorders, as a result of attempting to self-medicate, as well as cause them with depression and anxiety being especially common consequences of addiction. When a mental health disorder occurs alongside a substance abuse disorder, it is known as a dual diagnosis. Typically, cases of dual diagnosis are significantly harder to treat, and specialist care is usually required.
Impact of Long-Term Hydromorphone Abuse on the Brain
Long-term opioid abuse can involve regular respiratory depression, meaning less oxygen is available to the brain. Over time, this can cause permanent brain damage. Long-term opioid abuse has also been connected with impaired decision-making skills, an inability to respond effectively to stress, and poor behavioural regulation.
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Hydromorphone Overdose Explained
One of the biggest dangers associated with opioid consumption is overdose (the intake of more of a given substance than the body is able to handle effectively). Opioid overdose typically results in respiratory depression and arrest (insufficient or non-existent breathing) which can result in death, and even if patients survive can cause permanent brain damage.
The most common signs of opioid overdose are the “opioid overdose triad” of decreased consciousness or unconsciousness, pinpoint pupils, and respiratory depression; other symptoms may include muscle spasms and seizures. If you see any of these signs in someone known to have taken opioids, including hydromorphone, contact the emergency services immediately.
Hydromorphone Dependence Treatment Strategies
Unfortunately, opioid addiction is a significant and growing problem in the UK; however, one silver lining is that numerous high-quality treatment facilities now operate across the country with great experience in treating individuals addicted to opioids, including hydromorphone.
Addiction treatment typically consists of two phases: detoxification & withdrawal and therapy. The former phase addresses the immediate pressures of physical dependence; therapy uncovers and tackles the deep-seated psychological causes of addiction, and equips addicts with defence mechanisms against relapse.
Some treatment plans may involve the use of medication prior to – or even during – detoxification; for example, other safer legal opioids may be substituted for more problematic ones, making it easier to taper down dosages over time. Some patients may take such medication for months or even years before attempting to come off opioids altogether.
Inpatient and Outpatient treatment
Residential rehabilitation (rehab) facilities treating hydromorphone addiction may offer both inpatient and outpatient treatment options. Inpatient treatment will consist of detoxification and therapy, and a range of other elements including dietary and fitness plans; stays typically last between one and three months.
Outpatient sessions are mainly part of the aftercare programmes or follow-up therapies. Typical outpatient therapies are not part of the residential treatment offered in private rehabs of this kind, as evident from the name.
Hydromorphone Addiction Medications
Various medications are used in the treatment of opioid addiction. Some, including various benzodiazepines, are used to alleviate withdrawal symptoms specifically. Others, however, aim to reduce opioid consumption over time either prior to the commencement of a full treatment programme or as part of such a programme.
Methadone is commonly used as a substitute for more problematic opioids such as hydromorphone and can be prescribed for long periods as individuals gradually reduce their dosages. However, methadone itself is highly habit-forming and is frequently abused as a recreational drug.
Buprenorphine acts upon opioid receptors to reduce cravings and also prevent withdrawal symptoms from manifesting. It can be used both ahead of full detoxification, or as a means of long-term management to prevent relapse.
Naltrexone blocks the effects of opioids, thus disincentivising their use; however, it does not prevent the manifestation of withdrawal symptoms, nor does it reduce cravings.
Therapy for Hydromorphone Addiction
As noted above, therapy lies at the heart of addiction treatment. Various different therapy models and methodologies are frequently provided in the treatment of hydromorphone addiction, including:
- behavioural therapy
- cognitive behaviourial therapy (CBT)
- family therapy
- twelve-step programmes
- group counselling
Other Kinds of Intervention
Interventions are a common means of addressing addiction and can be extremely beneficial in enabling an addict to see the effect their addiction is having on those around them, and in reminding them that they are loved and have a reason to live. However, interventions can also do significant damage if carried out incorrectly. For more information on arranging an effective intervention, speak with an addiction specialist.
How to Help a Loved One Who is Addicted to Hydromorphone
If someone close to you is addicted to hydromorphone, it is understandable that you should want to tackle the situation head-on. However, doing so could cause more harm than good. Speak with an addiction specialist about the situation and discuss ways in which you can help your loved one; remember above all else to prioritise your safety and that of anyone around you.
Hydromorphone Addiction Statistics
- Hydromorphone was first synthesised in Germany in 1922.
- Just under 6,000kg of hydromorphone are produced each year worldwide. The average dose is 2 mg.
- In the UK, an estimated 2 million people have taken an opioid painkiller that was not prescribed to them.
- Each year, nearly 25 million opioid prescriptions are written in the UK.
- Over 2000 people die each year in the UK as a result of opioid use.
Ready to get help for your addiction?
If you are suffering from an addiction to hydromorphone, you need to get help – but that will only be effective if you are able and willing to own up to your condition.
If you have had enough of being a slave to hydromorphone, reach out for the help you need.
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