Hydromorphone
Hydromorphone was first synthesized and researched in Germany in 1924; Knoll introduced it to the mass market in 1926 under the brand name Dilaudid, indicating its derivation and degree of similarity to morphine It ne belongs to a class of drugs called “opioids,” which includes morphine. It has an analgesic potency of two to eight times that of morphine, but has a shorter duration of action and greater sedative properties.
Hydromorphone is legally manufactured and distributed in the United States. However, abusers can obtain hydromorphone from forged prescriptions, “doctor-shopping,” theft from pharmacies, and from friends and acquaintances.
Abstract
Hydromorphone belongs to a class of drugs called “opioids,” which includes morphine. It has an analgesic potency of two to eight times that of morphine, but has a shorter duration of action and greater sedative properties.
Hydromorphone is legally manufactured and distributed in the United States. However, abusers can obtain hydromorphone from forged prescriptions, “doctor-shopping,” theft from pharmacies, and from friends and acquaintances.
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Street Names
D
Dillies
Footballs
DL
Juice
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Brand Names
Dilaudid
Exalgo
Hydromorph Contin
Dilaudid-HP
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History
Hydromorphone was first synthesized and researched in Germany in 1924; Knoll introduced it to the mass market in 1926 under the brand name Dilaudid, indicating its derivation and degree of similarity to morphine (by way of laudanum) — compare Dicodid (hydrocodone), Dihydrin (dihydrocodeine) and Dinarkon (oxycodone). The brand name Dilaudid is more widely known than generic term hydromorphone, and because of this, Dilaudid is often used generically to mean any form of hydromorphone.
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Pharmacology
The chemical formula for hydromorphone is: C17H19NO3 - HCL
Hydromorphone and related opioids produce their major effects on the central nervous system and gastrointestinal tract. These include analgesia, drowsiness, mental clouding, changes in mood, euphoria or dysphoria, respiratory depression, cough suppression, decreased gastrointestinal motility, nausea, vomiting, increased cerebrospinal fluid pressure, increased biliary pressure, pinpoint constriction of the pupils, increased parasympathetic activity and transient hyperglycemia.
Several different parameters explored in detail below can impact hydromorphone's Absorption, Distribution, Metabolism & Elimination profile, with the result that the normal range of the morphine:hydromorphone potency ratio can be from half to double that published via the oral route and a bit less parentally.
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Uses
Like most opiates, hydromorphone is used recreationally, mostly because it produces euphoria, stress relief, and feelings of ""inner warmth"". According to recreational users, hydromorphone, when injected intravenously, produces a "head rush" and powerful euphoria extremely similar to heroin. Because the drug produces these effects, it makes it extremely susceptible to abuse. Users of the drug will not only develop a physical dependence to the drug, but also a strong physiological dependence, thus creating an addiction with repeated use. While physical dependence causes withdrawal, physiological dependence can create strong compulsions to use the drug which can last for a long time, even after the physical dependence is broken.
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Scheduling
Hydromorphone is a Schedule II drug under the Controlled Substances Act with an accepted medical use as a pain reliever. Hydromorphone has a high potential for abuse and use may lead to severe psychological or physical dependence.
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Psychological and physical addiction liability
The dependence liabilities of hydromorphone are essentiallysimilar to those of other schedule II opioid analgesics such as morphine. Hence effects such as physiological damage, lethargy, psychosis, depression, akathisia, and fatal overdose maybe experienced.
The short length of action of hydromorphone and other metabolic factors mean that the abstinence syndrome, or withdrawal, is brief but intense. A low dosing user of hydromorphone opting or otherwise forced to quit ""cold turkey can expect a withdrawal syndrome as intense as that of morphine but much more severe. It is compressed into a spike, peaking in 14 to 21 hours and resolving in 36 to 72 hours, provided the user is not taking other longer-acting opioids and has normal liver and kidney function. All of the effects of hydromorphone and its attendant withdrawal syndrome can be significantly lengthened by such factors. Possible but less common is the opposite: some patients require oral doses of hydromorphone as frequently as every 90 minutes, and the withdrawal syndrome can peak in as little as 9 hours. Users taking over 40 milligrams per day can experience painful withdrawal lasting up to two weeks with symptoms including constant shaking, cold sweats, diarrhoea, vomiting, muscle pain, body cramps, and insomnia. Even after the withdrawal, long-term users of this drug can experience symptoms for months, even years after, however, those symptoms are usually psychological, including drug cravings, feelings of self-doubt, of ""emptiness"", moderate depression, mild anxiety, and sometimes slight insomnia, though these symptoms occurring after the initial withdrawal are usually much more prominent in users who use the drug (or other drugs) recreationally, likely due to the fact that recreational users enjoy the effects that it has on their mood.
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Long Term Effects
The long-term effects of Dilaudid may include rashes, difficulty urinating, fainting, and difficulty breathing. If these side effects occur, make sure to contact a medical professional as soon as possible, as it may indicate a severe side effect that needs medical attention.
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Physical effects
The major hazards of hydromorphone include dose-related respiratory depression and sometimes circulatory depression
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Withdrawal Effects
More common side effects include light-headedness, dizziness, sedation, itching, constipation, nausea, vomiting, and sweating. Massive overdoses are rarely observed in opioid-tolerant individuals, but, when they occur, they may lead to circulatory system collapse. A particular problem that may occur with hydromorphone is accidental administration in place of morphine due to a mix-up between the similar names, either at the time the prescription is written or when the drug is dispensed. This has led to several deaths and calls for hydromorphone to be distributed in distinctly different packaging from morphine to avoid confusion. The effects of overdose can be exaggerated by dose dumping if the medication is taken with alcohol or benzodiazepines
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Medical Treatment options
The only medical treatment for hydromorphone addiction is stop taking it. If any side effects are observed discontinuing to use it may prove helpful. Treatment for Dilaudid addiction should include a personalized treatment plan, intensive counseling, individual, group or family therapy, spiritual counseling (if requested), drug education and information, developing new behaviors, as well as supervision and guidance under medical professionals and rehabilitation specialists at a Dilaudid rehab facility.Treatment for Dilaudid addiction should include a personalized treatment plan, intensive counseling, individual, group or family therapy, spiritual counseling (if requested), drug education and information, developing new behaviors, as well as supervision and guidance under medical professionals and rehabilitation specialists at a Dilaudid rehab facility.
Psychological treatment options
In addition to stopping the drug, psychological help is available to aid the user during the process. This helps patients change their habits and behaviors, so that addiction in the future is not as likely. A psychologist or psychiatrist is on-call at most hospitals, major health clinics, and in private offices. If the dependency on the drug is found to be psychological, it is likely that the patient will be set up with a psychologist or psychiatrist for a number of weeks until the addiction subsides.
Related drugs
Drugs that have similar effects include:
Heroin
Morphine
Hydrocodone
Fentanyl
Oxycodone
Related synthetics
The following are the synthetic derivatives of hydromorphone that are currently available:
Acetyldihydrocodeine
Benzylmorphine
Buprenorphine
Desomorphine
Dihydrocodeine
Dihydromorphine
Ethylmorphine
Diamorphine
Hydrocodone
Hydromorphinol
Hydromorphone
Nicocodeine
Nicodicodeine
Nicomorphine
Oxycodone
Oxymorphone
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References
[1] http://www.ncbi.nlm.nih.gov/pubmed/12818953
[2] http://www.rxlist.com/dilaudid-drug.htm
[3] http://www.webmd.com/pain-management/news/20050714/palladone-pain-drug-pulled-off-market
[4] http://www.pdrhealth.com/drugs/dilaudid
[5] http://www.purdue.ca/files/Dilaudid%20PM%20EN.pdf
[6] http://www.drugs.com/pro/hydromorphone.html
[7] http://www.dependency.net/learn/dilaudid/
Related Items
http://www.rxlist.com/dilaudid-drug.htm - Click here
http://www.drugs.com/pro/hydromorphone.html - Click here
http://www.purdue.ca/files/Dilaudid%20PM%20EN.pdf - Click here
Footnotes
| Date Published | 10/03/2012 |
|---|---|
| Posting Date | 10/03/2012 |
