Opioid medication used for pain relief Hydromorphone, also known as dihydromorphinone, and sold under the brand name Dilaudid among others, is a morphinan opioid used to treat moderate to severe pain. Typically, long-term use is only recommended for pain due to cancer. It may be used by mouth or by injection into a vein, muscle, or under the skin. Effects generally begin within half an hour and last for up to five hours. A 2016 Cochrane review (updated in 2021) found little difference in benefit between hydromorphone and other opioids for cancer pain.
Common side effects include dizziness, euphoria, sleepiness, nausea, itchiness, and constipation. Serious side effects may include abuse, low blood pressure, seizures, respiratory depression, and serotonin syndrome. Rapidly decreasing the dose may result in opioid withdrawal. Generally, use during pregnancy or breastfeeding is not recommended. Hydromorphone exerts its effects by activating opioid receptors, mainly in the brain and spinal cord. Hydromorphone 2mg IV is equivalent to approximately 10mg morphine IV.
Hydromorphone was patented in 1923. Hydromorphone is made from morphine. Hydromorphone is a therapeutic alternative on the World Health Organization's List of Essential Medicines. It is available as a generic medication. In 2022, it was the 233rd most commonly prescribed medication in the United States, with more than 1million prescriptions.
Safety at a Glance
High Risk- It is strongly recommended that one use harm reduction practices when using this drug.
- Hydromorphone is dangerous to use in combination with other depressants as many fatalities reported as overdoses are ...
- Toxicity: Like most opioids, unadulterated hydromorphone does not cause many long-term complications other than psychological a...
- Dangerous with: 3-Cl-PCP, 3-HO-PCE, 3-HO-PCP, 3-MeO-PCE (+43 more)
- Overdose risk: fatal or dangerous levels of oxygen deprivation. This occurs because the breathing reflex is supp...
If someone is in crisis, call 911 or Poison Control: 1-800-222-1222
Dosage
insufflated
intravenous
oral
Duration
insufflated
Total: 4 hrs – 6 hrsintravenous
Total: 3 hrs – 4 hrsoral
Total: 4 hrs – 6 hrsHow It Feels
Hydromorphone -- Dilaudid -- is the heavy artillery of the opioid world, and it announces itself with a rush that leaves no room for ambiguity. When administered intravenously, the onset is measured in heartbeats: a massive, almost violent wave of warmth erupts from the injection site and detonates through the body with a force that buckles the knees and steals the breath. Even by oral routes, the onset carries an authority that lesser opioids cannot approach, a depth of warmth that saturates the body to its marrow within twenty to thirty minutes.
The rush -- and this is a compound defined by its rush -- is often described as the single most pleasurable physical sensation the human nervous system can produce. A wall of warmth crashes through the chest, radiating outward in every direction simultaneously, flooding the extremities with a heat so intense it borders on the sexual. The muscles go completely liquid. The jaw drops open. The eyes close involuntarily as the entire conscious apparatus surrenders to a pleasure so overwhelming it temporarily obliterates the capacity for thought. For a few seconds or minutes, depending on the route, there is nothing but warmth -- no self, no world, no time, just an undifferentiated ocean of physical bliss.
As the rush subsides into the plateau, consciousness reconstitutes itself within a cocoon of profound comfort. The world beyond the body's immediate sphere becomes distant and irrelevant, heard as though from the far end of a long corridor. Pain is not merely suppressed but abolished, erased so completely that it is difficult to remember what it felt like. The emotional landscape is one of absolute serenity -- not happiness exactly, but a total absence of distress so complete it produces its own kind of joy. Breathing becomes dangerously shallow, each breath a slow, reluctant concession to biological necessity. The nod sets in: consciousness dips in and out like a boat rocking on gentle swells, each dip carrying you briefly into a warm darkness before surfacing again.
The physical signature is dramatic. Pupils contract to pinpoints. The skin flushes deeply, warm and slightly damp. The itch is intense, concentrated on the face and chest, demanding to be scratched with a persistence that becomes part of the experience's rhythm. Nausea can be severe, a violent counterpoint to the euphoria, the body's only available protest against the pharmacological onslaught.
The duration of the peak is moderate -- three to four hours -- and the decline, while not as precipitous as fentanyl analogs, carries a distinct sense of loss. The warmth does not fade so much as drain, leaving the body feeling hollow and exposed. The contrast between the peak and its absence is stark enough to etch itself into memory, a before-and-after that the nervous system will not easily forget.
Subjective Effects
The effects listed below are based on the Subjective Effect Index (SEI), an open research literature based on anecdotal reports and personal analyses. They should be viewed with a healthy degree of skepticism. These effects will not necessarily occur in a predictable or reliable manner, although higher doses are more liable to induce the full spectrum of effects.
Physical Effects
Physical(12)
- Constipation— A slowing or cessation of bowel movements resulting in difficulty passing stool, commonly caused by ...
- Diarrhea— Diarrhea is the occurrence of frequent, loose, or watery bowel movements as a side effect of certain...
- Headache— A painful sensation of pressure, throbbing, or aching in the head that can range from a dull backgro...
- Increased heart rate— A noticeable acceleration of heartbeat that can range from a subtle awareness of one's pulse to a fo...
- Motor control loss— A distinct decrease in the ability to control one's physical body with precision, balance, and coord...
- Nausea— An uncomfortable sensation of queasiness and stomach discomfort that may or may not lead to vomiting...
- Pain relief— A suppression of negative physical sensations such as aches and pains, ranging from dulled awareness...
- Physical euphoria— An intensely pleasurable bodily sensation that can manifest as waves of warmth, tingling electricity...
- Respiratory depression— A dangerous slowing and shallowing of breathing that can progress from barely noticeable reductions ...
- Sedation— A state of deep physical and mental calming that manifests as a progressive desire to remain still, ...
- Seizure— Uncontrolled brain electrical activity causing convulsions and loss of consciousness -- a life-threa...
- Spontaneous physical movements— Spontaneous physical movements are involuntary, seemingly random yet patterned body movements — twit...
Cognitive & Perceptual Effects
Cognitive(5)
- Amnesia— A complete or partial inability to form new memories or recall existing ones during and after substa...
- Anxiety— Intense feelings of apprehension, worry, and dread that can range from a subtle background unease to...
- Anxiety suppression— A partial to complete suppression of anxiety and general unease, producing a calm, relaxed mental st...
- Cognitive euphoria— A cognitive and emotional state of intense well-being, elation, happiness, and joy that manifests as...
- Depression— A persistent state of low mood, emotional numbness, hopelessness, and diminished interest or pleasur...
Pharmacology
Hydromorphone molecules exert their effects by binding to and activating the μ-opioid receptor as an agonist. This occurs due to the way in which opioids structurally mimic endogenous endorphins. Endorphins are responsible for analgesia, sedation, and cognitive euphoria along with physical euphoria. They can be released in response to pain, strenuous exercise, orgasm, or excitement. This mimicking of natural endorphins results in the drug's euphoric, analgesic (pain relief), and anxiolytic (anti-anxiety) effects.
The recreational effects of this compound, including cognitive euphoria and physical euphoria, occur because opioids structurally mimic endogenous endorphins which are naturally produced within the body and are also active on the μ-opioid receptor set in the brain. The way in which synthetic opioids such as heroin structurally mimic these natural endorphins results in their euphoric, pain relief and anxiolytic effects. This is because natural endorphins are responsible for reducing pain, causing sedation, and feelings of pleasure. The natural endorphins can be released in response to pain, strenuous exercise, orgasm, or general excitement.
Like most opioids, unadulterated hydromorphone does not cause many long-term complications other than psychological and physical dependence and constipation. The harmful or toxic aspects of hydromorphone's usage as a recreational substance are exclusively associated with not taking appropriate precautions in regards to its administration, overdosing, and using impure or adulterated batches of the substance.
Heavy dosages of hydromorphone can result in respiratory depression, leading onto fatal or dangerous levels of oxygen deprivation. This occurs because the breathing reflex is suppressed by agonism of µ-opioid receptors - this effect is proportional to the dosage of opiates consumed.
Hydromorphone can also cause nausea and vomiting; a significant number of deaths attributed to opioid overdose are caused by aspiration of vomit by an unconscious victim. This is when an unconscious or semi-conscious user who is lying on their back vomits into their mouth and unknowingly suffocates on their own vomit. It can be prevented by ensuring that one is lying on their side with their head tilted downwards so that the airways cannot be blocked in the event of vomiting while unconscious (also known as the recovery position).
Opioid overdoses can be fatal if not treated immediately by calling the local emergency medical services and administering an opioid antagonist such as naloxone to the overdosed user.
It is strongly recommended that one use harm reduction practices when using this drug.
As with other opiate-based painkillers, the chronic use of hydromorphone can be considered extremely addictive and is capable of causing both physical and psychological dependence. When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops their usage.
Tolerance to many of the effects of hydromorphone develops with prolonged use, including therapeutic effects. This results in users having to administer increasingly large doses to achieve the same effects. The rate at which this occurs develops at different rates for different effects with tolerance to the constipation-inducing effects developing particularly slowly. Hydromorphone presents cross-tolerance with Cross-all other opioids, meaning that after the consumption of hydromorphone all opioids will have a reduced effect.
The risk of fatal opioid overdoses rise sharply after a period of cessation and relapse, largely because of reduced physical tolerance to the depressant effects of the opioid. To account for this lack of tolerance, it is safer for a user that has been sober for an extended period of time to only dose a fraction of one's usual dosage when using again. It has also been found that the environment one is in can play a role in opioid tolerance.
In one study, rats with the same history of heroin administration were significantly more likely to die after receiving their dose in an environment not associated with the drug in contrast to a familiar environment. Because of the structral and chemical similarity of hydromorphone and heroin, it can be assumed that the same interaction between physical tolerance and the environment occurs in hydromorphone use.
Hydromorphone is dangerous to use in combination with other depressants as many fatalities reported as overdoses are caused by interactions with other depressant drugs like alcohol or benzodiazepines, resulting in dangerously high levels of respiratory depression.
Austria:** Hydromorphone is legal for medical use under the AMG (Arzneimittelgesetz Österreich) and illegal when sold or possessed without a prescription under the SMG (Suchtmittelgesetz Österreich).
Germany:** Hydromorphone is a controlled substance under Anlage III of the BtMG. It can only be prescribed on a narcotic prescription form.
Russia:** Hydromorphone is a Schedule II controlled substance.
Sweden: Hydromorphone is a prescription only medication.
Switzerland: Hydromorphone is a controlled substance specifically named under Verzeichnis A. Medicinal use is permitted.
Turkey: Hydromorphone is a 'red prescription' only substance and illegal when sold or possessed without a prescription.
United Kingdom:** Hydromorphone is a Class A, Schedule 2 drug in the United Kingdom.
United States:** Hydromorphone is a Schedule II Controlled Substance in the United States.
Responsible use
Safer injection guide
Opioids
Naloxone
Hydromorphone (Wikipedia)
Hydromorphone (Erowid Vault)
Hydromorphone (Isomer Design)
Hydromorphone (DrugBank)
Hydromorphone (Drugs.com)
Detection Methods
Standard Drug Panel Inclusion
Hydromorphone is a semi-synthetic opioid that is detected on standard opiate immunoassay panels, though cross-reactivity varies by manufacturer. The 6-keto group in hydromorphone reduces antibody affinity compared to morphine in some immunoassays. Extended opioid panels with hydromorphone-specific channels provide more reliable detection. Hydromorphone is also a metabolite of hydrocodone, which must be considered when interpreting results.
Urine Detection
Hydromorphone is detectable in urine for approximately 2 to 3 days. It is metabolized primarily by glucuronidation to hydromorphone-3-glucuronide, which is the predominant urinary metabolite. A small amount undergoes reduction to dihydromorphine. Confirmatory testing must distinguish hydromorphone from use versus hydromorphone as a metabolite of hydrocodone.
Blood and Saliva Detection
Blood concentrations are detectable for approximately 6 to 24 hours depending on formulation (immediate vs. extended release). Oral fluid testing can detect hydromorphone for 24 to 48 hours.
Hair Follicle Detection
Hair testing can detect hydromorphone for up to 90 days. Expanded opioid hair panels typically include hydromorphone as a specific analyte.
Confirmatory Testing
LC-MS/MS is preferred for quantitative analysis of hydromorphone, allowing precise measurement of parent drug and metabolites. The ratio of hydromorphone to hydrocodone metabolites helps determine whether the patient is taking hydromorphone directly or it is present as a hydrocodone metabolite.
Reagent Testing
Marquis reagent produces a purple color with hydromorphone. Mecke reagent produces a blue-green to dark blue reaction. These reactions are characteristic of the opiate class and consistent with morphine-backbone opioids.
Interactions
| Substance | Status | Note |
|---|---|---|
| 3-Cl-PCP | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| 3-HO-PCE | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| 3-HO-PCP | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| 3-MeO-PCE | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| 3-MeO-PCMo | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| 3-MeO-PCP | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| 4-MeO-PCP | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Alcohol | Dangerous | — |
| Atropa belladonna | Dangerous | Compounding CNS depression with anticholinergic effects; risk of cardiac events and respiratory failure |
| Benzodiazepines | Dangerous | — |
| Cake | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| Datura | Dangerous | Compounding CNS depression with anticholinergic effects; risk of cardiac events and respiratory failure |
| Deschloroetizolam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Deschloroketamine | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Desomorphine | Dangerous | Compounding respiratory depression and overdose risk |
| Diclazepam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Diphenhydramine | Dangerous | Compounding CNS depression with anticholinergic effects; risk of cardiac events and respiratory failure |
| Diphenidine | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Ephenidine | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Eszopiclone | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| Etizolam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Flubromazepam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Flubromazolam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Flunitrazepam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Flunitrazolam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Gaboxadol | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| GBL | Dangerous | — |
| GHB | Dangerous | — |
| Harmala alkaloid | Dangerous | Risk of serotonin syndrome and severe respiratory depression; potentially fatal |
| HXE | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Inhalants | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Ketamine | Dangerous | — |
| Lorazepam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Memantine | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Mephenaqualone | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| Metizolam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| Midazolam | Dangerous | Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths |
| MXiPr | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Naloxone | Dangerous | Compounding respiratory depression and overdose risk |
| Nicotine | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| Nifoxipam | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| O-PCE | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| PCE | Dangerous | Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration |
| Peganum harmala | Dangerous | Risk of serotonin syndrome and severe respiratory depression; potentially fatal |
| Pentobarbital | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| Phenobarbital | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| SAMe | Dangerous | Severe respiratory depression risk; leading cause of polydrug overdose |
| 3-FMA | Caution | Stimulants mask opioid sedation, increasing overdose risk when the stimulant wears off |
| 4-MMC | Caution | Stimulants mask opioid sedation, increasing overdose risk when the stimulant wears off |
| 8-Chlorotheophylline | Caution | Stimulants mask opioid sedation, increasing overdose risk when the stimulant wears off |
| Adrafinil | Caution | Stimulants mask opioid sedation, increasing overdose risk when the stimulant wears off |
| Benzydamine | Caution | Stimulants mask opioid sedation, increasing overdose risk when the stimulant wears off |
| Nitrous | Uncertain | — |
| PCP | Uncertain | — |
| 1,3-Butanediol | Low Risk & No Synergy | No significant pharmacological interaction; opioids may slightly dull the psychedelic experience |
| 25E-NBOH | Low Risk & No Synergy | No significant pharmacological interaction; opioids may slightly dull the psychedelic experience |
| 2C-T | Low Risk & No Synergy | No significant pharmacological interaction; opioids may slightly dull the psychedelic experience |
History
Hydromorphone belongs to the opioid class of substances, which has a history spanning thousands of years from the ancient use of opium poppy to modern synthetic and semi-synthetic analogues.
The isolation of morphine from opium in 1804 by Friedrich Sertürner marked the beginning of modern opioid pharmacology. Subsequent developments included the synthesis of heroin (diacetylmorphine) in 1874, the development of numerous semi-synthetic and fully synthetic opioids throughout the 20th century, and the identification of endogenous opioid receptors and peptides in the 1970s.
The opioid crisis of the early 21st century, driven largely by overprescription of pharmaceutical opioids and the subsequent emergence of illicit fentanyl and its analogues, represents one of the most significant public health challenges in modern history. This crisis has fundamentally reshaped discussions around opioid prescribing, addiction treatment, and harm reduction policy.
Hydromorphone exists within this complex pharmacological and social context, with its history shaped by its development, clinical utility, and the broader dynamics of opioid use and regulation.
Harm Reduction
It is strongly recommended that one use harm reduction practices when using this drug.
As with other opiate-based painkillers, the chronic use of hydromorphone can be considered extremely addictive and is capable of causing both physical and psychological dependence. When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops their usage.
Tolerance to many of the effects of hydromorphone develops with prolonged use, including therapeutic effects. This results in users having to administer increasingly large doses to achieve the same effects. The rate at which this occurs develops at different rates for different effects with tolerance to the constipation-inducing effects developing particularly slowly. Hydromorphone presents cross-tolerance with Cross-all other opioids, meaning that after the consumption of hydromorphone all opioids will have a reduced effect.
The risk of fatal opioid overdoses rise sharply after a period of cessation and relapse, largely because of reduced physical tolerance to the depressant effects of the opioid. To account for this lack of tolerance, it is safer for a user that has been sober for an extended period of time to only dose a fraction of one's usual dosage when using again. It has also been found that the environment one is in can play a role in opioid tolerance.
In one study, rats with the same history of heroin administration were significantly more likely to die after receiving their dose in an environment not associated with the drug in contrast to a familiar environment. Because of the structral and chemical similarity of hydromorphone and heroin, it can be assumed that the same interaction between physical tolerance and the environment occurs in hydromorphone use.
Hydromorphone is dangerous to use in combination with other depressants as many fatalities reported as overdoses are caused by interactions with other depressant drugs like alc
Toxicity & Safety
Like most opioids, unadulterated hydromorphone does not cause many long-term complications other than psychological and physical dependence and constipation. The harmful or toxic aspects of hydromorphone's usage as a recreational substance are exclusively associated with not taking appropriate precautions in regards to its administration, overdosing, and using impure or adulterated batches of the substance.
Heavy dosages of hydromorphone can result in respiratory depression, leading onto fatal or dangerous levels of oxygen deprivation. This occurs because the breathing reflex is suppressed by agonism of µ-opioid receptors - this effect is proportional to the dosage of opiates consumed.
Hydromorphone can also cause nausea and vomiting; a significant number of deaths attributed to opioid overdose are caused by aspiration of vomit by an unconscious victim. This is when an unconscious or semi-conscious user who is lying on their back vomits into their mouth and unknowingly suffocates on their own vomit. It can be prevented by ensuring that one is lying on their side with their head tilted downwards so that the airways cannot be blocked in the event of vomiting while unconscious (also known as the recovery position).
Opioid overdoses can be fatal if not treated immediately by calling the local emergency medical services and administering an opioid antagonist such as naloxone to the overdosed user.
It is strongly recommended that one use harm reduction practices when using this drug.
Tolerance and addiction potential
As with other opiate-based painkillers, the chronic use of hydromorphone can be considered extremely addictive and is capable of causing both physical and psychological dependence. When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops their usage.
Tolerance to many of the effects of hydromorphone develops with prolonged use, including therapeutic effects. This results in users having to administer increasingly large doses to achieve the same effects. The rate at which this occurs develops at different rates for different effects with tolerance to the constipation-inducing effects developing particularly slowly. Hydromorphone presents cross-tolerance with all other opioids, meaning that after the consumption of hydromorphone all opioids will have a reduced effect.
The risk of fatal opioid overdoses rise sharply after a period of cessation and relapse, largely because of reduced physical tolerance to the depressant effects of the opioid. To account for this lack of tolerance, it is safer for a user that has been sober for an extended period of time to only dose a fraction of one's usual dosage when using again. It has also been found that the environment one is in can play a role in opioid tolerance.
In one study, rats with the same history of heroin administration were significantly more likely to die after receiving their dose in an environment not associated with the drug in contrast to a familiar environment. Because of the structral and chemical similarity of hydromorphone and heroin, it can be assumed that the same interaction between physical tolerance and the environment occurs in hydromorphone use.
Dangerous interactions
Hydromorphone is dangerous to use in combination with other depressants as many fatalities reported as overdoses are caused by interactions with other depressant drugs like alcohol or benzodiazepines, resulting in dangerously high levels of respiratory depression.
Warning: Many psychoactive substances that are reasonably safe to use on their own can suddenly become dangerous and even life-threatening when combined with certain other substances. The following list provides some known dangerous interactions (although it is not guaranteed to include all of them).
Always conduct independent research (e.g. Google, DuckDuckGo, PubMed) to ensure that a combination of two or more substances is safe to consume. Some of the listed interactions have been sourced from TripSit.
Alcohol - Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely
Stimulants - Stimulants increase respiration rate which allows for a higher dose of opiates than would otherwise be used. If the stimulant wears off first then the opiate may overcome the user and cause respiratory arrest.
Benzodiazepines - Central nervous system and/or respiratory-depressant effects may be additively or synergistically present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position blackouts/memory loss likely.
DXM - Generally considered to be toxic. CNS depression, difficulty breathing, heart issues, and liver toxicity have been observed. Additionally if one takes DXM, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.
GHB/GBL - The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position
Ketamine - Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.
MAOIs - Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.
MXE - MXE can potentiate the effects of opioids but also increases the risk of respiratory depression and organ toxicity.
Nitrous - Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are common.
PCP - PCP may reduce opioid tolerance, increasing the risk of overdose.
Tramadol - Increased risk of seizures. Tramadol itself is known to induce seizures and it may have additive effects on seizure threshold with other opioids. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present.
Grapefruit - While grapefruit is not psychoactive, it may affect the metabolism of certain opioids. Tramadol, oxycodone, and fentanyl are all primarily metabolized by the enzyme CYP3A4, which is potently inhibited by grapefruit juice. This may cause the drug to take longer to clear from the body. it may increase toxicity with repeated doses. Methadone may also be affected. Codeine and hydrocodone are metabolized by CYP2D6. People who are on medicines that inhibit CYP2D6, or that lack the enzyme due to a genetic mutation will not respond to codeine as it can not be metabolized into its active product: morphine.
Overdose Information
fatal or dangerous levels of oxygen deprivation. This occurs because the breathing reflex is suppressed by agonism of µ-opioid receptors - this effect is proportional to the dosage of opiates consumed.
Hydromorphone can also cause nausea and vomiting; a significant number of deaths attributed to opioid overdose are caused by aspiration of vomit by an unconscious victim. This is when an unconscious or semi-conscious user who is lying on their back vomits into their mouth and unknowingly suffocates on their own vomit. It can be prevented by ensuring that one is lying on their side with their head tilted downwards so that the airways cannot be blocked in the event of vomiting while unconscious (also known as the recovery position).
Opioid overdoses can be fatal if not treated immediately by calling the local emergency medical services and administering an opioid antagonist such as naloxone to the overdosed user.
It is strongly recommended that one use harm reduction practices when using this drug.
As with other opiate-based painkillers, the chronic use of hydromorphone can be considered extremely addictive and is capable of causing both physical and psychological dependence. When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops their usage.
Tolerance to many of the effects of hydromorphone develops with prolonged use, including therapeutic effects. This results in users having to administer increasingly large doses to achieve the same effects. The rate at which this occurs develops at different rates for different effects with tolerance to the constipation-inducing effects developing particularly slowly. Hydromorphone presents cross-tolerance with Cross-all other opioids, meaning that after the consumption of hydromorphone all opioids will have a reduced effect.
The risk of fatal opioid overdoses rise sharply after a period of cessation and relapse, largely because of reduced
Dangerous Interactions
The combinations listed below may be life-threatening. Independent research should always be conducted to ensure safety when combining substances.
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Compounding CNS depression with anticholinergic effects; risk of cardiac events and respiratory failure
Severe respiratory depression risk; leading cause of polydrug overdose
Compounding CNS depression with anticholinergic effects; risk of cardiac events and respiratory failure
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Compounding respiratory depression and overdose risk
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Compounding CNS depression with anticholinergic effects; risk of cardiac events and respiratory failure
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Severe respiratory depression risk; leading cause of polydrug overdose
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Severe respiratory depression risk; leading cause of polydrug overdose
Risk of serotonin syndrome and severe respiratory depression; potentially fatal
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Severe respiratory depression risk; leading cause of polydrug overdose
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Severe respiratory depression; this combination is the leading cause of prescription drug overdose deaths
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Compounding respiratory depression and overdose risk
Severe respiratory depression risk; leading cause of polydrug overdose
Severe respiratory depression risk; leading cause of polydrug overdose
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Both cause respiratory depression and unconsciousness; vomiting while dissociated risks aspiration
Risk of serotonin syndrome and severe respiratory depression; potentially fatal
Severe respiratory depression risk; leading cause of polydrug overdose
Severe respiratory depression risk; leading cause of polydrug overdose
Severe respiratory depression risk; leading cause of polydrug overdose
Tolerance
| Full | Develops rapidly with repeated use |
| Half | 3 - 7 days |
| Zero | 1 - 2 weeks |
Cross-tolerances
Legal Status
Austria:** Hydromorphone is legal for medical use under the AMG (Arzneimittelgesetz Österreich) and illegal when sold or possessed without a prescription under the SMG (Suchtmittelgesetz Österreich).
Germany:** Hydromorphone is a controlled substance under Anlage III of the BtMG. It can only be prescribed on a narcotic prescription form.
Russia:** Hydromorphone is a Schedule II controlled substance.
Sweden: Hydromorphone is a prescription only medication.
Switzerland: Hydromorphone is a controlled substance specifically named under Verzeichnis A. Medicinal use is permitted.
Turkey: Hydromorphone is a 'red prescription' only substance and illegal when sold or possessed without a prescription.
United Kingdom:** Hydromorphone is a Class A, Schedule 2 drug in the United Kingdom.
United States:** Hydromorphone is a Schedule II Controlled Substance in the United States.
Responsible use
Safer injection guide
Hydromorphone (Wikipedia)
Hydromorphone (Erowid Vault)
Hydromorphone (Isomer Design)
Hydromorphone (DrugBank)
Hydromorphone (Drugs.com)
Experience Reports (1)
Tips (7)
Opioid tolerance and cross-tolerance are complex with Hydromorphone. Switching between different opioids requires careful dose conversion. Do not assume equivalent effects at standard conversion ratios; start lower than calculated.
Hydromorphone is a potent opioid and overdose can occur rapidly, especially via injection. Always have naloxone available. Never use alone. If transitioning from hydrocodone or other weaker opioids, remember that hydromorphone is 5-8 times more potent than morphine mg for mg. Equianalgesic dosing charts exist for a reason.
Hydromorphone (Dilaudid) has an extremely rapid onset when injected, producing an intense rush that many describe as the most euphoric of any opioid. This makes it exceptionally addictive via injection. The transition from snorting to IV use is a critical escalation point. Recognize this trajectory early.
Signs of opioid overdose from Hydromorphone: slow or stopped breathing, blue lips or fingertips, pinpoint pupils, gurgling sounds, unresponsiveness. If you see these, administer naloxone immediately and call 911.
Hydromorphone has vastly different bioavailability by route. Oral bioavailability is roughly 35%, intranasal approximately 50-55%, and IV near 100%. This means 16mg insufflated is NOT the same as 8mg IV. The math is not simple division. Always research bioavailability for your specific route and err on the conservative side.
In most US states, Good Samaritan laws protect you from drug charges if you call 911 for an overdose. Never hesitate to call emergency services. A legal charge is infinitely preferable to a death.
Community Discussions (1)
See Also
References (4)
- Opioid receptors — Pasternak & Pan Annual Review of Pharmacology (2013)paper
- PubChem: Hydromorphone
PubChem compound page for Hydromorphone (CID: 5284570)
pubchem - Hydromorphone - TripSit Factsheet
TripSit factsheet for Hydromorphone
tripsit - Hydromorphone - Wikipedia
Wikipedia article on Hydromorphone
wikipedia