Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN
Written By: Phillippe Greenough
Article Updated: 01/24/2021
Number of References: 7 Sources
The symptoms of Dilaudid withdrawal are very uncomfortable and the experience can be quite painful, both mentally and physically. This is a potent drug that poses similar withdrawal symptoms to other strong opioids like morphine and heroin, and withdrawal symptoms can include vomiting, shakes, and severe insomnia. Here we will take a look at the particulars of Dilaudid withdrawal including how this drug works, how withdrawal is produced, the symptoms and effects, as well as some effective treatments.
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The withdrawal timeline for Dilaudid withdrawal can vary between people, the early stages at least are fairly standard. The post-acute phase can exhibit some significant differences, with some people making a full recovery within weeks, while others may suffer symptoms for months, or rarely even years.
The acute phase, which includes the physical symptoms, will begin within hours of the last Dilaudid use. With a relatively short half-life of ~3 hours, Dilaudid withdrawal symptoms may begin about 6 to 8 hours after the last time someone used the drug. A half-life is a measure of the amount of time that it takes the body to process and metabolize the drug. A 3-hour half-life means that it takes the body 3 hours to go from the maximum amount of Dilaudid in the blood to half of that value. Withdrawal symptoms won’t begin until a fairly large amount of the drug has been removed from the blood and it is no longer exerting its effects on opioid receptors. While the symptoms begin mildly, they will rapidly escalate over the next 24 hours.
The symptoms of Dilaudid withdrawal are rarely fatal, but they are often very uncomfortable or even painful. The opioid system is a contributor to many other neurological functions besides the perception of pain, but this is often the most profound effect of Dilaudid withdrawal. These symptoms can increase in severity over the first few days after someone stops using Dilaudid, before plateauing, and finally dissipating over the next few days. These symptoms can become quite severe, and are often the reason that someone will continue to use Dilaudid; this is known as withdrawal avoidance. The body and mind can become so habituated to the effects of Dilaudid that the thought of withdrawal, or even life without the drug, can instill a great sense of fear and dread.
A general overview of the Dilaudid withdrawal timeline may look like this:
Once someone has become addicted to Dilaudid, the days immediately after they cease using it are very uncomfortable. The severity of symptoms can vary, but it is almost guaranteed to be unpleasant to some degree. These symptoms are not usually dangerous, but if someone had an underlying health condition then dangerous complications could arise. The cardiovascular abnormalities can complicate pre-existing heart conditions, while blood sugar changes and dehydration can increase risks of HHNS (hyperosmolar hyperglycemic nonketotic syndrome) or diabetic ketoacidosis for those with diabetes.
The symptoms that someone could expect to experience during the first week of Dilaudid withdrawal include:
By the beginning of the second week, the physical symptoms are often well on their way to resolution. As the physical symptoms fade, someone may become more aware of the psychological symptoms resulting in the perception of increased depression during this time, and anxiety and cravings may remain consistently high. Mood swings and fatigue may be improved slightly, but are often at a moderate level.
Some common symptoms that may persist into the second week of Dilaudid withdrawal can include:
These symptoms are much less severe than during the first week, but they can still cause substantial discomfort, however, they will improve throughout the week
The beginning of the third week often shows some improvement in someone’s state of mind. The fatigue and lethargy may begin to lift and insomnia may not be as severe as the last two weeks. All of the physical symptoms have usually resolved by now, although depression, anxiety, and cravings are commonly still present. During the fourth week, energy levels may be almost back to normal. Fatigue and lethargy, while still present, are often improved greatly. Symptoms of depression, anxiety, and cravings for Dilaudid can be expected to persist for some time. These may sometimes only last a few weeks in total, but they have been known to persist for months in some cases. Regardless of their total duration, symptoms will improve steadily the longer someone stays away from Dilaudid or opiate use.
The most common symptoms of Dilaudid withdrawal during the third and fourth week can include:
While the days or weeks immediately after stopping Dilaudid use are extremely uncomfortable, the post-acute phase of Dilaudid withdrawal can often be difficult as well. The symptoms during this phase are strictly psychological, but they may persist for a very long time, sometimes months or even years.
Some of the most common post-acute symptoms of Dilaudid withdrawal include:
Even though these symptoms may last much longer than the physical symptoms, they tend to dissipate with time, becoming ever less intense as the weeks pass. That being said, it is often necessary to receive medications and therapy during this phase of withdrawal, as these symptoms can act as a barrier towards someone building a new life in recovery. There are many psychiatric medications that may benefit someone experiencing severe post-acute withdrawal symptoms, and therapy can offer someone support and help them develop new, healthy coping skills.
There is a great deal of variation in the duration of Dilaudid withdrawal symptoms between individuals. Some of these differences are influenced by behavioral factors, while others are out of a Dilaudid user’s control. The intensity of the symptoms can also be affected by different factors, causing some people to suffer relatively severe symptoms while others only experience minor discomfort.
Some of the factors that can influence both the duration and intensity of Dilaudid withdrawal include:
Probably the largest contributing factor to the severity and duration of the symptoms of Dilaudid withdrawal is someone’s Dilaudid use habits. If someone were to regularly use large amounts of Dilaudid, the opioid system would undergo a large degree of downregulation. The more downregulation performed in the brain and body, the more severe the symptoms once someone stops using the drug. Likewise, the length of time someone uses the drug can affect the duration of symptoms. The longer the brain operates in an opioid-receptor-downregulated context, the more structural changes occur in the brain, known as remodeling. This can be reversed once Dilaudid use ceases, but it is a long process. The longer someone uses the drug, the more remodeling occurs, and subsequently, the longer it takes to reverse, leading to more prolonged symptoms.
Genetics certainly plays a role in addiction, although the extent of this role is not well understood. While the degree of influence is currently unclear, there is a marked trend for addiction to run in families. While the relationship is uncertain, it may be related to neuroplasticity, which is the ability of the brain to change and adapt more effectively. If someone with a high level of neuroplasticity begins using drugs like Dilaudid, their brain would be able to adapt to its presence more quickly or more completely than someone without such a level of neuroplasticity. This could lead to downregulation and remodeling happening sooner, thus leading to more severe withdrawal symptoms from a shorter period of use or even less total amounts used.
The presence of co-occurring mental health issues plays a role as well, albeit an indirect one. While psychological symptoms such as anxiety and depression are very common symptoms of Dilaudid withdrawal, these may be amplified if someone already suffered from either of these mental health conditions. The degree of depression or anxiety may be elevated in those with prior issues, or the duration may be extended. Either way, if someone has a mental health issue prior to going through withdrawal, they are likely to have a more negative experience than someone who was otherwise healthy.
Dilaudid is a very potent opioid painkiller drug that is a derivative of morphine. The active ingredient in Dilaudid is hydromorphone, and this compound is ~4 times as potent as morphine. While it is much more potent than morphine, it has a similar half-life of about 3 hours. It is known as a “pure opioid” and has an agonist (activating) action at all 3 major opioid receptor sites: the μ (Mu), κ (Kappa), and δ (Delta) receptors. The strongest effect, by far, is on μ-opioid receptors and this is how its potent painkilling effects are produced.
Through chronic Dilaudid use, the opioid system of the brain and body can become adapted to the continuous, strong stimulation this drug produces. This will initially manifest as downregulation, which is the process of reducing sensitivity at certain neurotransmitter receptors; in this case, the opioid receptors. After downregulation has begun to occur and the drug is used continuously, the brain may undergo further structural changes, known as remodeling, to operate more efficiently or effectively in this environment of downregulated opioid receptors. While downregulation can occur in a fairly short time, this remodeling process takes time to begin, and subsequently to reverse.
Once opioid receptor downregulation has occurred, someone will benign to experience Dilaudid withdrawal symptoms when they don’t use the drug for a while. Hydromorphone is quite potent and has a relatively short half-life, so these symptoms may begin between 6 to 24 hours after the last time someone used. The physical and most intense symptoms often begin mild and escalate over the first day or so, and can last about a week. Psychological symptoms may begin around this time as well, although these often persist much longer. Mental symptoms tend to be influenced more by the degree of remodeling that has occurred in the brain than the physical symptoms, so these can last for weeks or months.
The symptoms of Dilaudid withdrawal are very uncomfortable, and if someone wants the best chance to complete withdrawal, it is recommended they enter a Dilaudid detox center. These facilities can provide medical supervision, medications, and therapies that can help reduce the potential risks and the discomfort of Dilaudid withdrawal symptoms. Additionally, they can provide support services and referrals to continuing care after detox is complete. These centers are often the first step on the road to recovery and can be an invaluable asset for someone trying to overcome Dilaudid addiction.
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