This is one of a couple of meds that they regularly use with PCA (patient controlled analgesia) pumps. I had it after abdominal surgery and lemme tell ya, if you're on a basal infusion of 0.4 mg/hr., with 0.2 mg available every 10 min and 4 mg available every 4-6 hr for breakthru,... you can build up an insane tolerance.

As far as WDs, they are awful. My surgeon had to consult a pain mgt doctor prior to discharge because my total daily dose was the highest she'd ever seen. They converted me over to oxycontins at discharge, but tapered me immediately. Talk about feeling awful. The dysphoria is incredible... Crying spells, feeling like you could never possibly be happy again. It sucks.

As others have said: Use sparingly. As far as IV dilaudid compared with other IV pain relief, I'd say that dilaudid packs the biggest punch, but seems to have the shortest half-life of any of them. After a shot of a fairly high dose, severe pain goes away for about 45 minutes and then you either 1) fall asleep (if you're lucky) or 2) hurt again and have to wait 4-6 hrs for your next dose.

That's what they shot me up with after I busted my shoulder up. I practically fell out of the chair. The nurse had to help me over to the bed.

After I regained my composure I asked the nurse I she had a "to go" pack of the stuff. She laughed, and said, "No."

I was given this right after my accident and did not like the effects of this. I felt like I had no control over Wendy and then became nervous and started havinf panic attacks because I was affraid I was dying. Not a good feeling.

If 4mg instant-release hydromorphone is equivalent to 2 x 10/325 hydrocodone or a 10mg Percocet, it does not sound very strong to me. My OxyContin hardly holds me at all; and I can not get anything stronger prescibed.
It appears to work better when combined with 2mg alprazolam and 700mg carisoprodol.
I would like to try 8mg hydromorphone tablets, but they are not available here, where only 1.3 and 2.6mg dosages are on the market as PALLADONE i/r. I think you can get Palladone SR in an 8mg dose, but that means crushing up and all sorts to get the hydromorph into the system quickly.
CC

Oxycodone is much more potent orally than Dilaudid. Now IV Dilaudid is probably more potent than the oxy but everyone's opinion will differ. -ck

Oral hydromorphone has a very low bioavailability and is definitely fairly weak. However, ignoring the specifics regarding the route of administration, dilaudid feels much cleaner than oxycodone to me, with much less nausea and itchiness while keeping me much more lucid. But, if taken any way other than orally, hydromorphone is without a doubt more effective.

I'm prescribed hydromorphone for infrequent use to deal with kidney stones. The pain is intense and comes on quite rapidly, and pills usually just don't cut it.

I realize there is a negative sigma associated with this, but an MD friend of my father's actually suggested that I crush up the pills and insufflate them. Now, I do not even dare using pain meds recreationally lest they become less effective and I have to suffer even more pain, but in a moment of desperation I actually followed his advice.

Let me tell you, if the pain really is that bad, it's worth it. The pills are far more effective and begin working in about 5 minutes rather than one hour, which is a lifesaver when you're dealing with a kidney stone. I know some people will look on this and think it's only something junkies do, but it's actually made my problem infinitely more bearable.

Basically, for strictly oral usage, oxycodone is the way to go. For any other route, Dilaudid seems to me like the obvious choice.

You certainly can't wait for oral medication when you have renal colic - possibly the worst pain a human can suffer. You need IMMEDIATE relief, and I believe doctors should train patients to either inject themselves, giving them one injection to keep for an emergency, or do something like you mention. I wonder if Stadol, being a nasal spray, would be effective?

I was seriously injured in a high impact collision (caused by a 22 year old, uninsured driver). Blew my right pelvic socket wide open and I ended up "dead" for a few minutes trying to hold down the brake pedal. It's called bumper override. I was in an SUV. She was in a sedan. Bigger doesn't mean safer. Turns out the FTC has standards for all passenter vehicles; but, there are no standards for SUV's or light trucks. Her vehicle went up under mine and she put the impact of her 2700 pound of her vehicle along with the full cargo load I was carrying in my lap. There was a school bus in front of me (not kidding). If there is only one bit of anything left in me, it's that I did not hit that bus. I saw her coming. Was at a stoplight. There was absolutely nothing I could do. The settlement didn't even cover the medical expenses. Never figured I'd be totally disabled at 41 years old. Now that I'm done whining (as I'm quite sure there are so many of you who suffered and have suffered more than me, let me get to the good part...I've had every kind of surgery and procedure imaginable. Been to every kind of specialist possible. I have what's called ankylosing spondylitis and adhesive arachnoiditis (listed under the Social Security Diagnostic Disorders under M.I.N.E (medical improvement not expected). I have intractible pain, which causes my blood pressure to soar. My internal systems suffer as a result. I've been to ER's where they pump me full of morphine and demerol (which make me want to tear at my flesh due to side effects). I also get treated like a drug addict when the very last thing I want is what they give me. In October 07 I withstood the rigors of a psych evaluation and several interviews with a pain psychologist at one of this country's most reknowned medical facilities (university affiliated). I was told I qualified for implantation of a Spinal Cord Stimulator - both physically and psychologically. I was nearly giddy with joy.

I just found out that Medicare won't pay for it. You know why? I've never been on opioid therapy. They would (understandably) prefer to pay $5.00/bottle for a prescription than $20,000.00 for an electronic surgical implant - but there is no doctor that will prescribe on a regular basis. In addition, I don't drive and walk only with the aid of several orthotic devices and braces, so getting to doctor's visits every two weeks (for monitoring) is a challenge in and of itself. If there are any pain veterans out there, who are kind-spirited, I've asked God and now I'm asking you to help me. Most people who suffer from my physical conditions are on some sort of opiods - oxycotten (sp?), mophiene sulfate, etc. Problem is my allergies. I'm on several different meds, but nothing for pain. Now the pain is literally killing me. My blood pressure (due to pain) soars. I've been a member for awhile, but never ordered anything for pain because I kept holding on and holding out for the Spinal Cord Stimulator. I read everything (b/c at times I can't move anything but my eyeballs. Some of your responses are so technical and advanced, I feel stupid. Living on SSI is not what it's made out to be...I was a teacher. I love children.The pain is literally killing me. I want to live to see my grandchildren. I've run out of options. What works for severe, chronic, intractible pain (feels like I've been sheared in half) that works for people prone to allergies and who live on (not by choice) a limited budget? Blessings, Crista

cristas,

Sorry to hear about all that. I'm surprised that with your apparent allergic reactions, the doctors haven't tried various synthetic opioids, which is usually the case when patients are allergic.

Your pain sounds quite unrelenting, and two obvious choices to me would be fentanyl and methadone.

Fentanyl is probably more desirable than methadone and generally has less side effects than other opioids, and although it is quite fast-acting, patches are available which slowly release the drug over up to a period of 3 days.

Methadone, while carrying a bit more risk as far as side-effects go, is also great for chronic pain as it is very long-lasting and is *extremely* cheap. Also, methadone is particularly good (possibly even the best) among the opioids for controlling neuropathic pain, which I believe (although I'm not 100% sure) is the kind of pain that usually results from arachnoiditis.

These drugs are unfortunately not really available online and can be difficult to get from doctors even with the most legitimate of problems. All I can say is if your doctor isn't willing to let you try these, look for one who will. It's really heartbreaking to hear about stories like yours. I'm fortunate here in Canada that my family and I have always had access to the care we required. My prayers go out to you

From what I understood in the movie, "Drugstore Cowboy" dilaudid is pharmaceutical grade heroin. I'd say your state of well-being is slightly better than it would be with two 10/325s, but that's just my opinion.

These chemical names can be confusing, especially when thrown around in movies like Drugstore Cowboy.
Pharmaceutical grade heroin is diamorphine. Dilaudid is hydromorphone. They are not the same.
However, hydromorphone is sometimes referred to as diamorphone which can easily be confused with diamorphine.
One example of the two drugs' pharmacokinetics is the estimate that hydromorphone (IV on a mg to mg basis) is five times more potent than heroin/diamorphine.
Easy to get the names mixed up but important differences do exist.

they do say that dilaudid is like pharmaceutical grade heroin in the movie. although thats not true at all. people seem to say that about any opiate addicts inject. "hillbilly heroin" ring a bell?

but yeah, they found a small bottle of pure hydromophone (I'm guessing, it was powdered, although the bottle did say dilaudid).

I can only hope that people don't acquire their definitive pharmaceutical information from movies like Drugstore Cowboy.
But I'm afraid that many do.

oh definetly, usually the people making the movies do little research to figure out if what they are portraying is real.

the only movie I've seen having to do with opiates that was the closest to real life would be Trainspotting (except I never seen a baby on the ceiling). but requiem and man with the golden arm, drugstore cowboy, basketball diaries, I see a bunch of holes in.

If you look it up, T's and blues were a sought after drug combo in the 70's and 80's when and if heroin was scarce. That part of the movie was (kinda) true. But they did mix up the "blues" part. But more realistic than seeing "Nurse Jackie" snorting some red beads in the bathroom. And possibly more realistic than having a show about a known drug addict running a whole department in a teaching hospital in NJ.

http://www.wikidoc.org/index.php/Oxymorphone

http://www.time.com/time/magazine/article/0,9171,954843,00.html

DeeRock,

Even Trainspotting is fairly unrealistic. I know its for the sake of the movie, but the way Renton goes in and out of addiction seemingly at will isn't too close to the mark.

how does renton go in and out of addiction seemingly?

he never actually quits until the end of the movie.

the first time, he locked himself in a room, and had valium, which makes it somewhat easier and he still burst out the door within' minutes of closing it. then he was doing methadone, and OD'd when he did heroin ontop of it. the only time he wasn't on drugs (and he was still smoking hash) and he seemed fine is when him and sickboy were shooting at the dog in the park with the BB gun, and that was like day 1 with no opiates which really isn't that bad.

so, let me know what part you're talking about where he goes from being in and out of addiction seamlessly.

xxx off topic deleted xxx

I had a Dilaudid pump after major surgery. Thank God it put me out for the first few days. After that, I noticed the pain relief is short lived. It did make me less aware of my surroundings which was merciful. The PILLS though, don't work anything like the IV. I got those in the hospital when they removed me from the pump and they offered comparatively little relief. It is less nauseating than Morphine and seems to be the hospital's preferred pain drug (the one I went to).

Oh I hate morphine. That stuff makes me so sick nausous. Then they have to give me reglan or something comperable to that. For the most part I just tell them I cant take it. That happened to me when I was on MScontin even in a low dose it made me sick......dilaudid shots in the ER for short term works ok never had it in pill form though.

I get hydromorphone 8s for BT pain. At my level of CP, they are fairly mild, yet do work. There are a couple of other ways to use dilaudid pills, but this Board generally does not
prefer these kinds of discussions. Watch Intervention, and you can sometimes see dilaudid being abused. I take as directed by my doc-- the HM pills come in 2, 4 and 8 mgs. in the States. Overseas (some parts of Europe) there is an ER formulation called Jurnista. I believe it might be in trials for approval in USA; not sure. It has a very difficult to defeat time release mechanism called "TimerX."

Since this old thread has been resurrected, and I just saw the old movie Drugstore Cowboy- I believe the "blues" they refer to in the movie was Numorphan, which was IR oxymorphone. That drug is back currently under the name Opana, and comes in 5 and 10 mg. IR, and 10, 20, 30, 40 mgs ER strengths. It's very expensive, w/o very good insurance. Generic dilaudid, on the other hand is less than a dollar a pill. Hope this info helps a little... I did like seeing William Burroughs in the "Cowboy" film- that scene at the end was priceless when he sweeps aside all the lesser prescription bottles on the bed, saying "that stuff is for squares!" Then he picks up the dilaudid bottle and says something like "this stuff is the real deal..." Pretty clever - Burroughs loved dilaudid in real life- Just read his famous book- "Junky."

No, the "blues" were pyribenzamine. "T" was Talwin. Heroin substitute. No, was not a narcotic.

U could be right, O & W...there is so much urban myth that floats around about that old movie. Maybe some thought it was numorphan, because it was a blue pill available in those times...talwin- got that in a hospital once for a pre-surgical procedure.

Great sig quote, btw! Chicago's public art comes to mind- some of the Calder pieces downtown, maybe?

Oh, good guess! Old movie? "Gone With the Wind" was an old movie LOL.

<Mexican accent on>
I don't need no stinkin movie to know this stuff.
/<Mexican accent off>

I have suffered chronic migraine headaches for over 25 years. I am 45 years old now. I was also in a severe rear end collision that did neck and back damage. After years of trying preventive meds and every therapy you can think of down to bio feedback I have finally found a great pain management doctor.

After taking Percocet 10/325s for several years I built a tolerance which is really scary as I didn't want to have to take more than I was due to the tylenol in it. My new doctor has put me on Oxycodone 30mg instant release. I never knew there was such a medication. It is basically 30mg of Percocet with NO tylenol in it!!!

So far, except for extreme attacks this works really well!!! You can take it every four hours and can even cut them in half to get 15mg is 30 is too much or not quite enough.

As I was spending sometimes up to 12 hours in extreme pain and vomiting in the waiting room at the emergency room, because as we all know, migraine sufferers are usually labeled "drug seekers" at the ER, so we seem to wait longer than others!!! They usually give me 2mg dilaudid and 4.4mg Zofran IV for the pain. It is very effective and relief starts almost immediately. You can also get the same dosage intra muscular. The main difference being this.....IV treatment relief is almost immediate but doesn't last as long. IM treatment takes appx. 30 - 45 min to get relief but lasts much longer.

To avoid such long waits I actually have a prescription for 2 shots of dilaudid that I can inject myself every month. I inject in the thigh as trust me, the hip is really hard to reach.

I am so grateful that I have finally found a pain management doctor that treats me with respect. He is very diligent as well. If I obtain controlled substances from ANY other he will IMMEDIATELY release me and stop treating me.

As far as dilaudid pills....someone posted earlier that dilaudid was only available in IV. Not true, it is available in 2, 4 and 8 mg tablets as well as suppositories. I don't find the pills to be very effective but the suppositories can help if the pain isn't out of control.

Again, I only use dilaudid for the worst pain!!! I control the milder with the Oxycodone. My doctor has told me that if I find I have to increase he will put me on a low dose Oxycontin and use the oxycodone for break through pain.

He has also explained to me the difference in dependency and addiction. I am definitely dependent on my medication as I have chronic daily pain and have to take it daily. Addiction is when you take more and more than your prescribed dose for the "high" that you get from it.

As far as withdrawal, I was treated some years ago with Hydrocodone (Lortab, Vicodin) and can tell you that coming off hydrocodone was much worse than coming off of oxycodone. Coming off hydrocodone gave me severe diarrhea, muscle cramps and just a feeling of crawling out of my skin. Oxycodone on the other hand gave me a little stomach problems and a sense of drab just no energy.

I am hoping that menopause will bring some relief as my severe migraines seem to be hormonal. Who would have ever thought that a woman would pray for menopause!!!

Hope this info has been at least a little bit helpful.

i feel you on the migraines, i get the absolute worse, they seem to last about24 to 48 hours start to finish but most opiates intensify , a little opiate and a good benzo tend to help mine, sometimes i can go to sleep and wake with it eased. i hate vomiting and that is instant as soon as my headache comes on, dark room, very still, no noise or motion... hate them!

my daughter gets horrible migraines.......I can tell when she has one even tho its hard for her to express her pain but she turns white as a ghost, she cant have any light....any noise...and the 1st sign of it is her running to the bathroom and profuse vomiting. I feel so bad cuz with her disabilities its hard for her to explain it but she used to get the hydro's and then her neurologist retired and a DO dr took over and cut her off.

Cold turkey! I was mad....so now I just give her some of my pain stuff when it gets that bad...its usually worse in the summer time cuz she cant handle staying in the heat for x amount of time. Ive only had a few of them in my lifetime so I know how bad she feels. It really pissed me off when they cut her cold turkey after 11yrs! I know its cuz the DEA cracking down.

But I have been told that there are certan opiates that causes the rebound thing.

Mosts pain meds cause a rebound because they wear off in 4-6 hours. Methadone is one drug I can think of that doesn't because it lasts longer than 12 hours.

Did you mean hydrocodone instead of hydromorphone?

Ohhhhh yes hydro's LOL sorry I didnt read the thread clearly so I guess its my turn to be off topic! I get methadone 10mgs x3 daily and you right they dont cause rebound issues.....OH boy I feel stupid now LOL

Ive never tried dilaudid except for post surgical procedures......

Thanks for pointing out my screw-up! It was late when I posted that so maybe I was delerious! LOL J/K anyway thanks again and sorry for posting on the wrong thread

DO should have tapered her instead of cold turkey! migraines tricky to treat especially if frequent. a medication called toradol can be helpful.