HYDROMORPHONE (Trade names: Dilaudid, Palldone)

Hydromorphone, derived from morphine is approximately five times as active biologically as morphine and is marketed as one of the most effective Schedule II opioid analgesic drugs attainable on the market today. It is marketed in small glass vials, single doses (1, 2, and 4mg/mL) and multiple dose vials (20 mL of 2mg/mL), tablets (2, 4, and 8 mg) and suppositories (3mg). The FDA approved a prolonged delivery capsule formula for marketing on September 24, 2004, sold as Palladone, containing 12, 16, 24, and 32mg of Hydromorphone. Up by 106 percent, from about 470,000 in 1998, prescriptions for Hydromorphone products increased to 970,000 in 2003. Lately physicians have been prescribing Hydromorphone as another option to OxyContin. Collective manufacturing allotment for Hydromorphone as approved by DEA for allowable national needs increased from 766 Kilograms in 1998 to 1,651 Kilograms in 2003. Up to date information demonstrates that the determinable health results are increasing. The estimated increase from 937 emergency departments episodes in 1996 to 2,667 episodes in 2002 all involved Hydromorphone use.

Legal uses

In patients where an opioid an analgesic is appropriate for moderate to severe pain Hydromorphone is administered to alleviate the pain. Like with the administering of morphine, sufficient doses of hydromorphone will alleviate even the most severe pain. The product Hydromorphone in the extended release form named Palladone, is meant for the management of constant to bearable to extreme pain. It's use is confined to opioid-tolerant patients requiring constant around the clock analgesic with a high effectiveness opioid for a period of time drawn out for weeks, months, or longer. Breaking, chewing, opening, dissolving or crushing capsules of Palladone can lead to the absorption of potentially lethal doses. Therefore it is very important that Palladone be swallowed whole.

Chemistry/pharmacology

Hydromorphone, (4, 5-epoxy-3hydroxy-17-methlmorphinan-6-one, dihydrohydroxy-codeinone; dihydromorphinone; dimorphone) is semi-synthetic opioid agonist derived from morphine. When using the ready to use field test kits Hydromorphone HCI will test positive for an opiate. Hydromorphone liabilities are very near to those of other Schedule II opioid analgesics such as morphine and oxycodone. A few of these liabilities would be pharmacological and toxic effects, clinical indications and variances, and abuse and dependence. When injected intramuscularly or taken orally a dose of 1.3 and 7.5 mg of Hydromorphone generates analgesia nearly like that of a 10 and 30 mg dose of morphine. When administered through injection and orally the analgesic effect of Hydromorphone is felt within 15 and 30 minutes. Usually these effects last for more that 5 hours. Having a longer duration of action and requiring only once a day administration are benefits of Palladone in an extended-release product. Other opiods generate feelings of relaxation, euphoria, less anxiety, decline in respiration, constipation, papillary blockage, and cough elimination and with Hydromorphone a person will experience feeling effects very close to these. Dangerous overdoses of Hydromorphone can cause severe respiratory decline, drowsiness advancing to stupor or coma, skeletal muscle elasticity, cold and moist skin, narrow pupils, lowering of blood pressure and heart rate and death. Naloxene or Nalmefene are authentic opioid aggressors used specifically as antidotes preventing respiratory depression caused from hydromorphone overdose. Deadly respiratory depression in children, above all very small children is a very high risk if exposed to Palladone.

Illicit uses

Before the existing notoriety of hydrocodone and oxycodone amid drug abusers, low dose (2 and 4mg) instantaneous release Hydromorphone formulations (i.e.Dilaudid) were the dominant opioid products for abuse and recreation during the 1970's and 1980's. The DEA targeted Hydromorphone for investigation as early as 1979. Dilaudid carries street names such as: dust, juice, dillies, smack, D, and footballs. Mainly among rural and suburban populations abuse of Hydromorphone is commonly found here. Because of the 12 to 32 mg of Hydromorphone found in Palladone is what makes this product popular and highly desired for abuse and diversion by opioid abusers and doctor shoppers.

Illicit distribution

Among DEA field offices located in New York, Chicago, St.Louis, San Antonio, Atlanta, Boston, Dallas, Detroit, Houston, Los Angeles, and Washington D.C. using Dilaudid as a diversion is being reported. The main sources for obtaining Hydromorphone are by forging prescriptions, doctor shopper's unscrupulous pharmacists and physicians, and armed robberies and night break-ins of pharmacies and nursing homes. The most common dosage strength of 4mg tablets reportedly sells for $5 to $100 per tablet on the streets depending on what area of the country you are in. According to a Federal database for drug seizures, there were 39 in 2002 and 31 in 2003. Information from state and local seizures of Hydromorphone was at 621 and 485 in 2002 and 2003 accordingly.

A combination of all this information and reports resulted in Hydromorphone being in Schedule II of the Controlled Substance Act of 1970.

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