Approximately 1 in 4 emergency room admissions may be attributed to having ingested a combination of alcohol and medication.1 Combining the powerful prescription opioid drug hydromorphone (Dilaudid) and alcohol can be particularly dangerous and may result in profoundly slowed breathing (respiratory depression) and in some cases death.
The Side Effects of Taking Dilaudid With Alcoholic Drinks
Doctors are careful to assess any contraindications of the medications they prescribe to help assure that the side effects of any combination of drugs may be avoided. Yet a number of people who take prescription drugs also consume alcohol. Doctors should inquire about alcohol use prior to prescribing opioid drugs like Dilaudid. However users aren’t always fully forthcoming with such information. Even when explicitly stated, either verbally or printed on the label, warnings to refrain from mixing drugs and alcohol all too frequently fall on deaf ears.
If you’ve consumed alcohol while taking medication in the past without having experienced negative effects or perhaps having enjoyed pleasurable effects, you may not think twice about doing so again with another medication. Yet different drugs interact with alcohol in different ways, and it’s particularly dangerous to mix Dilaudid and alcohol.
Dilaudid is a narcotic used to treat pain. Hydromorphone, the active ingredient in Dilaudid, is derived from morphine. It is similar to drugs like heroin, both in chemical composition and its effects. Possible side effects of Dilaudid include:2
- Difficulty concentrating.
- Impaired thinking and judgment.
Similar to other drugs that are referred to as opioid agonists such as oxycodone and methadone, Dilaudid is associated with a high risk of respiratory depression.3 When comparing standard doses of the prescription opioids, Dilaudid is several times stronger than many other commonly used painkillers like hydrocodone and oxycodone.
As a result, Dilaudid has an even higher risk for abuse. The development of an extended release form of Dilaudid was developed specifically to address the problems associated with abuse because a slower, controlled release of the drug potentially minimizes the otherwise rapidly and rewarding opioid high experienced with an instant-release formulation.4
Using hydromorphone and alcohol together considerably increases the risk of respiratory depression. Their combination can be lethal.
One previous factor that made the combination of Dilaudid and alcohol so dangerous was that alcohol interfered with the mechanism that regulated the release of the drug. The specific formulation of hydromorphone in question was known as Palladone. The consequence of taking Palladone with alcohol was referred to as “dose dumping”—a situation where a drug that is designed to release gradually enters the bloodstream very rapidly.
Palladone was pulled from the market in 2005 in large part due to the dose dumping phenomenon. The current available controlled-release formulation of hydromorphone, now marketed as Exalgo, does not exhibit this effect.
With the problem of prescription drug abuse on the rise, the dangers associated with combining Dilaudid and alcohol are particularly troubling. It’s estimated that nearly 9% of the population will abuse heroin or prescription opiates during their lives, and nearly 70% of people with opiate addictions also engage in problem drinking.5,6
Concerns of Mixing Alcohol with Other Opiates
Withdrawal from Dilaudid and Alcohol
Withdrawal from Dilaudid and alcohol produce very different symptoms and risks. Consequently, the treatment of dependence and addiction to Dilaudid and alcohol is more complicated. In particular, opioid addiction has a high incidence of relapse, demanding a need for ongoing treatment and aftercare following the discontinuation of use.
Medically supervised addiction treatment is often used to lessen the symptoms associated with Dilaudid withdrawal. The three main treatment approaches include:
Rapid Opioid Detox
This controversial treatment approach designed to reduce the intensity of symptoms during the initial days of Dilaudid withdrawal. While under anesthesia, the person is injected with large doses of opioid-blocking drugs. The risks include vomiting, which is particularly dangerous when anesthetized. This is not a substitute for the ongoing care and the support needed to prevent relapse.4
Medication to Treat Withdrawal Symptoms
With this treatment approach, individual medications are administered to the person to address distinct symptoms of opioid withdrawal. Usually a drug is used to lessen the anxiety and muscle aches that define Dilaudid withdrawal. Clonidine, an alpha agonist drug, is often prescribed. Additional medications for symptoms such as cramping, vomiting, and diarrhea may also be given.4
Opioid Replacement Therapy
This treatment approach administers medications that have some of the same effects of Dilaudid, but that are active longer and don’t produce the same type of high. The most common substitute drugs administered are buprenorphine and methadone. These drugs may also be used for long-term maintenance. The disadvantage to the use of these drugs is that stopping their use results in the onset withdrawal symptoms. Abrupt discontinuation of methadone in particular may result in serious illness and even death.
Alcohol withdrawal may also be medically treated when assessed to be serious. In most cases, benzodiazepine drugs are effectively used for this purpose. Some medications have been used to treat alcoholism for long-term maintenance, primarily to reduce cravings. However, non-medical treatment has been shown to be just as effective in the treatment of alcohol use disorders.7
Treatment for Addiction to Dilaudid and Alcohol
Treatment for addiction to Dilaudid and alcohol is available on both an inpatient and outpatient basis. However, inpatient or residential treatment is frequently sought for poly-substance abuse, including those of co-occurring opioid addiction and alcoholism.
Inpatient treatment provides around-the-clock care in a residential facility for approximately 30-90 days. During inpatient treatment, individuals have limited access to the outside world so that they can focus solely on healing and recovery. Outpatient treatment is also available and is preferred by people who wish to continue their usual daily schedules and life activities, such as working, going to school, and caring for loved ones.
Treatment for addiction to Dilaudid and alcohol on an inpatient or outpatient basis may include a combination of the following:
- Medically assisted detox
- Medications to reduce cravings and prevent relapse
- Individual counseling and therapy
- Group/family counseling and therapy
- 12-step programs/support groups
- Cognitive behavioral therapy (CBT)
- Motivational incentives
- Community reinforcement
- Dialectical behavioral therapy (DBT)
- Art/recreation therapy
- Relapse prevention
Hotline to Call
Please call us if you need information about treatment for addiction to Dilaudid or alcohol for yourself or for a loved one.
- National Institute on Alcohol Abuse and Alcoholism. (1995). Alcohol-Medication Interactions. Alcohol Alert, No. 27, PH355.
- National Institutes of Health. (2014). Hydromorphone.
- United States Food and Drug Administration. (2007). Dilaudid Oral Liquid and Dilaudid Tablets.
- National Institutes of Health. (2013). Opiate Withdrawal.
- National Institute on Drug Abuse. (2005). Principles of Drug Addiction Treatment: A Research-Based Guide.
- Holder, H.D. (1992). “Effects of Alcohol, Alone and in Combination with Medications.” Walnut Creek, CA: Prevention Research Center, 1992 as cited in National Institute on Alcohol Abuse and Alcoholism (1995). Alcohol Alert.
- National Institute of Drug Abuse. (2005). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).