In the following post, I will refer to hydromorphone by its alternate name, Dilaudid. This was originally not only a "brand" product name, but a general non chemical name for hydromorphone; much like Dicodid is for hydrocodone; Dionine is for ethylmorphine; Numorphan is for oxymorphone; Paramorphan is for dihydromorphine; and Dromoran is for morphanol (racemorphan).
Research has demonstrated its potency. And in some respects, its superiority, to morphine.
Every 8mg of Dilaudid you inject equates to roughly 50mg of IV morphine in analgesic effect. Dilaudid however, causes a greater ratio of euphoria to analgesia by the parenteral routes - While the drug is 6.6x stronger than morphine as a painkiller, hydromorphone is 10x stronger than morphine in euphoric effect when taken in equianalgesic doses. So while every 8mg Dilaudid equates to 50mg morphine in painkilling, it equates to around 80mg of morphine in subjective effects (such as euphoria, anxiolysis, excitement). Again, this applies to the IV route. Not orally.
12mg of IV dilaudid is as effective as 78mg of morphine in relieving pain; and as euphoric & narcotic as a whopping 120mg morphine.
Experience has shown that physical dependence with hydromorphone is marked after 2 weeks of regular use. The opioid withdrawal syndrome generally comes on rapidly and is more intense than that of morphine, but shorter in duration.
In a study of five morphine addicts, morphine dependence was satisfied with hydromorphone (six times daily), at about 1/7th the dose of morphine. It was concluded that the "addiction sustaining action" of hydromorphone is seven times greater than that of morphine.
In a 1930's study in morphine addicts, 90mg of hydromorphone per day effectively substituted for 340mg morphine per day. The addicts were unaware of this substitution, but all seven subjects noted that the effects of hydromorphone were stronger, and that anxiety and restlessness appeared after 3-3.5 hours post injection as opposed to 5-5.5 hours with morphine. This is not surprising, dilaudid is known for its rapid onset and offset. The effects are marked by a rapid & intense onset which is uniquely euphoric compared to other narcotics, similar in to heroin. A typical narcosis follows, which is relatively shortlived. Larger doses or poly-use with a sedative will prolong dilaudid's effect.
Hydromorphone is also superior to morphine in that it causes a lesser degree of side effects. There is less nausea & vomiting, less itching, less psychomotor impairment and less mental clouding with dilaudid. It may be more or less sedating than morphine, and similar in its tendency to produce a nod in high doses. A cleaner or more refined effect in the case of dilaudid however, may equate to its lesser degree of subjective effects when taken orally. This along with its low bioavailability and absence of a rush may explain reports of less of a high when swallowed (some debate this, citing that a state of well being is present, but subtle with dilaudid.)
Its parenteral to oral ratio is 1 to 4. With oral dilaudid, 6mg must be swallowed to match the painkilling effects of 1.5mg of IV hydromorphone or 10mg morphine; and it may require more to achieve a comparable euphorigenic effect. Dilaudid can be taken intranasally (snorted), with slightly better efficacy than oral use; every 1 mg of dilaudid which is snorted equals roughly 0.66 mg of oxymorphone, or 5 mg oxycodone, by the same route.
User Experiences With Dilaudid/Hydromorphone
(Sources include Erowid, Opiophile, Bluelight)
"Looking back, the time after that first rush is alot like a heroin high, doped up feeling, slowed breathing/heart rate, contracted pupils, feeling 'itchy' all over, and generally feeling no pain, cares, or worries at all. But that RUSH, I get a pretty good rush from a nice shot of heroin, but nothing but an overdose shot could give me anything even close to this. I also remember that temperature stopped bothering me, so I sat out on the porch to smoke a cigarette and enjoy the night time... with no shirt on, in the winter. But I didn't care, hell I was flying." (IV Hydromorphone User)
"I could already feel the overwhelming "rush" (as I now learned) half way through the shot, I pushed her home....WOW. I had to take a few deep breaths and relax, it was so intense, never felt like this before. Now even though the rush is gone, got a nice high, and I am enjoying it more then oxycodone." (IV Hydromorphone User)
"..I register dark red and push down the plunger. Just 15 seconds afterwards, I can feel something starting in my chest. At first you're not sure exactly what the feeling is, but you damn sure know SOMETHING is coming. The only way I can describe the feeling is that all your muscles tighten quickly and then immediately become completely relaxed. The feeling starts in your chest and moves throughout your whole body in a matter of seconds. The rush lasts about a minute and can only be described as heaven on earth.. I am left with a warm feeling throughout my body and a euphoria that comes in waves, especially when closing and opening the eyes (nodding). The high is similar to oxycodone, but is not nearly as sedating and hydromorphone is more euphoric in my opinion." (IV Hydromorphone User)
"I began to feel this rush, this sensation traveling all throughout my body. I welcomed this warm, pleasant sensation to reach every part of my body, relieving all tension, pain, and stress that were present beforehand. I was very pleased with this dosage, and I had wanted to voice it, however I was in just too much bliss to do so. I constantly thought to myself during this that I was peaking, only to be submerged even deeper into the opiate ocean." (Intranasal Hydromorphone User)
"Not but 3 seconds later did I get the most intense rush that took my whole body by storm. Initially, it's like every muscle in my body contracted, starting with my throat and quickly spreading to the rest of me, and then released and became completely relaxed. The 'rush' I call this lasts only 5-10 seconds or so but I find it to be the single most pleasurable drug effect I've ever felt. After the initial rush, a warm wave of pleasure took over my whole being; the day's aches and worries gone in a flash." (IV Hydromorphone User)
“The euphoria is gorgeous, as it’s a BEAUTIFUL cool spring day outside, and im using this experience doing yard sculpting, (flowers, art, etc).. I had to come in and sit down cause I kept getting the nods, nods so good I feel as though i get a few hours of sleep... I started nodding about 20 minutes after ingestion..” (Oral Hydromorphone User)