Hydromorphone and Morphine Are Not the Same Drug!

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HYDROmorphone and Morphine are not the same drug! HYDROmorphone and morphine are deemed high risk/high alert medications. An Independent Double Check (IDC) must be done to avoid errors when administering all high risk drugs. Please refer to Clinical Practice Standard 1-20-6-3-260. HYDROmorphone and morphine need to knows: HYDROmorphone is 5 times more potent than morphine! (e.g., 1 mg of HYDROmorphone PO is equivalent to 5 mg of morphine PO) When administered via the subcutaneous route, these drugs are twice as strong! Therefore when converting between oral and subcutaneous routes half the dose. (10 mg of oral morphine = 5 mg of subcutaneous morphine) HYDROmorphone and morphine: The name game. Both drugs are used in the management of moderate to severe pain. HYDROmorphone and morphine come in different brand names and formulations. HYDROmorphone = Dilaudid (Injectable), Jurnista (SR), HYDROmorph Contin (SR) Morphine = Morphine Sulphate (Injectable), MS-IR, M.O.S. (Liquid/Tablet/SR), M-Eslon (SR), Statex (Liquid/Tablet/Supp.), Doloral (Liquid), MS Contin (SR), Kadian (SR) (SR=Slow Release CAP) *As per NH, use the generic names (NOT THE BRAND NAME), of these drugs in your documentation. Common side effects: 3 ‘B’s of opioid prescribing: Common: Nausea, Vomiting, Constipation, Sedation, Syncope, Xerostomia (Dry Mouth), If your client is on an opioid: Delirium, Restlessness, Urinary Retention. Do they have a Breakthrough? Less Common: Respiratory Depression, Do they have something for Barfing? Opioid-Induced Neurotoxicity, Myoclonus, Do they have something for their Bowels? Pruritis (itching). Opioid induced neurotoxicity: What does it look like? Opioid induced neurotoxicity is the result of a build up of toxic opioid metabolites in the blood stream. Client’s who are elderly, dehydrated or with poor renal function are at higher risk. Opioid induced neurotoxicy can present with many of the following symptoms: confusion/delirium, hallucinations, a heightened sensitivity to touch or pain (allodynia/ hyperalgesia), twitching (myoclonus) and in severe cases can lead to a seizure. If you suspect your client is neurotoxic CALL THEIR DOCTOR ASAP! Reference: NH Hospice Palliative Care Program Symptom Guidelines, (2008) the northern way of caring northernhealth.ca Reference: 10-513-6033 (06/16).

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Hydromorphone
Hydromorphone WHAT IS HYDROMORPHONE? sedation, and reduced anxiety. It may also cause Hydromorphone belongs to a class of drugs mental clouding, changes in mood, nervousness, called “opioids,” which includes morphine. It and restlessness. It works centrally (in the has an analgesic potency of two to eight times brain) to reduce pain and suppress cough. greater than that of morphine and has a rapid Hydromorphone use is associated with both onset of action. physiological and psychological dependence. WHAT IS ITS ORIGIN? What is its effect on the body? Hydromorphone is legally manufactured and Hydromorphone may cause: distributed in the United States. However, • Constipation, pupillary constriction, urinary retention, users can obtain hydromorphone from nausea, vomiting, respiratory depression, dizziness, forged prescriptions, “doctor-shopping,” impaired coordination, loss of appetite, rash, slow or theft from pharmacies, and from friends and rapid heartbeat, and changes in blood pressure acquaintances. What are its overdose effects? What are the street names? Acute overdose of hydromorphone can produce: Common street names include: Severe respiratory depression, drowsiness • D, Dillies, Dust, Footballs, Juice, and Smack progressing to stupor or coma, lack of skeletal muscle tone, cold and clammy skin, constricted What does it look like? pupils, and reduction in blood pressure and heart Hydromorphone comes in: rate • Tablets, capsules, oral solutions, and injectable Severe overdose may result in death due to formulations respiratory depression. How is it abused? Which drugs cause similar effects? Users may abuse hydromorphone tablets by Drugs that have similar effects include: ingesting them. Injectable solutions, as well as • Heroin, morphine, hydrocodone, fentanyl, and tablets that have been crushed and dissolved oxycodone in a solution may be injected as a substitute for heroin.
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Do You Know... Methadone
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Hydromorphone Hydrochloride) CS-II WARNING: DILAUDID ORAL LIQUID and DILAUDID TABLETS CONTAIN HYDROMORPHONE, WHICH IS a POTENT SCHEDULE II CONTROLLED OPIOID AGONIST
DILAUDID® ORAL LIQUID and DILAUDID® TABLETS (hydromorphone hydrochloride) CS-II WARNING: DILAUDID ORAL LIQUID AND DILAUDID TABLETS CONTAIN HYDROMORPHONE, WHICH IS A POTENT SCHEDULE II CONTROLLED OPIOID AGONIST. SCHEDULE II OPIOID AGONISTS, INCLUDING MORPHINE, OXYMORPHONE, OXYCODONE, FENTANYL, AND METHADONE, HAVE THE HIGHEST POTENTIAL FOR ABUSE AND RISK OF PRODUCING RESPIRATORY DEPRESSION. ALCOHOL, OTHER OPIOIDS AND CENTRAL NERVOUS SYSTEM DEPRESSANTS (SEDATIVE-HYPNOTICS) POTENTIATE THE RESPIRATORY DEPRESSANT EFFECTS OF HYDROMORPHONE, INCREASING THE RISK OF RESPIRATORY DEPRESSION THAT MIGHT RESULT IN DEATH. DESCRIPTION Proprietary name: DILAUDID ORAL LIQUID Established name: hydromorphone hydrochloride Route of administration: ORAL (C38288) Active ingredients (moiety): hydromorphone hydrochloride (hydromorphone) # Strength Form Inactive ingredients 1 5 MILLIGRAM LIQUID purified water, methylparaben, propylparaben, sucrose, glycerin, sodium (C42953) metabisulfite Proprietary name: DILAUDID TABLETS Established name: hydromorphone hydrochloride Route of administration: ORAL (C38288) Active ingredients (moiety): hydromorphone hydrochloride (hydromorphone) # Strength Form Inactive ingredients 1 2 MILLIGRAM TABLET D&C red #30 Lake dye, D&C yellow #10 Lake dye, lactose, magnesium (C42998) stearate, sodium metabisulfite 2 4 MILLIGRAM TABLET D&C yellow #10 Lake dye, lactose, magnesium stearate, sodium metabisulfite (C42998) 3 8 MILLIGRAM TABLET lactose anhydrous, magnesium stearate, sodium metabisulfite (C42998) DILAUDID (hydromorphone hydrochloride), a hydrogenated ketone of morphine, is an opioid analgesic. The chemical name of DILAUDID (hydromorphone hydrochloride) is 4,5α-epoxy-3- hydroxy-17-methylmorphinan-6-one hydrochloride. The structural formula is: M.W. 321.8 Each 5 mL (1 teaspoon) of DILAUDID ORAL LIQUID contains 5 mg of hydromorphone hydrochloride. In addition, other ingredients include purified water, methylparaben, propylparaben, sucrose, and glycerin. DILAUDID ORAL LIQUID may contain traces of sodium metabisulfite.
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Hydromorphone Hydrochloride) C-II
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Federal Register/Vol. 85, No. 230/Monday, November 30, 2020
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Urine Drug Screening
Urine drug screening Urine drug screens (UDS) are a valuable tool in our management of patients on chronic opioid therapy, however, the results can be misleading and clinical judgment is needed in interpreting results. The basic, initial UDS most clinicians use is usually done by immunoassay. It can identify drugs present in the urine by class (e.g. opioids, benzodiazepines, amphetamines). Immunoassay UDS will give positive results for both a drug being taken and for its metabolites. Codeine, for example, is metabolized to hydrocodone or morphine and then to dihydrocodeine and hydromorphone. Heroin is metabolized to morphine. All of these will be identified as opiates on the basic UDS. Oxycodone is metabolized to oxymorphone; these will be identified as oxycodone on immunoassay UDS. It is therefore important to consider drug metabolism in interpreting UDS test results: hydromorphone may be detected in a patient on morphine hydrocodone may be detected in a patient taking codeine oxymorphone may be the only drug detected in a patient on oxycodone since it is a long lasting metabolite morphine may be the only drug detected in a heroin user. When a basic urine drug screen gives results that do not fit or which cannot be explained, it is a good idea to send the sample for confirmatory testing. This testing is usually done by gas chromatography- mass spectrometry (GC/MS) and will provide more sensitive and specific results. Drug Detection Times (since last use): Drug or Class Detection Time Alcohol 6 - 12 hours Amphetamine or methamphetamine 48 hours Barbiturates, short acting 24 hours Barbiturates, long acting 3 weeks Benzodiazepines, short acting 3 days Benzodiazepines, long acting 30 days Cocaine 2 – 4 days Marijuana, single use 3 days Marijuana, daily use 2 weeks Codeine 48 hours Heroin 2 – 4 days Hydromorphone 2 – 4 days Methadone 3 days Morphine 2 – 3 days Oxycodone 2 – 4 days Detection of drugs can also be affected by other factors.
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