Treatment, Dilaudid (hydromorphone) is quick and very effective. It is five times more effective than morphine and a good choice for emergency department pain management, where Dilaudid (hydromorphone) has been shown to reduce pain scores from pretreatment to post-treatment by 70% in clinical trials. When given IM, it works in about 10 minutes, but with the oral form, it does have a longer duration. Dosing is: 0.5-1mg IV every 15 minutes and titrate to pain level (but keep titration with the previous tolerance). Contraindications: Potential for delirium in pediatric patients (it is rarely used under 6 years of age) or potential for hyperalgesia (be very cautious with titration or increase/discontinue dosing). Adrenal insufficiency is possible with long-term users; have to check cortisol level for those. Cytochrome: CYP2D6 poor metabolizers may accumulate in excess of amount (genotype for excess use). We can now refill through e-commerce websites for an option for patients that can’t leave home, however, Europol has reported that 80% of the total illicit trafficking traffic is opioids. To ground the ethical background of obtaining prescriptions, do try to use portals that can potentially be audited to track who obtains. If a patient already buy Dilaudid online, make sure it is from an online store that is also administered to or through a tracked batch process, alerts for allergies, etc.
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