Hydromorphone use for acute pain: Misconceptions, controversies, and risks

Maryann Mazer-Amirshahi, PharmD, MD, MPH; Sergey Motov, MD; Lewis S. Nelson, MD

doi:10.5055/jom.2018.0430

Authors

Maryann Mazer-Amirshahi, PharmD, MD, MPH
Sergey Motov, MD
Lewis S. Nelson, MD

DOI:

https://doi.org/10.5055/jom.2018.0430

Keywords:

HM, ED

Abstract

Hydromorphone (HM) is a potent opioid analgesic that is commonly administered in the emergency department (ED) and other acute care settings, such as medical surgical wards. In recent years, there has been a significant increase in the ED administration of HM relative to other opioids. Although HM is an effective analgesic, its use has been commonly implicated in adverse drug events and medication errors. In addition, intravenous HM has potent euphoric effects that may contribute to its abuse liability. There are limited data regarding how acute parenteral administration of opioid analgesics in the setting of high rates of preexisting chronic opioid use (medical or nonmedical) may contribute to or reinforce addictive behavior, making the potential contribution of rising HM administration to subsequent prescription opioid abuse and overdose uncertain. This review addresses the pharmacology of HM, recommended dosing, its efficacy for acute pain, as well as its tolerability, safety, and abuse profiles. Controversies and strategies for appropriate use of this medication are also described.

Author Biographies

Maryann Mazer-Amirshahi, PharmD, MD, MPH

Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC

Sergey Motov, MD

Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York

Lewis S. Nelson, MD

Department of Emergency Medicine, Rutgers New Jersey School of Medicine, Newark New Jersey

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