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Fentanyl vs. Dilaudid – Which Drug Is Stronger?

Fentanyl and Dilaudid are both highly potent opioid pain relievers. They are intended to be used in medical settings for people who have long-term severe chronic pain that needs to be managed. Both medications are designated by the Drug Enforcement Agency as Schedule II controlled drugs.

Both fentanyl and Dilaudid work by stimulating nerve receptors in the brain that increase tolerance to pain and reduce the perception of pain. This is how all opioid pain relievers work, and this is why they are so effective at reducing pain.

Dilaudid Basics

Dilaudid is comprised of hydromorphone hydrochloride. It is used for the management of acute pain, such as pain related to surgery, and moderate chronic pain, such as that experienced by cancer patients.

Dilaudid is offered in various dosage forms that includes pills, extended-release pills, suppositories, and a liquid.

Fentanyl Basics

Fentanyl is a synthetic opioid narcotic that is approximately 50 to 100 times stronger than morphine, according to the National Institute on Drug Abuse. The medication is sometimes used to treat chronic pain in patients who have developed a tolerance to other opioid drugs.

It is available as a transdermal patch to be applied to the skin and a transmucosal form as well as an injectable. Other forms include lozenges, mouth sprays, nasal sprays, or buccal tablets.

Fentanyl may be sold under the brand names Duragesic, Actiq, Sublimaze, Subsys, or Abstral. The fentanyl patch is often used to manage severe chronic pain, such as with cancer or hospice patients. The transmucosal form is offered as a nasal spray or lollipop.

What Are the Similarities and Differences Between Fentanyl and Dilaudid?

The side effects of both drugs are similar, and they work in similar ways within the body. They can both be addictive, so both medications are controlled substances.

The following side effects may occur with both fentanyl and Dilaudid:

  • Dizziness
  • Drowsiness
  • Headache
  • Constipation
  • Itching
  • Rash
  • Loss of appetite
  • Respiratory depression

Dilaudid’s side effects also include sweating and flushing.

drug addiction

Some side effects from fentanyl are different than those associated with Dilaudid.

  • Muscle tension
  • Depressed heart rate
  • Anxiety
  • Depression
  • Confusion
  • Dry mouth
  • Abdominal pain
  • Hallucinations
  • Euphoria

Because both fentanyl and Dilaudid are powerful opiate drugs that can cause tolerance and dependency, both carry the potential of withdrawal when the medications are stopped. Withdrawal happens when the body has become acclimated to having the medication and experiences a reaction when the medication is no longer present.

Symptoms of withdrawal from fentanyl and Dilaudid are similar.

  • Nausea
  • Vomiting
  • Diarrhea
  • Muscle pain
  • Muscle spasms
  • Coughing
  • Nasal discharge
  • Sweating
  • Yawning
  • Tearfulness

Why Is One Medication Used Over the Other?

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The choice between using fentanyl or Dilaudid will largely depend on the condition the medication is indicated for and the severity of the associated symptoms. Doctors and patients must consider many factors when deciding on the best option for pain management.

The choice of medication may depend on how severe the pain symptoms are, whether the patient is able to tolerate oral or injectable delivery, and the patient’s individual medical history and previous medication use. Both medications come with the risk of respiratory depression, death from overdose, tolerance, dependency and addiction, and driving impairment.

The Benefits and Drawbacks of Fentanyl Use

Fentanyl is stronger than Dilaudid and should only be used in cases of severe pain when other forms of pain relief have not been successful. This could happen if a patient has developed a tolerance to other opioid medications and they are no longer effective.

Because it comes in several different forms, patients have several options for how to take fentanyl. This can be beneficial for patients with pain conditions that prevent certain methods of delivery. The options allow them to work with their doctor to find a method of delivery that works best for them.

While the fentanyl patch is good for long-term chronic pain management as well as for patients who may not be able to use other forms of delivery, this method is not fast-acting. Therefore, the patch is not necessarily the best delivery method for acute episodes of pain. Some of the benefits of the patch are that it provides good long-term pain relief and can reduce the number of medication dosages a patient has to take throughout the day.

Fentanyl is a powerful medication and can be dangerous when not used as directed under a doctor’s care. Even people using the medication as directed can develop a tolerance to the drug, and they may seek out higher dosages as tolerance develops. Patients can easily overdose if they are not careful to take the medication as prescribed.

Fentanyl should not be used by people with respiratory conditions, such as asthma or chronic obstructive pulmonary disease, or those with slow heart rates. Fentanyl can cause respiratory depression and increase the risk of overdose or death in these cases.

The Benefits and Drawbacks of Dilaudid Use

Dilaudid is used to treat moderate to severe pain. This medication works faster and is about two to eight times more potent than morphine. However, the effects of the drug don’t last as long and cause greater sedation.

Dilaudid is also available in a cheaper generic form, making the medication more appealing when cost is a factor. This medication may be a better choice in cases where a quick-acting pain reliever is needed and when a patient has a lower tolerance to opioids.

There are some drawbacks of Dilaudid that should be considered. The medication can cause constipation when used long term and can be dangerous when mixed with other substances, such as alcohol or muscle relaxers. Dilaudid can be addictive, and overdose can be fatal if respiratory depression is triggered.

drowsy woman

How Can You Tell if Someone Is on Fentanyl or Dilaudid?

The signs and symptoms of a person on fentanyl or Dilaudid will be similar, but they may also have different individual responses depending on how much of a tolerance to the drug each person has. Some signs that a person may be on fentanyl or Dilaudid are:

  • Oversedation
  • Drowsiness
  • Exhilarated behavior

Which Drug Is More Commonly Used?

There is some evidence that the use of fentanyl and Dilaudid has increased since 2011 based on emergency department visits related to the drugs.

A case study from the Western Journal of Emergency Medicine found that morphine was still the most commonly used intravenous opioid drug in hospitals, but the use of Dilaudid had increased dramatically. Dilaudid use rose from 27.5 percent to 42.9 percent of total opioid use, while fentanyl increased only slightly, from 3.6 percent to 4.3 percent.

What Are the Dangers of Illicit Use?

Fentanyl has quickly become implicated as a major contributor to the opioid overdose crisis in the United States. Over 130 people a day die in the U.S. from opioid overdoses, indicating a serious national crisis that has dramatically escalated in the past few years.

The Centers for Disease Control estimates that opioid addiction and misuse costs the U.S. approximately $78.5 billion every year. This includes the cost of health care, addiction treatment, law enforcement costs, lost economic productivity, and emergency services.

Fentanyl can be illegally manufactured in illicit drug markets and has been imported from overseas markets into the U.S. illegal drug trade. This influx of a cheap synthetic substance has allowed drug dealers to cut heroin, cocaine, or other drug supplies with fentanyl, creating a powerfully addictive substance that has proven deadly to unsuspecting consumers.

Dilaudid has also been diverted to illegal street markets, making it a serious concern for public health and law enforcement officials. The DEA reports that the main sources of illicit Dilaudid use are forged prescriptions, doctor shopping, diversion by pharmacists and doctors, and robberies of pharmacies and nursing facilities.

An estimated 18,224 emergency room visits resulted from nonmedical use of Dilaudid in 2011.

Both fentanyl and Dilaudid are powerful drugs with a high potential for abuse and addiction.  They should always be used under the supervision of a medical doctor and taken only as prescribed.

While fentanyl is a more potent form of opiate pain relief, Dilaudid also carries risks. When misused, both medications carry the risk of death via overdose.

Both Dilaudid and fentanyl will cause dependency if used long term. They should only be used when absolutely necessary to control pain associated with acute or chronic conditions.

These medications can be a great source of relief for those who suffer from chronic pain or have other painful illnesses, but recreational use of these drugs is very dangerous.


Drug Scheduling. Drug Enforcement Administration.

Fentanyl. (June 2016). National Institute on Drug Abuse.

Fentanyl. Drug Enforcement Administration.

Hydromorphone. Drug Enforcement Administration.

Hydromorphone. (July 2013). Drug Enforcement Administration Office of Diversion Control.

Opioid Overdose. Centers for Disease Control.

Over Overdose Crisis. (January 2019) National Institute on Drug Abuse.

The Changing Use of Intravenous Opioids in an Emergency Department. (December 2015). Western Journal of Emergency Medicine.

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