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Dilaudid vs. Morphine: Which Is Best for Pain?

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Nov 22, 2023 • 10 cited sources

Dilaudid and morphine are opioid painkillers. Doctors use these tools for patients experiencing pain ranging from moderate to severe. Dilaudid is the stronger drug, but both of these medications can trigger misuse, withdrawal symptoms and opioid use disorder (OUD). 

This table can help you understand both drugs at a glance:[1,2]

What is it? Opioid painkillerOpioid painkiller 
Common side effects Lightheadedness, dizziness, sedation, nausea, vomiting, sweating, dysphoria, euphoria and dry mouth Constipation, nausea, sedation, lightheadedness, dizziness, vomiting and sweating 
Withdrawal symptomsRestlessness, watery eyes, runny nose, yawning, perspiration and chillsRestlessness, watery eyes, runny nose, yawning, perspiration and chills 
WarningsLife-threatening respiratory depression, adrenal insufficiency and high blood pressureLife-threatening respiratory depression, adrenal insufficiency and high blood pressure
BenefitsPowerful painkiller; available as tablets and oral solutions Multiple strengths and formats available 
Drawbacks High risk of misuse and OUD High risk of misuse and OUD 

What Is Dilaudid?

Dilaudid is a prescription painkiller. This brand-name drug contains hydromorphone, a potent opioid that works quickly.[3]

The generic form of Dilaudid is simple hydromorphone. Liquid and tablet forms exist, and they’re all made for oral use. Street names for this drug include D, dillies, dust, footballs, juice and smack.[3]

Doctors rarely use Dilaudid as the first step in pain management. Hydromorphone is much stronger than morphine.[3] Treatment teams typically start with a weaker opioid (like morphine). If that doesn’t work, they escalate to something stronger. 

Dilaudid is considered dangerous as people can crush the tablets, mix them with water and inject the solution as a heroin substitute.[3] Anyone with a prescription for this drug is watched very closely for signs of misuse. It may be hard to get refills because of this misuse potential. 

People who use Dilaudid for long periods can develop physical dependence. Quit using the drug abruptly, and you can develop withdrawal symptoms like restlessness, watery eyes, runny nose, yawning, perspiration and chills.[1] 

For some people, these symptoms are strong enough to spark a return to drug misuse. People return to misuse simply to make the discomfort go away. 

What Is Morphine?

Morphine is a synthetic narcotic derived from opium. Within the United States, a small amount of morphine is used as a morphine-only product. The rest is processed into codeine and other opioid drugs.[4]

Brand-name medications that include morphine include MS Contin, Roxanol and Kadin. Street names include dreamer, emsel, first line, God’s drug and mister blue.[4]

Morphine comes in plenty of formats, including pills, tablets, liquids and more. Some medications combine morphine with other elements, such as acetaminophen. You may be taking a medication with morphine without knowing it. 

As a weaker opioid, morphine is typically used for mild or moderate pain. This type of problem typically fades as your body heals. It’s rare to take morphine for long periods. But if you use the drug for a long time, you can develop physical dependence. 

If you develop physical dependence, you can develop withdrawal symptoms when you quit abruptly. Those symptoms include restlessness, watery eyes, runny nose, yawning, perspiration and chills.[2]

What’s the Difference Between the Two Prescription Opioids?

Dilaudid and morphine are opioid painkillers. They are within the same class. But important differences separate them. Here’s what you need to know: 


Dilaudid is the stronger of the two medications. Researchers say it’s between two and eight times stronger than morphine.[3] 

Since Dilaudid is the more powerful medication, it’s rarely the first choice for pain. Doctors may start with morphine first and then switch to Dilaudid if you’re still uncomfortable. They always prefer to keep patients on the less potent substance due to risks of misuse, OUD and other side effects.

Onset of Action 

It’s hard to perform direct comparisons in the onset of action of Dilaudid and morphine. But researchers say hydromorphone has a rapid onset of action.[3] Take both pills, and Dilaudid will likely work faster. 

However some forms of morphine are injectable, so doctors can put the medication directly into the bloodstream. These medications likely work faster than oral versions. 

Duration of Effects 

Researchers measure how long a drug lasts with a tool known as the half-life. When four to five of these periods pass, the drug is rendered inactive. 

Hydromorphone have a half-life of about 2.3 hours.[1] Morphine has a half-life of about two hours.[2] These two medications last for a very similar amount of time, but Dilaudid lasts a little longer. 


The brand-name formulation of Dilaudid is only available in oral formats. Both tablets and liquid are available, but they’re made to enter the body through the digestive system. 

Morphine is a versatile substance that’s available in multiple formats, including both oral and injectable forms.[4]

Side Effects 

Opioids cause a similar set of side effects, no matter what type doctors choose. They include lightheadedness, dizziness, sedation, nausea, vomiting, sweating, dysphoria, euphoria and dry mouth.[1] 

Side effect severity tends to vary by drug strength. Since Dilaudid is the more powerful drug, it can cause severe side effects.

Medical Use 

Opioids like Dilaudid and morphine are used for pain control. Morphine is versatile and included in several different medications, including some designed for cough control. Dilaudid is only used for pain control. 

Is Dilaudid Stronger Than Morphine?

Yes, Dilaudid is much stronger than morphine. Since researchers say that hydromorphone (the active ingredient in Dilaudid) is two to eight times stronger than morphine, it’s a much more intense drug.[3]

If you’re using morphine, you can’t simply switch to Dilaudid. These two medications are very different, and you should consult with a doctor about the switch. And if you’re using Dilaudid, switching to morphine can lead to withdrawal symptoms. 

What Is the Potential for Opioid Misuse?

Dilaudid and morphine are opioid-based drugs that come with a high potential for misuse. Even people who never thought they would misuse drugs can develop significant problems when they take these drugs. 

Dilaudid’s hydromorphone has a high potential for misuse, which is similar to that seen in other potent opioid drugs.[1] Morphine comes with similar risks, as it’s also an opioid.[5] 

Experts say that morphine is sought by drug users, including those with OUD.[5] Dilaudid is also sought out by drug users, as they can crush their pills and inject them.[1]

Opioid drugs like Dilaudid and morphine cause physical dependence. Withdrawal symptoms are caused by physical dependence.[6] Your brain and body are accustomed to the drug, and they can react when it’s not available. 

OUD, or addiction, is separate from physical dependence. People who are addicted to a drug will keep using the medication despite the consequences. They have a psychological attachment to the drug that is very hard to break. Opioids like Dilaudid and morphine can cause this issue too. 

How Misuse & OUD Are Best Treated

Physical dependence is best treated with Medication for Addiction Treatment (MAT) programs. Doctors use therapies like Suboxone to ease chemical imbalances.[7] 

The buprenorphine in Suboxone loosely latches to opioid receptors within the brain, easing withdrawal symptoms.[8-10] People can get sober without feeling sick. 

OUD is also treated with MAT. After people are sober, they keep using Suboxone to lessen drug cravings. The continued participation in MAT helps people build sober skills and create a healthy lifestyle. 

Bicycle Health offers MAT via telemedicine. Visit experts in a video appointment, and pick up your Suboxone at a local pharmacy. 

You can combat drug misuse in the privacy of your own home. And know you’re getting expert help no matter where you live. Contact us to find out if this model is right for you. 

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

  1. Dilaudid prescribing information. U.S. Food and Drug Administration. Published March 2021. Accessed October 24, 2023.,019892s037lbl.pdf
  2. Morphine sulfate tablets prescribing information. U.S. Food and Drug Administration. Published March 2021. Accessed October 24, 2023.
  3. Hydromorphone. United States Drug Enforcement Administration. Accessed October 24, 2023.
  4. Morphine. United States Drug Enforcement Administration. Published April 2020. Accessed October 24, 2023.
  5. Morphine sulfate injection prescribing information. U.S. Food and Drug Administration. Published November 2011. Accessed October 24, 2023.
  6. Dilaudid oral liquid and Dilaudid tablets. U.S. Food and Drug Administration. Accessed October 24, 2023. 
  7. Velander JR. Suboxone: Rationale, science, misconceptions. The Ochsner Journal. 2018;18(1):23-29. 
  8. Shulman M, Wai JM, Nunes EV. Buprenorphine treatment for opioid use disorder: An overview. CNS Drugs. 2019;33(6):567-580. 
  9. Mancher M, Leshner AI. The effectiveness of medication-based treatment for opioid use disorder. Medications for Opioid Use Disorder Save Lives. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Medication-Assisted Treatment for Opioid Use Disorder; National Academies Press (US); 2019. 
  10. Martin SA, Chiodo LM, Bosse JD, Wilson A. The next stage of buprenorphine care for opioid use disorder. Annals of Internal Medicine. 2018;169(9):628. 

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