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Fentanyl vs. Dilaudid | Potency & Side Effects

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Feb 9, 2024 • 9 cited sources

Fentanyl is extremely potent, up to 100 times stronger than morphine, while Dilaudid is very strong but only about five to seven times stronger than morphine.[1] 

Both drugs have similar side effects, including respiratory depression, which can be life-threatening. Fentanyl’s higher potency makes it the riskier option, however, especially in cases of misuse or opioid use disorder (OUD). 

An overdose on either drug can be reversed if treated promptly with medications like naloxone. Because fentanyl is so strong, multiple doses may be required to reverse an overdose. Quick action is essential to prevent serious harm or death in either case.

The Differences Between Fentanyl & Dilaudid (Hydromorphone)

This table breaks down the differences between fentanyl and Dilaudid:[1-4]

PotencyExtremely potent; requires smaller dosesPotent but not as strong as fentanyl; moderate doses required
AppearanceAvailable in various forms, including patches, lozenges, tablets, nasal sprays and injectable solutionsPrimarily available as tablets or injectable forms 
CostsTypically around $50–$64 per gram $5–$100 per 4-mg tablet 
UsesUsed for severe pain management in medical settings, especially for pain after surgeries or chronic painUtilized in medical settings to manage moderate to severe pain, often in postoperative scenarios or when other pain medications are insufficient
AccessibilityControlled substance available medically; also sold on the black marketGenerally prescribed medically; controlled substance that is also found on the black market
Overdose & MisuseIn 2021, there were 70,601 overdose deaths linked to synthetic opioids, mainly fentanylIn 2021, about 1.62 million people used hydromorphone products, and roughly 190,000 individuals (0.1%) misused them

How Potent Is Fentanyl?

Fentanyl is an incredibly strong synthetic opioid used to manage severe pain. It’s estimated to be 50 to 100 times more powerful than morphine and about 50 times stronger than heroin. Even tiny amounts of fentanyl can seriously affect the body, possibly causing breathing problems and overdose, which can be fatal.[5]

Medical experts use fentanyl carefully in situations where strong pain relief is necessary, like during surgery. Fentanyl is rarely prescribed for use at home because it is so strong. 

The risks associated with fentanyl do not stop with diverted medical prescriptions. This synthetic opioid is most often made and sold on the street. It is used to cut other products like heroin, or it is molded into the shape of pills that people commonly ask for, like oxycodone. In these cases, the risks associated with its potency come from the fact that people may not even realize that they have bought or used fentanyl until it’s too late. 

Side Effects of Fentanyl

While individual responses may vary, these are common side effects of fentanyl:[5]

  • Nausea 
  • Vomiting
  • Constipation
  • Drowsiness 
  • Dizziness
  • Headache
  • Pale skin
  • Itchiness 
  • Rash
  • Excessive sweating
  • Dry mouth
  • Weakness 
  • Fatigue
  • Hypotension
  • Respiratory depression

How Potent Is Dilaudid?

Dilaudid (hydromorphone) is a strong pain-relieving opioid medication that is roughly five to seven times more powerful than morphine but nowhere near as strong as fentanyl.[6]

Doctors usually prescribe Dilaudid for the treatment of severe pain, like after surgery or for people who are living with chronic pain. The drug comes in different forms, including pills and a liquid. The drug is prescribed for use in a clinical setting as well as for home use.

Though Dilaudid is not as strong as fentanyl, it is still potent with an addictive nature and potential for misuse. Only take the drug as prescribed. Avoid mixing it with other substances, including alcohol, to decrease the risk of overdose and other ill effects. 

Side Effects of Dilaudid

Like fentanyl, Dilaudid may not affect all users in exactly the same way, but some commonly reported side effects include the following:[1] 

  • Nausea 
  • Vomiting
  • Constipation 
  • Drowsiness 
  • Dizziness
  • Stomach pain
  • Itchiness
  • Rash
  • Sweating
  • Dry mouth
  • Shallow, weak or very slow breathing
  • Respiratory depression

Is One More Dangerous Than the Other? 

Both fentanyl and Dilaudid (hydromorphone) are potent opioid medications that share similar risks, but fentanyl’s exceptional potency brings a higher level of danger. Milligram for milligram, the risks associated with even accidentally inhaling fentanyl make it far more dangerous than Dilaudid.

While Dilaudid is an opioid and deadly in its own right, fentanyl is produced on the street and commonly mixed in with other substances. This practice has triggered a surge in overdose fatalities.[5] 

Because it is sold by weight, many drug dealers will cut drugs like heroin or illicit prescription painkillers with innocuous substances to stretch a batch. Then, they mix in fentanyl, which is far cheaper, to boost its potency. Buyers get a much stronger hit than they are prepared for, and many overdose. 

While Dilaudid is also potent, it is not used in the same way that fentanyl is on the street. Nonetheless, its misuse or excessive consumption can result in significant health hazards. Similar to fentanyl, Dilaudid can induce respiratory depression, particularly when consumed in high doses or in conjunction with other depressants like alcohol.[1]  

When used outside of the bounds of a prescription, both drugs can be deadly. Both foster the development of OUD and all associated risks, including the regular risk of overdose with each use of either drug.

Are Overdoses on Fentanyl & Dilaudid Reversible?

Overdoses involving either fentanyl or Dilaudid can be fatal if untreated, but they are  reversible with prompt medical intervention. The administration of naloxone, an opioid reversal medication also known by the brand name Narcan, can effectively counteract the effects of either drug in the system and reverse the overdose.[7,8] 

In both cases, time is critical. Immediate naloxone administration and medical treatment are needed to reverse the overdose before the brain has been without oxygen for too long. If Narcan isn’t given in time, the overdose cannot be reversed, and it may be fatal. 

It’s also important to note that because fentanyl is so much stronger than Dilaudid, more than one dose of naloxone may be needed to fully stop the effect of the drug during overdose.[9] 

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. Drug fact sheet: Hydromorphone. Drug Enforcement Administration. Published April 2020. Accessed August 23, 2023.
  2. How much fentanyl is available on the darknet? Australian Institute of Criminology. Published March 2019. Accessed August 23, 2023.
  3. Hydromorphone. Drug Enforcement Administration. Published April 2023. Accessed August 23, 2023.
  4. Drug overdose death rates. National Institute on Drug Abuse. Published June 30, 2023. Accessed August 23, 2023.
  5. Fentanyl facts. Centers for Disease Control and Prevention. Published June 27, 2023. Accessed August 23, 2023.
  6. Lowe A, Hamilton M, Greenall BScPhm MHSc J, Ma J, Dhalla I, Persaud N. Fatal overdoses involving hydromorphone and morphine among inpatients: A case series. CMAJ Open. 2017;5(1):E184-E189. doi:10.9778/cmajo.20160013
  7. 5 things everyone should know about fentanyl. University of Colorado Boulder. Accessed August 23, 2023.
  8. Naloxone for opioid overdose: Life-saving science. National Institute on Drug Abuse. Published March 30, 2017. Accessed August 23, 2023. 
  9. Carpenter J, Murray BP, Atti S, Moran TP, Yancey A, Morgan B. Naloxone dosing after opioid overdose in the era of illicitly manufactured fentanyl. J Med Toxicol. 2020;16(1):41-48. doi:10.1007/s13181-019-00735-w

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