If you’re a fan of police procedurals, you might recall an episode of the television show Criminal Minds where one of the main characters, Dr. Spencer Reid, is held captive and tortured by a serial killer. The killer forcibly injects him with the narcotic painkiller Dilaudid over the course of two days, during which time Dr. Reid has a seizure and nearly dies. After he’s rescued, Reid begins acting erratically, having mood swings during which he suddenly becomes angry or paranoid. Of course, being a television show, once he’s confronted by his coworkers it doesn’t take long for him to seek help and get clean. But what is Dilaudid, and is its portrayal in the show accurate?
Dilaudid is a brand name for the medication hydromorphone, part of a group of drugs called narcotic analgesics. It comes in liquid and tablet form, and as extended-release tablets, and it’s used to relieve moderate to severe pain in opioid-tolerant patients who need around-the-clock pain relief for an extended period of time. The extended release version is typically taken once a day, and the other forms no more than every six hours. It’s habit forming with extended use, and withdrawal symptoms include restlessness, teary eyes, runny nose, yawning, sweating, chills, hair standing on end, muscle or joint pain, widening of the pupils, irritability, anxiety, backache, weakness, stomach cramps, difficulty falling asleep or staying asleep, nausea, loss of appetite, vomiting, diarrhea, fast breathing, and fast heartbeat.
It is possible to overdose on hydromorphone. Some symptoms of overdose include slowed or stopped breathing, sleepiness, muscle weakness, cold and clammy skin, narrowing or widening of the pupils, slowed or stopped heartbeat, dizziness, fainting, and coma. Overdoses can be reversed with naloxone.
So, it’s true that Dilaudid is an addictive drug, and Reid’s near-death experience – most likely an overdose, or at the least a dangerously high dose – was certainly possible. Withdrawal would explain his irritability, paranoia, and other mood problems. But is it really possible to become addicted to a drug over the course of two days? Studies have shown that doctors who limit the supply of opioids they prescribe to three days or less may help patients avoid the dangers of addiction. There is also evidence that, among patients with cancer, a single day’s dose of a narcotic painkiller can result in six percent of those patients being on an opioid a year later.
Clearly, the first days are the most important when it comes to the potential for abuse and addiction, and that’s just for people who are taking medications as directed. In the show, Reid was injected many times over the course of two days, although we don’t know the exact number or what the dosage was. Still, it seems entirely within the realm of possibility that he could have developed a dependence in that time.
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