I'm fine with the shift away from dilaudid but I'm far from the majority who now considers it a dirty word, akin to IV heroin solely responsible for turning innocent pt's all into homeless drug seekers. It's incredible to me how quickly physicians are swayed and influenced (for right or wrong) into changing mass opinions on drugs, therapies, treatments, etc.. through concerted and coordinated efforts at reforming our practice habits at the state, hospital, CMG, employer level. We wouldn't even be having a discussion about dilaudid 10 years ago. In fact, we'd probably all feel highly pressured to GIVE IT d/t press ganey scores, pt satisfaction, etc.. Personally, I'd much rather have latitude NOT to give it than silently forced to give it more often so I'm happy with the change even if I don't exactly march to the drum. I feel that for once we've been given an element of our autonomy back in how we choose to treat pain in the ED. However, it can be equally as frustrating for me on occasion when I need to treat someone for legit pain and have additional hoops to jump through in order to given an IV narcotic/opioid. Be that as it may, I still consider our current environment preferable to how it was 10 years ago when nurses were harassing us non stop about pain scores.
I would also add from personal experience, that I had dilaudid exactly once in my life after a cervical ACDF and I just remember waking up from surgery feeling like there was a molten hot bar of metal in my neck. I've got a very high pain tolerance but this was easily a 9. I remember the nurse asking me if I needed anything for pain and I croaked "yes please". She gave an unknown amount of dilaudid..I dunno maybe 0.5 or 1mg and it felt like a crashing sea of cool water flowing over my face and neck and dulling the pain to a very tolerable 4 or 5. I was able to drift off to sleep for awhile and I don't remember ever feeling any sort of euphoria. The stuff works when used appropriately. I can't speak about morphine because I've never had it.