Hydromorphone is a highly potent semi-synthetic opioid that is utilized to treat moderate-to-severe acute and chronic pain, both malignant and non-malignant. It is a derivative of morphine, but it differs by being metabolized mainly into hydromorphone-3-glucuronide. Hydromorphone is a relatively quick-acting drug with a short half-life, and its main dosage forms include oral tablets, injections, intravenous (IV), and suppositories. The efficacy of hydromorphone compared to morphine and oxycodone has been mixed, with generally no significant difference between the medications being found. Hydromorphone has become a popular choice for patient-controlled analgesia postoperatively. Special populations to be considered when prescribing hydromorphone include patients with renal impairment, pediatric patients, and pregnant patients, with research limited in the latter two populations. Further research is warranted in special populations, including pregnant and pediatric populations, including its best practice role in acute and chronic pain management.