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Most people don't make the distinction at the street level but any heroin user can tell the difference. One is a very "pharmaceutical high" and the other types are a more natural. You can even taste the difference in your mouth. One is just a synthetic(the fetanyl based china white) and the other types are either "black" or "brown" tar heroin or the more usual brownish type of small rocks or powder. There are many different things used to cut these drugs on the street level. Anyways as to the effect of dilaudid. Most heroin users do prefer the IV use of dilaudid because it gives one of the most intense rushes of all the painkillers although fetanyl is very close. The only problem is that though it has a great rush when injected the overall high afterwards doesn't compare to the street drug heroin. Mind you this is for informative purposes only. I do not ever recommend ANYONE using heroin or any other illegal OR legal drug unless they need it. Just thought I would give my 13 year of experience and opinion to the matter. As far as prescription painkillers/analgesics go Dilaudid is one of the strongest but fentanyl is also. But alot of doctors will switch people around when you gain a tolerance or you aren't receiving the same benefits in pain management as before.