Opioid Medication Strength: A Comparison
When prescription painkillers were marketed to the public in 1996, they were deemed safe and powerful to help those with both acute and chronic pain. Doctors and pharmaceutical companies didn’t anticipate the risk of chronic addiction that would ensue after use of these opioid medications. Due to the misrepresentation of opioids risks, prescriptions were being written and filled at an alarming rate for chronic pain treatment. The result of overprescribing opioid pain killers has led to an increasingly devastating number of people who became dependent on these medications, leading millions to addiction, and even fatalities from overdose. In response to the opioid crisis, recovery services developed treatment plans for those suffering from opioid use disorder.
This list shows the most commonly prescribed opioid medications ranked from strongest to weakest:
Fentanyl
About 50 to 100 times stronger than morphine, this opioid is the cause of many newer overdose deaths as it is being sold illicitly on the street and mixed with heroin, cocaine, and methamphetamine in fatal doses. The DEA has highlighted fentanyl’s increased presence in counterfeit pills and the associated significant risk of overdose deaths.
Heroin
This is an illicit opiate drug classified as a **Schedule I substance with a very high potential for dependency. It is not used medically or prescribed. It’s about two to five times stronger than morphine on average and can be mixed with extremely potent substances like fentanyl or carfentanil. Heroin was responsible for nearly 15,000 overdose deaths in 2018.
Hydromorphone
Used to treat moderate to severe pain while being up to eight times stronger than morphine, available as an injection, tablet, liquid, or suppository.
Oxymorphone
An extended-release opioid medication that is often sold on the black market even though it is prescribed to treat moderate to severe pain in patients who no longer respond to the effects of other pain medications. It is about ten times stronger than morphine when injected.
Methadone
An FDA-approved medication used to treat opioid addiction through medication-assisted treatment (MAT), is about three times stronger than morphine. It’s helpful in the long-term maintenance for people with opioid use disorder and is dispensed under medical supervision.
OxyContin
The brand name for the drug Oxycodone and is available in an extended-release form of opioid. It’s used to treat moderate to severe pain and is about 50 percent stronger than morphine. It was in the past a leading cause of overdose deaths among those with opioid use disorder.
Percocet
A drug that is a combination of oxycodone and acetaminophen in tablet, liquid oral solution, and capsule form and is prescribed to people after surgery or for acute severe pain.
Morphine
Brand names include MS Contin and Duramorph, morphine is used as pain-management for those with cancer or terminal illness. It is also used for relief of severe acute pain, and is available in tablets, capsules, suppositories, and injectable liquid.
Hydrocodone
It’s prescribed under many brand names such as Vicodin, Norco, and others, and is commonly prescribed for pain management after surgery, injury, or chronic pain sufferers. It comes in pill or syrup form and is about the same strength as morphine, and is often combined with other pain relievers like ibuprofen or acetaminophen.
Codeine
A fairly short-acting opiate that treats moderate pain that is commonly prescribed with aspirin or acetaminophen. It comes in tablet, capsule, and liquid form and is frequently sold illegally on the black market.
Demerol
Also known as meperidine, this drug was withdrawn from the United States market in 2010. Meperidine is an opioid that is used to treat moderate to severe pain. It’s about ten times less potent than morphine. It comes as an injectable solution, tablet, or oral liquid.
Tramadol
With about a tenth of the potency of morphine, the drug, sometimes called Ultram, is often used to relieve moderate to moderately severe pain and is legally marked as a **Schedule IV substance.
*According to the US Dept. of Justice Drug Enforcement Division (DEA), Section 812 of the Controlled Substances Act (21 U.S.C. §801 et seq.) (CSA) lists substances which were controlled in 1970 when the CSA was enacted. Since then many substances have been added, removed, or transferred from one schedule to another.
Drugs and other substances that are considered controlled substances under the Controlled Substances Act (CSA) are divided into five schedules. Substances are placed in their respective schedules based on whether they have a currently accepted medical use in treatment in the United States, their relative misuse potential, and likelihood of causing dependence when misused.
**Schedule I Controlled Substances: Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for misuse.
**Schedule IV Controlled Substances: Substances in this schedule have a low potential for misuse relative to substances in Schedule III.
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Those who feel they may be dependent or addicted to any of these opioid substances, whether they were prescribed or obtained illicitly, are strongly advised to seek medical treatment at a local recovery services clinic.
