An increasing number of those who are addicted to opioids are encountering more potent and lethal drugs. Therefore, the resulting death rates related to overdoses continue to rise despite years of warnings and attempts by health professionals and experts to intervene.
For this reason, we have compiled a list of opioids strongest to weakest in an effort to help people understand which drugs are the riskiest and have the highest potential for life-threatening complications when abused.
Carfentanil is an extremely powerful analgesic 10,000 times stronger than morphine that is only indicated for use on large animals such as horses and elephants. Just two milligrams is enough to sedate an animal of this size. As such, it is not intended for humans, and there is no known safe dosage.
In recent years, illicitly produced carfentanil has been found as a buffering agent in heroin and other drugs. As a result, hundreds of deaths in the state of Ohio alone have been related to its unintentional use. It is believed that if bare skin touches even a small amount of carfentanil, severe complications can occur, including death.
In 2018, the Food and Drug Administration (FDA) approved Dsuvia, a relatively new prescription painkiller. The drug comes in the form of a sublingual (under the tongue) tablet that is used to rapidly relieve pain in those who have experienced profound trauma, such as particularly painful broken bones, severe burns, or gunshot wounds.
Dsuvia contains the fully synthetic opioid sufentanil, which is 5-10 times stronger than Fentanyl itself, and 1,000 times more powerful than morphine. Critics of this medication state that an opioid of this strength is unnecessary and will only serve to further the ongoing opioid overdose epidemic in the U.S.
Fentanyl is a synthetic opioid that may be up to 50 times stronger than heroin. Legally, Fentanyl can be found as a prescription drug (e.g., Duragesic) that is sometimes used to manage severe pain related to surgery or injury. It may also be prescribed to individuals who suffer from chronic pain who do not respond well to weaker opioids or have developed a tolerance to them.
Due to its high potency and potential for dependence and addiction, Fentanyl is classified by the Drug Enforcement Administration (DEA) as a schedule II drug and is considered to be extremely dangerous and lethal. A mere two-milligram dose of Fentanyl may be enough to kill a full-grown human.
Heroin is an illicit, schedule I semi-synthetic opiate derived from morphine, an opium alkaloid, and as such, is not considered to have any legitimate medical purpose. Heroin’s potency may also be profoundly affected by other adulterants, which may include Fentanyl, carfentanil, or other opioids.
Heroin has an exceptionally high potential for abuse, dependence, and addiction and can be delivered into the body by injecting, smoking, or snorting. It is most often found as a whitish powder or sometimes as a black tacky substance known as black tar heroin. When injected, heroin reaches the brain and bloodstream more rapidly than many other opioids where it converts back to morphine and induces near-immediate effects, including a rush of euphoria.
Buprenorphine (e.g., Suboxone) is a drug that is most commonly used to treat opioid addiction, and some may be surprised to discover that it is forty times more potent than morphine. For these reasons, among others, it is highly controlled. However, as a partial opioid agonist, buprenorphine does not produce the powerful analgesic or euphoric effects that other opioids can. For this reason, it is sometimes used for the treatment of pain as a safer alternative to oxycodone and other more potent opioids.
#6. U-47700 or Pink
U-47700 (also known as Pink) is an illegal synthetic opioid about 7-8 times stronger than morphine. In recent years, this drug has become widely available on the black market, and due to its high potency and lack of government regulation, it has concerned health officials as overdoses have steadily continued to increase.
Hydromorphone (e.g., Dilaudid) is another prescription opioid roughly four times more powerful than morphine. Due to its high potential for abuse and physical dependence, hydromorphone is classified by the DEA as a schedule II drug. It has been frequently used as a heroin substitute because it can be readily diluted in liquid and injected directly into the bloodstream, a method of administration that helps the user to feel its effects more rapidly.
Oxymorphone is also a Schedule II substance and prescription painkiller around three times stronger than morphine. It used to be manufactured by Endo International under the brand name Opana and was indicated to treat moderate-severe pain. It was usually found in tablet form but also sometimes as an injectable solution.
Currently, oxymorphone’s presence in the legal or illicit drug market appears to be scant, as Opana’s maker announced in the summer of 2017 that it would remove Opana ER from the drug market, following the FDA’s request to do such.
Methadone is a fully-synthetic opioid with a similar potency as oxymorphone. It is primarily used under strict medical supervision to treat addiction and withdrawal symptoms related to other opioids such as heroin, and non-medical use is illegal. Although methadone is chemically dissimilar to heroin and morphine in some ways, it still can produce similar effects such as euphoria, especially when abused.
Oxycodone (e.g., OxyContin, Percocet) is only about 50% stronger than morphine but is still classified by the DEA as Schedule II substance with a high potential for abuse and dependence. It is commonly prescribed to relieve moderate to severe pain and has been abused since the 1960s for its euphoric and sedating effects.
An alkaloid derived from the opium poppy, morphine is a natural opiate that, like its human-made counterparts, is classified as a schedule II controlled substance. It is most commonly used and abused in the United States in the forms that include injectable and oral solutions and ingestible tablets.
Hydrocodone (e.g., Norco, Vicodin) is nearly as powerful as morphine and is indicated for the treatment of moderate pain. It is currently the most frequently prescribed painkiller in the U.S. Hydrocodone is also a schedule II substance and an excellent example of how a relatively weak opioid can still be misused and pose significant risks to one’s health.
Like morphine, codeine (e.g., Tylenol 3) is a natural opium alkaloid that has relatively low potency. It is sometimes used to treat mild-moderate pain and can also be found in prescription cough and cold formulations. It still has a potential for misuse and overdose, however. In recent years, it’s become increasingly popular in the rap hip hop community as “Lean” or “Sizzurp,” a drug cocktail that also includes soda, such as Sprite, and hard candy like Jolly Ranchers.
Meperidine (e.g., Demerol) was the first opioid to be synthesized. Meperidine is not as strong as most other opioids but is still classified by the DEA as a Schedule II drug due to having some potential for abuse. Meperidine is now widely considered to be ineffective when compared to other opioids but is sometimes prescribed nonetheless.
Tramadol (e.g., Ultram) has a potency is similar to that of meperidine. Unlike other opioids, it is classified as a schedule IV drug, however, and is therefore considered to have less potential for abuse and physical dependence. Despite this, tramadol can still be misused by those who suffer chronic pain.
Getting Help for Addiction
If you or someone you love is suffering from an addiction to opioids or other substances, please contact us as soon as possible to learn about our detox and treatment options. Just Believe Recovery offers a full spectrum of care, including evidence-based services, tools, and support that individuals direly need to achieve abstinence and begin to experience long-lasting sobriety and wellness!