The Opioid Crisis
The opioid crisis in the United States is threatening the very fabric of our society, with over 2 million people suffering from opioid addiction. The epidemic is disturbing, as 90 Americans die from an opioid overdose everyday.
Opioids are powerful drugs that induce feelings of euphoria and relieve pain, and should only be taken for short periods of time. Regardless of potency, all opioids are potentially addictive and can lead to overdose. But, different opioids may have different effects and risks depending on frequency of use and how they are taken.
List Of Opioids From Strongest To Weakest
Fentanyl is a synthetic opioid that is 30-50 times more potent than heroin. Fentanyl is a prescription drug generally prescribed for patients to manage severe pain after surgery. Common brand names for Fentanyl include Actiq, Duragesic, and Sublimaze. It may also be prescribed for patients with chronic pain who have built a physical tolerance to other opioids.
Due to its potency and addictive qualities, Fentanyl is a schedule II drug and is considered dangerous. Just a tiny dose of Fentanyl can kill a person, about .25 of a milligram. Fentanyl overdose deaths are on the rise, as most of the 5,500 opioid related deaths in 2014 were caused by Fentanyl.
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Heroin, the second strongest opioid, is a semi-synthetic opioid derived from morphine, a natural substance that comes from the poppy plant. Heroin is the only illegal drug included in this list, as most opioids serve a medicinal purpose, whereas Heroin does not.
Heroin is also the only schedule I drug on the list, and has a very strong potential for abuse. It is used by injecting, snorting, or smoking, and is often found as a white or black powder, or a black sticky substance. When injected, Heroin enters the bloodstream and then brain more rapidly than other opioids, creating immediate feelings of euphoria.
Hydromorphone is another strong opioid that is 2 to 8 times more potent than morphine. Prescribed as a severe pain reliever in the brand name Dilaudid, Hydromorphone produces feelings of sedation and relaxation.
Hydromorphone is a schedule II drug with high potential for abuse, likely leading to physical and psychological dependence. It is commonly abused as a substitute for Heroin because it can be dissolved in liquid and injected into the bloodstream to experience the effects faster.
Although fourth on the list, Oxymorphone is a very strong opioid. Found in the brand name Opana, Oxymorphone is prescribed to treat moderate to severe pain. It generally comes in tablet form, but is sometimes prescribed as an injectable solution.
Oxymorphone is a schedule II opioid with potential for both abuse and dependence. It is abused by oral ingestion, snorting, and injection, and can be illegally bought off the street, acquired through forged prescriptions, or stolen during pharmaceutical robberies.
While Methadone is used under strict medical supervision to treat addiction or painful symptoms of withdrawal, nonmedical use is illegal. Methadone is chemically dissimilar to Heroin and Morphine, but still produces similar effects of euphoria and sedation.
Methadone is a schedule II drug and, when abused, can lead to physical and psychological dependence. Swallowed as a tablet or injected as a liquid, Methadone abuse can produce adverse health effects if not administered under careful medical supervision.
While Oxycodone isn’t as strong as the above opioids, it is still considered a schedule II drug with high potential for abuse and dependence.
Found in brand names Oxycontin, Roxicodone, and Percocet, Oxycodone is generally prescribed to relieve moderate to moderately severe pain. Oxycodone is routinely prescribed in the United States, and has been abused since the 1960s for its sedating and calming effects.
Morphine is the only natural opiate (non-synthetic opioid) on the list, but is included because the potency of opioids are often compared to Morphine. Often prescribed to treat pain when other opioids are ineffective, Morphine is similar in potency to Oxycodone.
Morphine is a schedule II controlled substance, and was traditionally misused used as an injectable liquid, but can now be administered as oral solutions and ingestible tablets. Injecting Morphine is usually preferred, as it enters the bloodstream and reaches the brain more quickly.
Hydrocodone is near equipotent to morphine, and is generally prescribed to treat moderate pain. Some brand names for Hydrocodone include Vicodin, Lortab, and Hycodan. More potent than Codeine, Hydrocodone is the most frequently prescribed opioid in the United States, with a staggering 136 million prescriptions filled in the first several months of 2014.
Hydrocodone is a schedule II drug commonly abused with alcohol. A 2013 survey found that over 24 million people over the age of 12 had taken Hydrocodone for no medical reason. Hydrocodone is a good example of how a weaker opioid can be abused and pose serious health risks; in 2011, over 82,000 emergency room visits were attributed to Hydrocodone.
Codeine is weaker in potency, and is generally prescribed to treat mild to moderate pain, and may be used with other medications to reduce coughing.
Depending on which drug it is combined with, Codeine is either a schedule II, III, or V drug. Schedule II Codine is found in some forms of Morphine. Other prescriptions, like Tylenol with Codeine are schedule III, and are stronger than cough medicines that contain less than 200 milligrams of Codeine (schedule V).
Meperidine, brand name Demerol, was the first synthetic opioid ever created. Meperidine is weaker than most other opioids, but is still considered a schedule II drug because of the potential for abuse.
Physical dependence and tolerance is likely to develop quicker than most opioids, making abuse of this drug as dangerous as any opioid. Although, Meperidine is considered medically ineffective compared to other opioids.
Tramadol has similar potency to Meperidine, but, as a schedule IV drug, has less potential for physical dependence, tolerance, and abuse. However, Tramadol, or brand name Ultram, can still be abused by those suffering from addiction or chronic pain.
In 2012, 3.2 million people reported to have used Tramadol for nonmedical purposes. Although Tramadol is the weakest opioid on the list, it is still commonly abused and can lead to addiction.
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Opioid Addiction Treatment Options
If suffering from addiction from anything on the above list of opioids from strongest to weakest, then treatment is needed. Treatment may initially include medically supervised detoxification (detox) to help ease the pain of withdrawal.
Furthermore, Medication-assisted Treatment, or MAT, makes use of carefully administered drugs like Naltrexone, Buprenorphine, and Methadone to decrease opioid use and related death, and increase the likelihood of a person staying in treatment.
MAT is also most effective when combined with behavioral treatments at an inpatient treatment centers. Inpatient treatment can provide various behavioral therapies, like cognitive behavioral therapy and dialectical behavioral therapy. These will likely be used in conjunction with MAT to create the best chances for successfully managing opioid addiction after treatment.