List of Opioids Strongest to Weakest

Opioids encompass a range of drugs, including prescription medications such as morphine and oxycodone, as well as illegal substances like heroin. These drugs engage with opioid receptors located in the brain, spinal cord, and other parts of the body, initiating a cascade of biochemical reactions that lead to the release of dopamine, which helps alleviate pain. However, this same mechanism also induces feelings of pleasure and euphoria, contributing to a significant risk of dependence and addiction. Since morphine was first isolated from opium, which comes from the poppy plant, during the Civil War, medical advancements have led to the development of various semi-synthetic and synthetic opioids that replicate the chemical structure of opium. Nowadays, opioids are available in different strengths to address a wide spectrum of pain, with the classification of opioid strongest to weakest depending on their potency.

While opioids are highly effective and often essential for pain management, they are also recognized as some of the most potent and addictive medications available. Consequently, many individuals have developed substance use disorders after being prescribed these drugs, which has tragically contributed to the overdose crisis in the United States. The rise of more powerful, illicitly manufactured opioids like fentanyl and its analogs has further exacerbated the situation, as highlighted by the Drug Enforcement Administration (DEA). As central nervous system (CNS) depressants, they can slow down breathing and heart rate to dangerous levels which can lead to a fatal overdose. There are numerous types of opioids, each varying in strength, but all carry a risk of opioid addiction regardless of their potency.

A list of opioids ranked by potency includes:

1. Fentanyl: Known as the most powerful prescription opioid, fentanyl is 50 to 100 times stronger than morphine. It is typically prescribed for intense pain management, particularly in surgical and cancer settings. Fentanyl’s illicit production has contributed to the opioid epidemic as it is being used as a cutting agent in a wide range of street drugs. Its extreme potency means that even a dose as small as two milligrams, comparable to 5-8 grains of salt.
2. Heroin: An illegal substance derived from morphine, heroin can be injected, snorted, or smoked Users typically experience intense feelings of pleasure, euphoria, and sedation. Heroin is highly addictive and poses serious long-term health risks, including organ damage and mental health issues.
3. Morphine: A natural opium derivative, morphine is widely prescribed for severe pain relief, such as in cancer treatment or post-surgery. Morphine acts on the nervous system and brain to impede pain signals, while also inducing feelings of relaxation and euphoria, which raises the risk of dependence and addiction. Its potency is the standard for opioid strength measurement.
4. Hydromorphone: Commonly recognized by its brand name Dilaudid, is a powerful opioid often prescribed for managing severe pain. It carries a significant risk of abuse and addiction, being approximately 5 to 7 times more potent than morphine. This medication can induce strong feelings of euphoria and sedation. Both injectable forms and tablets can be misused by crushing and dissolving them for injection, sometimes as an alternative to heroin.
5. Oxycodone: Roughly 1.5 to 2 times stronger than morphine, typically used for moderate to severe pain relief. It comes in both immediate-release and extended-release versions. In the 1990s, misconceptions about its addiction potential misled healthcare providers, resulting in a surge of prescriptions that played a significant role in the initial wave of the opioid crisis.
6. Hydrocodone: Hydrocodone is prescribed for individuals experiencing severe and ongoing pain who require consistent opioid treatment and cannot find relief with other medications. Additionally, it serves as a cough suppressant and is about 1.5 times less potent than morphine.
7. Codeine: With a strength of about one-tenth that of morphine, is utilized for mild to moderate pain relief and as a cough suppressant. It is often combined with acetaminophen or aspirin. Common side effects include dizziness, fatigue, confusion, and euphoria, but it generally has a lower risk of addiction compared to hydrocodone.
8. Tramadol: Tramadol is indicated for moderate to moderately severe pain, including post-surgical discomfort. It is usually prescribed when pain is significant enough to necessitate opioid treatment, especially when other pain relievers are ineffective or intolerable. Tramadol is considerably weaker than morphine, with a potency ranging from one-tenth to one-fifteenth that of morphine.

 

What Is the Strongest Opioid?

Fentanyl is recognized as the most potent prescription opioid available for human use. Unfortunately, it is also being illicitly produced in various strengths and is often mixed with a variety of street drugs such as heroin, cocaine, and MDMA to enhance their euphoric effects while keeping costs low. This alarming trend has played a significant role in the ongoing opioid crisis, as highlighted by the Pacific Northwest National Laboratory (PNNL). On the other hand, carfentanil holds the title of the most powerful opioid, being 100 times more potent than fentanyl and 1000 times stronger than morphine. Its primary use is as a tranquilizer for large animals, such as elephants, and it is not meant for human use. Nevertheless, the presence of highly potent fentanyl analogs, including carfentanil, in the illegal drug market has escalated the risk of fatal overdoses.

What Is the Weakest Opioid?

Weaker opioid medications, such as codeine and tramadol, are prescribed for pain management. Despite being less potent, they still pose a significant risk of dependence and addiction. Additionally, there are very mild opioids used for treating diarrhea, like diphenoxylate and loperamide, which have a minimal potential for abuse. Diphenoxylate, marketed as Lomotil, is a prescription medication often paired with atropine to deter misuse. On the other hand, loperamide, known as Imodium, is available over-the-counter and is considered an extremely weak opioid that typically does not penetrate the blood-brain barrier at standard doses. However, research published in the National Library of Medicine indicates that some individuals may misuse loperamide at higher doses, experiencing euphoric effects that can lead to potential abuse and addiction.

What Is the Most Addictive Opioid?

Opioid addiction is a chronic disorder characterized by an individual’s inability to stop using despite negative impacts on their health and daily life. All opioids carry an abuse and addiction potential despite their opioid potency ranking. This includes prescription medications that, when taken as directed, can still lead to dependence and potentially a substance use disorder if not identified and treated early. More potent opioids are more likely to lead to tolerance and dependence, making fentanyl the most addictive opioid. However, weaker opioids like hydrocodone and oxycodone which carry an abuse potential, are more frequently prescribed and can also lead individuals into the cycle of addiction. As users build tolerance to these milder opioids, they may start misusing them or seek out stronger alternatives, such as heroin or illicit fentanyl, to achieve the same high. Additionally, withdrawal symptoms can arise when trying to quit, which only intensifies the compulsion to continue using.

What Opioid Causes the Most Overdoses?

Fentanyl has emerged as a leading cause of drug overdoses in recent years. Its remarkable potency means that even the tiniest amounts can lead to a fatal overdose. A significant factor in the rise of fentanyl-related overdoses is its common mixing with other illegal substances, including heroin, cocaine, methamphetamine, and fake prescription pills. Many users are unaware that fentanyl is included, which significantly heightens the risk of unintentional overdose. Fentanyl’s rapid action in the body can lead to acute respiratory depression, a major factor in opioid overdose fatalities. While various harm reduction measures, such as fentanyl test strips, have been implemented, the United Nations Office on Drugs and Crime has raised concerns about a new class of highly potent synthetic opioids called nitazenes. These substances are infiltrating the illegal drug market and cannot be detected by existing test strips, further exacerbating the overdose crisis.

WhiteSands Can Help You Overcome Addiction to Opioid Strongest to Weakest

Any opioid strongest to weakest carries a risk for addiction. It is very easy for someone to be prescribed an opioid medication and develop dependence quickly, which can turn into addiction if not addressed quickly. At WhiteSands Treatment, we offer customized treatment programs that focus on both the physical and psychological dimensions of addiction. Utilizing evidence-based therapies and medical detox, we support individuals in their journey to recovery, regardless of opioid strength ranking. Conquering opioid addiction is undoubtedly difficult, but with the expert support at WhiteSands Treatment, you can reclaim your life and break free from the chains of addiction.

Contact WhiteSands Today to Learn More About Opioid Strongest to Weakest Addiction Treatment Options

At WhiteSands Treatment, we provide a full spectrum of care tailored to address opioid addiction strongest to weakest, ranging from medical detox to inpatient and outpatient treatment options. Our medical detox program features continuous supervision by a dedicated team of healthcare professionals, including doctors and nurses, who are available around the clock to administer medications that alleviate opioid withdrawal symptoms and prioritize patient safety during the detox process. Once patients complete detoxification, they can smoothly transition into one of our extensive rehabilitation programs, selecting either inpatient or outpatient care based on their individual needs. Throughout these programs, our clinicians focus on identifying and tackling the underlying issues of addiction while empowering patients with essential skills and strategies for achieving long-term sobriety.

If you’re interested in discussing our opioid addiction treatment options at WhiteSands Treatment, please reach out to our 24/7 helpline at 877-855-3470.

External Source

• Centers for Disease Control and Prevention (CDC) – U.S. Overdose Deaths Decrease in 2023, First Time Since 2018
• Drug Enforcement Agency (DEA) – Fentanyl
• Pacific Northwest National Laboratory (PNNL) – Fentanyl Analogs
• National Library of Medicine – Loperamide abuse
• United Nations Office on Drugs and Crime – February 2024 – UNODC EWA: Nitazenes – a new group of synthetic opioids emerges

 

If you or a loved one needs help with abuse and/or treatment, please call the WhiteSands Treatment at (877) 855-3470. Our addiction specialists can assess your recovery needs and help you get the addiction treatment that provides the best chance for your long-term recovery.