List of Most Dangerous Opioids: Strongest to Weakest

Legacy Healing Center Blog

The opioid epidemic has claimed more than half a million lives since 19991. And opioids continue to play a huge role in drug-related deaths, with almost 75% of drug overdoses in 2020 involving opioids.  In other words, opioids come to play. They do NOT mess around. They’re highly addictive and extremely destructive, not only to people who use them, but to the loved ones affected by opioid use disorder (OUD), and to the community at large. If you or a loved one need drug rehab in Florida, reach out to Legacy Healing Center to break free from drug or alcohol use disorder.

Some people try to justify or rationalize it by stating it’s natural because it comes from the poppy plant or that it’s safe because it’s prescribed by doctors to manage chronic, post-injury, or post-surgical pain. Don’t get sucked into the lies. Don’t rationalize. Opioids are dangerous when used outside of their prescribed and intended purposes. 

If you or someone you love is struggling with OUD, opioid detox is the first step in your recovery journey. Withdrawing from opioids in a medically-supervised environment can help you manage the symptoms and safely purge the drug from your body.

Most Dangerous Opioids: Strongest to Weakest

This list ranks opioids from strongest to weakest and uses morphine as the benchmark3. Having a better understanding of opioids can help you manage your health and well-being better. You can also use this list with your healthcare provider to find the best option for managing pain while reducing the risk of OUD occurring or relapsing. 

Remember, help is always available. Opioid addiction treatment can help you rehabilitate from the drug and live a better life.

• Carfentanil

Carfentanil is the most potent fentanyl analog detected in the U.S. and is about 10,000 more potent than morphine and 100 times stronger than fentanyl4. 

It is sometimes used as a tranquilizer for elephants and other large mammals. It can be lethal in humans in quantities as small as 2 milligrams (a pile of powder about the size of a pen tip.) In fact, carfentanil is so potent, first responders are cautioned to be extraordinarily mindful not to be accidentally exposed through inhalation or even skin contact. When used in a transdermal method, much like a fentanyl patch, a minor touch or inhalation can prove fatal.

• Fentanyl

100 times stronger than morphine and 50 times stronger than heroin, fentanyl is highly addictive and dangerous. Often used medically as transdermal patches to treat severe pain from surgeries or end-stage cancer, it’s long-lasting. 

It’s also frequently illegally manufactured and laced into other illegal drugs. In fact, many people use or overdose on fentanyl without knowing or intending to use it5. Fentanyl-laced marijuana, meth, heroin, and cocaine are common. The potent effects of fentanyl make the drugs more addicting and stretch the profits of illegal manufacturing. 

Unfortunately, you cannot tell if a drug has been laced with fentanyl by looking at it, tasting it, or smelling it. Fentanyl-laced pills are also common and may be sold as counterfeit versions of legitimate drugs, such as oxycodone, hydrocodone, or amphetamines. ONLY accept pills prescribed to you by a physician and filled at a legitimate pharmacy. Do NOT buy or accept pills from another person, even if they tell you it’s a legit medication.

•  Buprenorphine

Similar in strength to fentanyl, it’s about 80-100 times more potent than morphine. However, it has a “ceiling effect,” meaning the euphoric effect people use opioids to achieve plateaus6. Because of this, buprenorphine is frequently used in the treatment of opioid addiction, in conjunction with counseling and other behavioral therapies. 

Careful, precise use of buprenorphine can be helpful in weaning off opioids. However, it can still be used illicitly. Its danger comes when someone overdoses in an effort to chase the euphoria in spite of the plateau.

• Hydromorphone

Hydromorphone is 4 to 7.5 times stronger than morphine, but is not as commonly misused as many other opioids. However, its illicit uses include forged prescriptions, to “doctor-shoppers,” who bounce from one physician to another to gain excessive access to opioids, to thieving pharmacies, hospitals, and nursing homes. 

Hydromorphone is also one of the more commonly abused opioids by those in the healthcare profession, such as pharmacists, doctors, nurses, and more.

• Heroin

Heroin is approximately 2 to 4 times more potent than morphine7. However, it is always illegal and has no approved or legitimate uses. It is highly addictive and is frequently laced with other drugs, including fentanyl, or used in conjunction with other substances such as cocaine. This combination is known as a speedball. 

Heroin is also frequently used with alcohol. Although heroin is less potent than some other drugs, it is sometimes used by people who have initially been prescribed legitimate opioids, such as oxycodone. It’s also switched to as a drug of choice by people who have illegally used prescriptions but have found access to prescription medications to either be too difficult to obtain or too expensive.

• Methadone

Much like buprenorphine, methadone is used as a part of medically-assisted treatment for drug detox to help patients break free from opioid addictions8. It is slightly more potent than morphine and works to both relieve physical pain and withdrawal symptoms while not having the same euphoric effect as other opioids. 

Methadone lessens the effects of illicitly-used opioids. It is often dispensed at a methadone clinic, but may sometimes be permitted to be taken at home between visits.However, it can still be addictive and should only be taken exactly as prescribed in precise doses and never shared. 

• Oxycodone

Oxycodone, sometimes shortened to “oxy” is an extended-release pain-relieving opioid that’s approximately 1.5 times as potent as morphine9. When used as prescribed, it can help relieve pain. However, when used illicitly, it does produce euphoria and is still addicting. 

It is sometimes taken as an intact pill. It can also be chewed or crushed, then either swallowed, snorted, or injected. This can render it more dangerous because it is intended to be extended-release. Oxycodone is sometimes used by those trying to step down their use from other, stronger opioids.

• Hydrocodone

Hydrocodone is about the same potency as morphine and is among the most commonly prescribed opioid in the U.S10. It’s often combined with acetaminophen. Illicit manufacturing of hydrocodone is not common. Rather, diverting or obtaining false prescriptions is the most frequent method of acquiring it for personal use or illegal distribution.

• Morphine

Morphine has been used to relieve pain since it was isolated from the opium poppy in the 1800s. As a result, it is one of the most studied and understood opioids, which is why it is the standard to which others are compared. While it is still prescribed to manage moderate to severe pain, it is still addictive and should only be used under a physician’s care and as directed11,12.

• Codeine

Codeine is approximately 1/10th the potency of morphine. It’s used to treat mild-to-moderate pain and may also be used to relieve coughs3,13. While it is much less potent, it is still an opioid and still has addictive properties.

Treatment Options

When opioids have taken over your life, no matter how or why you started, even if it was through a legit prescription, there are great treatment options available. You can get free from your opioid of choice at Legacy Healing Centers. We know the illegal use of opioids is a way of self-medicating, treating either physical, mental, or emotional pain. We are here to guide you to a deeper place of understanding the underlying causes and find healthy tools and skills to live without opioids.

Upon arriving at a beautiful Legacy Healing Center, an assessment will be completed to determine the appropriate level of treatment care. Depending on the opioid you’ve been using, length of time, etc. you may be enrolled in the Partial Hospitalization Program, or PHP, which may include medically supervised detox. Safely stepping down and weaning off the physical dependency on opioids is an important part of recovery. PHP allows you to stay on-site at our beautiful residential facility.

You may start in PHP, then step down to Intensive Outpatient Program (IOP), or you could start in our IOP, depending on your specific needs. With IOP, you could continue to stay at the residential facility or live off-site, even at home, especially if you have exceptional support. This allows more flexibility for work or school while still providing intense therapy, treatment, and group support as you grow in your sobriety.   

We also offer ongoing support including Outpatient Programs and Family Programs. Drug and alcohol use disorders affect those who love you as well. Outpatient provides continual access to therapy and group support. 

The Family program provides education and training for those who love you. This could include family counseling and helps them in their own road to recovery as well as helping them understand the right ways to support and encourage you in your sobriety without unintentionally enabling or hindering your recovery.

Find Help Today

Today can be the first day of your journey to break off the shackles of OUD. And it all starts when you contact us at 888-858-0137. You’ll speak to a treatment specialist at Legacy Healing Center who will give you exactly what you need: hope. Your recovery journey starts here, with Ladies and Gentlemen, helping Ladies and Gentlemen reclaim an active and healthy life without opioids.

References

1. Centers for Disease Control and Prevention. (2022, June 1). Opioid data analysis and resources. Centers for Disease Control and Prevention. Retrieved June 30, 2022, from https://www.cdc.gov/opioids/data/analysis-resources.html 
2. Centers for Disease Control and Prevention. (2022, May 23). Opioid basics. Centers for Disease Control and Prevention. Retrieved June 30, 2022, from https://www.cdc.gov/opioids/basics/index.html 
3. Table A6.2, approximate potency of opioids relative to morphine; po and … (n.d.). Retrieved June 30, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK537482/table/appannex6.tab2/ 
4. Carfentanil: A dangerous new factor in the U.S. opioid crisis. (n.d.). Retrieved June 30, 2022, from https://www.justice.gov/usao-edky/file/898991/download 
5. Centers for Disease Control and Prevention. (2022, February 23). Fentanyl facts. Centers for Disease Control and Prevention. Retrieved June 30, 2022, from https://www.cdc.gov/stopoverdose/fentanyl/ 
6. Centers for Disease Control and Prevention. (n.d.). Buprenorphine prescribing practices and exposures reported to a Poison Center – utah, 2002–2011. Centers for Disease Control and Prevention. Retrieved June 30, 2022, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6149a1.htm 
7. Reichle, C. W., Smith, G. M., Gravenstein, J. S., Macris, S. G., & Beecher, H. K. (1962, April 1). Comparative analgesic potency of heroin and morphine in postoperative patients. Journal of Pharmacology and Experimental Therapeutics. Retrieved June 30, 2022, from https://jpet.aspetjournals.org/content/136/1/43#:~:text=The%20results%20of%20the%20present,first%20150%20minutes%20after%20injection 
8. What is methadone? Psychiatric Research Institute (PRI). (n.d.). Retrieved June 30, 2022, from https://psychiatry.uams.edu/clinical-care/cast/what-is-methadone/ 
9. Centers for Disease Control and Prevention. (2021, February 17). About CDC’s opioid prescribing guideline. Centers for Disease Control and Prevention. Retrieved June 30, 2022, from https://www.cdc.gov/opioids/providers/prescribing/guideline.html 
10. Hydrocodone (trade names: Vicodin , Lortab , Lorcet-HD , hycodan … (n.d.). Retrieved June 30, 2022, from https://www.deadiversion.usdoj.gov/drug_chem_info/hydrocodone.pdf 
11. E;, N. S. K. P. R. K. (n.d.). [history of opium poppy and morphine]. Dansk medicinhistorisk arbog. Retrieved June 30, 2022, from https://pubmed.ncbi.nlm.nih.gov/17152761/ 
12. Drug fact sheet: Morphine – dea.gov. (n.d.). Retrieved June 30, 2022, from https://www.dea.gov/sites/default/files/2020-06/Morphine-2020.pdf 
13. Center for Drug Evaluation and Research. (n.d.). Codeine information. U.S. Food and Drug Administration. Retrieved June 30, 2022, from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/codeine-information#:~:text=Codeine%20is%20an%20opioid%20pain,some%20cough%20and%20cold%20medications