Opioids are a class of drugs that are naturally or synthetically derived from the opium poppy plant. This drug class contains both powerful and mild narcotics that are used to treat chronic pain as well as pain from injury or surgery. Opioids work by binding to mu-opioid receptors in the brain and central nervous system and changing the way a person perceives pain. In addition to providing essential pain relief, opioids can also be abused to produce feelings of warmth, euphoria, or a “high.”

Opioids are some of the most addictive drugs in the world. While all opioids have similar side effects, some are stronger than others. The stronger the opioid, the higher the potential is for abuse and addiction. Sadly, the abuse of potent opioids–and even mild opioids in high doses–can lead to life-threatening overdoses.

In 2020, more than 56,516 people died as a result of an overdose involving synthetic opioids other than methadone. The vast majority of these overdose deaths involved one of the strongest opioids on the planet–fentanyl.[1] In recent years, fentanyl-related overdose deaths have skyrocketed as the drug has contaminated the black market drug supply, being found in all kinds of substances ranging from heroin and prescription opioids to prescription benzodiazepines.

List of Opioids From Strongest to Weakest

While fentanyl is extremely powerful and deadly, it isn’t the strongest opioid out there. The following is a list of opioids from strongest to weakest.

Lofentanil

Lofentanil is a fentanyl analog that is extremely similar to carfentanil–but it is slightly stronger. Lofentanil is one of the strongest, most potent opioids available today.[2] For reference, this opioid is thought to be 5,000-10,000 times stronger than morphine, and morphine is already a fairly potent opioid drug.

While lofentanil use is rare, even medicinally, the risk for abuse and overdose is extremely high. People can overdose on a very small amount of the substance and it may take repeated doses of naloxone to reverse the effects.

Carfentanil

The next strongest opioid is carfentanil. Like lofentanil, carfentanil is a fentanyl analog that has similar, but stronger effects. Carfentanil is 100 times more potent than fentanyl and 5,000 times more potent than heroin.[3] This drug is so strong that it is used as a tranquilizing agent for elephants and other large mammals, but less than a 2mg dose can be fatal to humans.

In recent years, carfentanil has become increasingly common in the illicit drug supply and has been the cause of several opioid overdose fatalities.

Fentanyl

Fentanyl is a powerful opioid that is commonly found on the streets and abused by opioid users. Unlike carfentanil and lofentanil, fentanyl is also used in hospitals and the emergency room for pain management in people who are tolerant to other opioids, such as cancer patients. It is thought to be 50 times stronger than heroin and 100 times stronger than morphine. Currently, fentanyl is the leading cause of opioid and drug overdose deaths in the United States.[4]

Heroin

Heroin is the strongest opioid that is not available by prescription. Heroin is an illegal drug that has no medicinal value. This opioid is derived from morphine but is far more powerful. It enters the bloodstream quickly, creating a rapid high as well as a high potential for abuse and addiction.

Hydromorphone (Dilaudid) and Oxymorphone (Opana)

Hydromorphone and oxymorphone are two powerful opioids that are several times stronger than morphine, but not as potent as heroin, fentanyl, and fentanyl analogs. They are both approved for medicinal use to treat chronic or severe pain. However, due to the potency, these drugs carry a high risk for abuse and addiction.

Methadone

Methadone is a prescription medication that is used to help treat symptoms of opioid withdrawal and dependency, but the medication is an opioid itself, and it’s among one of the strongest. However, methadone prescriptions are strictly regulated and controlled, and the medication is primarily only used in conjunction with an opioid treatment program.

As far as the effects go, methadone is structurally similar to heroin, but it is not as potent. If abused, it can produce the same effects as morphine, heroin, and other opioids.

Oxycodone (OxyContin, Roxicodone, Percocet)

Oxycodone is one of the most commonly abused prescription opioids. It is sold under the brand names Percocet and Roxicodone, but it used to be available under the brand name OxyContin. OxyContin found itself at the center of controversy, however, as it was marketed as a non-addictive opioid. In reality, OxyContin was just addictive–if not more addictive–than other opioid drugs.[5]

Morphine

Morphine is a naturally occurring opiate that may be prescribed in place of other synthetic opioids that are ineffective at relieving a patient’s pain. Even though it is not synthetic, it is still extremely potent.

Hydrocodone (Lortab, Vicodin, Zohydro ER)

Hydrocodone (sold under the brand names Lortab, Vicodin, and Zohydro ER) is the most common opioid prescription medication in the U.S. According to the DEA, more than 83.6 million hydrocodone-based prescriptions were dispensed in 2017.[6] Although hydrocodone is not the strongest opioid on this list, it still carries a risk for abuse and addiction.

Codeine

Codeine is one of the weaker opioid medications available. It is commonly found in prescription cough syrups which are abused illicitly and sometimes called “lean” or “purple drank.” Codeine can also be prescribed to treat mild to moderate pain in a pill form that contains Tylenol and codeine.

Meperidine (Demerol)

Meperidine (Demerol) is a synthetic opioid but it is one of the weakest opioids on this list. It is approved by the FDA to treat pain and comes in the form of an injectable solution, pill, and oral solution. Even though meperidine is milder than other opioids, it can still be habit-forming.[7]

Tramadol (Ultram)

Tramadol is the weakest opioid. It has about one-tenth the potency as morphine does. Being the weakest opioid, it is thought to be less addictive than stronger opioids like heroin and fentanyl.

Find Opioid Addiction Treatment for Yourself or a Loved One

Regardless of how potent the opioids you are taking are, you should only ever take opioids as prescribed by your doctor. Using opioids in any other way than directed can pave the way for an opioid use disorder or addiction.

If you or a loved one are struggling with opioid addiction, there is help available. At Moving Mountains Recovery, we understand how serious addiction to opiates is. We are passionate about helping people find freedom from their addiction and rebuild their lives on a strong foundation of recovery. We have a team of motivated and compassionate professionals that are dedicated to helping people recover. We are ready to answer any questions about opiate addiction and help where we can.

Contact us today to see if our opioid rehab is right for you.

References:

1. https://nida.nih.gov/drug-topics/trends-statistics/overdose-death-rates
2. https://pubchem.ncbi.nlm.nih.gov/compound/Lofentanil#section=InChI-Key
3. https://www.justice.gov/usao-edky/file/898991/download
4. https://www.dea.gov/resources/facts-about-fentanyl
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/
6. https://www.deadiversion.usdoj.gov/drug_chem_info/hydrocodone.pdf
7. https://www.sciencedirect.com/topics/medicine-and-dentistry/pethidine