Opioids are quite powerful medications that relieve pain and produce feelings of euphoria, and should only be taken for short periods of time for acute pain, such as after an injury or surgery.
Regardless of strength, all opioids are potentially addictive and can lead to overdose if misused.
However, different opioids cause different effects and risks depending on the frequency of use and the route of administration.
The following list of pain medications includes commonly used and abused opioids and opiates, from strongest to weakest in potency.
Opioids and opiates are controlled substances with a high potential for abuse, dependence and tolerance and must be administered under supervision.
1. Carfentanil:
Carfentanil is a synthetic drug that is 10,000 times more powerful than morphine and 100 times more powerful than medical-grade fentanyl itself.
It is mainly used by veterinarians to sedate large animals such as elephants and is not indicated for human use, but is occasionally found on the black market.
However, even tiny doses can be fatal, and many deaths have occurred due to carfentanil being laced into heroin or other drugs unknown to the user.
2. Fentanyl:
Fentanyl is also a synthetic opioid that is up to 50 times more powerful than heroin. Fentanyl is a prescription drug that is quite rarely prescribed to patients to treat severe pain after surgery, but because of fentanyl’s potency and potential for abuse, it is usually administered very slowly into the system via a transdermal patch or lozenge.
However, black market fentanyl is not typically a product of prescription drug abuse. According to the Drug Enforcement Administration, most fentanyl on the streets comes from China or Mexico, where it was manufactured in illegal labs and sold over the Internet to cartels and dealers or to individuals.
Like carfentanil, a very small dose (even incidental skin exposure) of Fentanyl can kill a person, about 0.25 milligrams. Fentanyl overdose deaths are increasing as most of the 5,500 opioid-related deaths in 2014 involved fentanyl.
3. Heroin:
Heroin, it is the third strongest narcotic and is a semi-synthetic opioid derived from morphine, a natural compound that comes from the poppy. Heroin is the only completely illegal Schedule I drug (drugs with accepted medical uses and a high potential for abuse) included in this list, as most opioids are available by prescription, while heroin is not considered an accepted medical use.
Heroin has a very high potential for abuse, especially if injected. However, it can also be consumed by snorting or smoking, and is often found as a whitish powder or a black sticky substance (black tar heroin).
When heroin is injected, it enters the bloodstream and brain much faster than other opioids, causing immediate intense feelings of euphoria.
4. Hydromorphone:
Hydromorphone is another powerful opioid that is up to 8 times more powerful than morphine. It is prescribed as a severe painkiller, under the brand name Dilaudid, and causes feelings of sedation and relaxation.
Hydromorphone is a schedule II drug (substances with a high risk of abuse, a serious risk of psychological or physical dependence and recognized medical use).
It is often abused as a substitute for heroin because it can be dissolved in water and injected into the bloodstream, causing rapid and intense effects similar to those of heroin.
5. Oxymorphone:
Even though it is ranked number 5, oxymorphone is still a very strong opioid. Oxymorphone may be prescribed to treat moderate to severe pain. It usually comes in tablet form, but is sometimes prescribed as an injectable. It can be abused orally, or by snorting or injecting.
