What are the Strongest Opioids?

the strongest opioids on table

Published on August 10th, 2020

Opioids are a highly abused class of drugs that include some of the world’s most potent and addictive substances. While any use or abuse of opioid drugs can be dangerous, some are more powerful than others.

What Are the Different Types of Opioid Drugs?

Opioids are a class of drugs that include:

  • Natural opiates like morphine and codeine
  • Semi-synthetic/manmade opioids like hydromorphone, hydrocodone, oxycodone, and the illegal drug heroin
  • Synthetic/manmade opioids like fentanyl, methadone, and tramadol1

Prescription painkillers like hydrocodone (Vicodin) and OxyContin are well-known drugs, but these opioid painkillers can produce a high when they are abused. As a result, prescription opioids are frequently abused and heavily contribute to the opioid abuse problem in the U.S.

What Are the Risks of Using Opioid Drugs?

The risks of using opioid drugs are more apparent than ever, with more Americans dying of drug overdoses than car crashes.2 Most deadly drug overdoses in America involve prescription opioid drugs.

In addition to the very real risk of overdose, abusing opioid drugs comes with many other risks, such as:

  • Medical problems
  • Accidental injury/physical harm
  • Tolerance
  • Dependence
  • Painful and/or dangerous withdrawal symptoms
  • Addiction

What are the Strongest Opioids?

Several other opioid drugs have been developed since the discovery of morphine, which is typically used as a base comparison for other opioid drugs. Morphine itself is a powerful opioid, but several more recently developed opioids are hundreds or thousands of times stronger. Here are some of the strongest opioids currently, in no particular order.


Dsuvia is a relatively new opioid drug that was recently approved by the FDA. It is an oral tablet form of the drug sufentanil and is five to 10 times more potent than fentanyl.3 It is designed to only be used in patients who have not responded to other forms of pain medication. Dsuvia comes in a 30 mcg pre-filled disposable, single-dose applicator and is only administered by medical professionals in hospitals or similar settings, so it’s not likely to be abused.4,5 However, the FDA’s approval of such a powerful opioid drug in the midst of America’s opioid crisis is highly controversial.


Carfentanil is another dangerous opioid drug and according to the DEA, it is 10,000 times more potent than morphine and 100 times more potent than fentanyl. Carfentanil is a white powdery substance and a synthetic opioid that is used to tranquilize elephants and other large mammals. This drug is so powerful that even just touching it can cause side effects like dizziness, clammy skin, shallow breathing, and potentially even heart failure.6 Any exposure to carfentanil is highly dangerous.

Drug dealers may mix carfentanil into other substances so they can provide their buyers with a more potent and addictive drug. This greatly increases a person’s likelihood of overdosing on a drug, especially if they are unaware that they ingested carfentanil and choose to use other street drugs, prescription drugs, or alcohol simultaneously.

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    Another powerful synthetic opioid, fentanyl is 50 to 100 times more potent than morphine. Although it is used medically to treat patients with severe pain, it is also manufactured and used illegally. Synthetic opioid drugs like fentanyl are now the most common drugs involved in U.S. drug overdose deaths. In fact, according to the National Institute on Drug Abuse, 59.8 percent of opioid-related deaths involved fentanyl in 2017 compared to 14.3 percent in 2010.7

    Most fentanyl-related deadly overdoses in the U.S. are linked to synthetic fentanyl that was manufactured in other countries and mixed with other addictive drugs like cocaine, heroin, or meth. Drug dealers often mix fentanyl with other drugs to provide their customers with a more powerful and addictive high. However, that means many drug users also unknowingly ingest fentanyl in various amounts and in combination with a host of other drugs.

    Buprenorphine (Butrans)

    Buprenorphine is a medication that is used to treat moderate to severe ongoing pain. It was also approved by the FDA to treat opioid use disorder. It is 25 to 100 times stronger than morphine and has a high risk of dependence and abuse. Although it does not provide a euphoric high, patients make try to take more than one transdermal dose home with them at a time. Overdoses may occur if buprenorphine is taken with street drugs or alcohol and children are at risk of overdosing if buprenorphine sublingual doses are left lying around the house.

    Buprenorphine abuse has decreased since its release as a drug used to treat opioid use disorder, but some individuals may still try to divert the drug to sell or self-medicate for symptoms of pain, depression, or opioid withdrawal, rather than attempting to use buprenorphine to get high, like many other prescription opioid drugs.


    Hydromorphone (Dilaudid) is a potent Schedule II prescription opioid drug that has a very high potential for abuse and dependence. Medically, it’s used to relieve pain and works by stimulating receptors on nerves in the brain to increase pain tolerance and reduce the perception of pain. It is two to eight times stronger than morphine. Although medically useful, hydromorphone is frequently abused and ER visits associated with the abuse of this drug increased from 12,142 in 2008 to 18,224 in 2011.8

    Hydromorphone is manufactured in several different forms, including tablets, oral liquid solutions, and injectable solutions. People who abuse it typically feel its effects within 15 to 30 minutes and often get addicted after long-term use. They may also use it simultaneously with other opioids, like Percocet, morphine, or Vicodin.


    Hydrocodone is a prescription opioid medication used to treat moderate to severe pain and is usually prescribed after surgery, for chronic pain, or to treat pain caused by an injury. It is intended to be taken on a short-term basis but misusing it or continuing to take it for a long time can cause addiction and dependence.

    Hydrocodone is a very powerful and addictive drug, which makes it a prime candidate for abuse. It comes in both syrup and tablet form and is about as strong as morphine. People who abuse hydrocodone use various street names for it, such as hydro, vikes, tabs, and Watsons.


    Oxymorphone (Opana) is three to 10 times stronger than morphine, depending on how it’s administered and it is highly addictive. In fact, it is so highly abused that the manufacturer of Opana pulled Opana ER (the extended-release formulation of the drug) off the market, following a request from the FDA.9 It is a Schedule II opioid drug and many people who abuse it inject it, which produces a powerful, euphoric high. However, abusing oxymorphone this way also increases the user’s risk of contracting HIV.


    OxyContin is about 50% stronger than morphine. It’s the brand name for the drug oxycodone, which is used to treat moderate to severe pain. Oxycodone is a highly addictive and powerful drug and may even cause dependence or addiction when taken as prescribed by a doctor.

    OxyContin is one of the most common prescription opioid drugs involved in deadly overdoses. It is sold in tablet form and one tablet is intended to last the entire day. However, many people who abuse it chew the pills or crush them and dissolve them in water before injecting the solution. These methods are intended to accelerate the release time and provide a powerful high.

    Common street names for OxyContin include Oxy, OC, hillbilly heroin, kickers, killers, O, and blue.


    Morphine is one of the most popular pain-relief medications and is about three times stronger than codeine. It produces feelings of euphoria and is easy to get, which makes it particularly attractive for drug abusers. Classified as a Schedule II narcotic by the DEA, morphine produces effects that are similar to those of heroin, fentanyl, and oxycodone, and overdose can cause cold, clammy skin, lowered blood pressure, depressed breathing, sleepiness, coma, and possible death.10

    Morphine is prescribed under various brand names such as Duramorph, Roxanol, and Infumorph P/F. People who take excessive or large doses of morphine or who use it with other drugs or alcohol are more likely to develop an addiction or dependence on the drug.


    Percocet is only legally available with a valid prescription. It is a combination medication that contains oxycodone and acetaminophen and produces effects similar to heroin and morphine when it is abused. Percocet produces feelings of pleasure and well-being, which contribute to high levels of abuse.

    Percocet is administered in many different forms, including tablets, a liquid solution, and capsules. Many people may mistakenly believe that it’s safer to abuse Percocet than heroin simply because it’s a prescription drug. However, this is not the case. People who misuse Percocet are at risk of developing dependence, addiction, or overdosing, especially if they combine Percocet with other street drugs, opioids, or alcohol.


    Heroin is a powerful, illegal opioid drug that produces a fast and strong high, especially when it is injected. It is highly addictive and can be two to five times stronger than morphine, depending on how it’s used. An estimated 9.2 million people worldwide use heroin and many people who abuse prescription opioid painkillers transition to heroin abuse because it’s cheaper and easier to get.11

    Heroin is most often manufactured in powder form (usually white or brown). However, it can also be black tar heroin, which is a black, sticky substance. Most people who abuse heroin snort, sniff, inject, or smoke it, and many people also combine it with crack cocaine, a practice known as “speedballing.”


    Methadone is about three times stronger than morphine and it is an FDA-approved prescription medication used to treat opioid addiction. It’s often used for long-term maintenance in opioid addiction recovery and can only be used at an outpatient clinic with direct medical supervision. It is safer than some other narcotics but still has the potential to cause addiction and dependence.

    Methadone works to treat opioid addiction by blocking the high from other opioid drugs like codeine, morphine, heroin, hydrocodone, and oxycodone. It also helps prevent cravings and withdrawal symptoms to help people stay sober.

    Methadone is not a cure for opioid addiction, rather, it is known as “replacement therapy” and it is generally just one part of an ongoing treatment plan designed to help individuals overcome their opioid addiction.

    Tramadol (Ultram)

    Tramadol is about one-tenth as potent as morphine. It is a prescription opioid that is used to treat moderate pain. It is classified as a Schedule IV substance because it has the potential to cause addiction and dependence.

    When taken, tramadol causes pleasurable effects including enhanced mood and euphoria. As a result, users may repeatedly take large doses of the drug to enhance its effects. Most people who abuse tramadol have struggled with substance abuse problems at some point.

    Demerol (Meperidine)

    Demerol is the brand name for the drug meperidine. It’s about seven to 10 times less potent than morphine and is used to treat moderate or severe pain. Meperidine is a Schedule II drug and is also used as an anesthetic.

    Some people may abuse Demerol because it produces feelings of well-being, pleasure, and euphoria. People who misuse this drug may “doctor shop” or visit several different doctors to get prescriptions for the drug. They may also forge prescriptions or steal it from friends, family members, or other people’s medicine cabinets so they can use it to get high.

    People who abuse Demerol typically snort it or inject it to enhance its effects and feel a more powerful high. Meperidine may also be referenced as “demmies” by those who abuse it.

    What Is the Best Treatment for Opioid Addiction?

    Regardless of the differences among these opioids, abusing any type of opioid drug is unsafe and can quickly lead to tolerance, dependence, and addiction. Many people who are addicted to opioid drugs end up in emergency rooms because they are in crisis. From there, doctors or nurses may recommend ongoing treatment. Other individuals may want to stop using opioids but feel like they are unable to due to uncomfortable withdrawal symptoms. They may choose to enroll in medical detox or use some other type of medication-assisted treatment to get sober.

    Medical detox is often an excellent way to start the treatment process and begin recovering from opioid addiction. It provides proper medical care, 24/7 monitoring by professional addiction treatment specialists, and clinical treatment for the psychological symptoms of opioid withdrawal.

    After detox, treatment staff will recommend ongoing care based on the client’s needs, circumstances, and financial ability. This may include residential rehab, outpatient rehab, or sober living.

    If you or a loved one is struggling with opioid addiction, the staff at Briarwood Detox Center is here to help. Call (512) 277-3103 to learn more about our opioid detox program today.


    1. https://teens.drugabuse.gov/blog/post/real-teens-ask-what-are-different-types-opioids-0
    2. https://drugfree.org/article/opioids-risks-explained/
    3. https://health.usnews.com/health-care/patient-advice/articles/2018-12-13/dsuvia-the-newest-opioid-raises-safety-questions
    4. https://www.self.com/story/dsuvia-controversial-new-fda-approved-opioid
    5. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/209128s000lbl.pdf
    6. https://www.dea.gov/press-releases/2016/09/22/dea-issues-carfentanil-warning-police-and-public
    7. https://www.drugabuse.gov/publications/drugfacts/fentanyl
    8. https://www.deadiversion.usdoj.gov/drug_chem_info/hydromorphone.pdf
    9. https://www.pharmacytimes.com/product-news/endo-to-pull-opana-from-the-market-following-fda-request
    10. https://www.getsmartaboutdrugs.gov/sites/getsmartaboutdrugs.com/files/files/Morphine_R.pdf
    11. https://www.drugfreeworld.org/drugfacts/heroin/international-statistics.html

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