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.
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.
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
- Painful and/or dangerous withdrawal symptoms
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.
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
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 five to 10 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
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 for contracting HIV.
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
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