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List of opioids from strongest to weakest

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Synthetic or semisynthetic Opioid drugs and Natural opiates are frequently exploited for both their euphoric and sedative effects. The drugs may be completely different in their power and therefore the dosage that has to be taken for acute or chronic pain will make a lot of difference.

 

A careful selection of opiates its management can provide effective pain relief while supporting the current epidemic of opioid abuse, dependence, addiction, overdose, and death.

 

Comparison of the Power of opioids

Morphine is the predominant alkaloid present in the opium poppy plant seed and is the most potent natural opiate and the power of all other opioids and is estimated against that of 30 (mg) of morphine and the estimated morphine milligram equivalent (MME).

You can calculate the MME of an opioid by dividing 30 mg by the drug’s morphine equivalent conversion factor.

The conversion factor for an oxycodone, such as OxyContin is 1.5.

  • The estimated MME for oxycontin is therefore 20 mg.

When you take a high dosage of a potent opioid which is equal to that of a less potent opioid it results in serious outcomes which include overdose and can cause death.

A Comparison Chart of Commonly Prescribed Opioids

 

Brand Name Generic Name Onset of Action MME Doses Usual Dosing Type of PainTreated
Duragesic Fentanyl ER 2.5 mg 12-100 mcg/hour transdermal patches 72 hours ·         Chronic

·         Severe

·         Round-the-clock dosing needed

·         Other opioids ineffective

Dilaudid hydromorphone hydrochloride IR 7.5 mg 2-4 mg tablets 4-6 hours ·         Acute

·         Chronic

·         Severe

Opana oxymorphonehydrochloride IR 10 mg 10 -20 mg tablets 4-6 hours ·         Acute

·         Chronic

·         Moderate

·         Severe

Methadone Methadone hydrochloride IR 10mg 2.5-10 mg 3-4 hours ·         Moderate pain

·         Severe pain

60-80 mg daily ·         Addiction treatment
Roxicodone oxycodonehydrochloride IR 20 mg 5-15 mg tablets 4-6 hours ·         Acute

·         Chronic

·         Moderate

·         Severe

OxyContin oxycodone, slow release ER 20 mg 10 mg tablets 12 hours ·         Chronic

·         Moderate

·         Severe

·         Round-the-clock dosing

·         Other opioids ineffective

Percocet oxycodone plus 325 mg acetaminophen IR 20 mg 5-10 mg tablets 3-6 hours ·         Acute

·         Chronic

·         Moderate

·         Severe

Morphine Sulfate morphine sulfate IR 30 mg 15-30 mg tablets 3-4 hours ·         Scute

·         Chronic

·         Moderate

·         Severe

MS Contin morphine sulfate ER 30 mg 15 mg tablets 8-12 hours ·         Chronic

·         Severe

·         Round-the-clock dosing

·         Other opioids ineffective

Vicodin hydrocodonebitartrate plus 300 mg acetaminophen IR 30 mg 5 -10 mg tablets 4-6 hours ·         Acute

·         Chronic

·         Moderate

·         Moderately severe

Codeine There are some brands that are listed here as immediate release, such as Opana, that come in extended release formulations. 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.-Sulfate codeine sulfate IR 200 mg 15-60 mg tablets 3-4 hours ·         Acute

·         Mild

·         Moderate

·         moderately severe

Demerol meperidine hydrochloride IR 300 mg 50-150 mg tablets 3-4 hours ·         Acute

·         Moderate

·         Severe

Ultram tramadol hydrochloride IR 300 mg 25-100 mg tablets 4-6 hours ·         Acute

·         Moderate

·         Moderately severe

 

 

Some of the brands that are listed here as immediate releases, such as Opana, also come in extended release formulations.

 

2016 CDC Guideline for Prescribing Opioids for Chronic Pain and Opioid  Treatment

 

The usage of an opioid completely depends on the level of pain, whether the pain is acute or chronic, as well as a person’s other individual factors. A doctor has to take a note from various sources of opioid prescribing guidelines to ensure the safe use of opioids.

According to the guideline of CDC for Prescribing Opioids, Chronic Pain intends to ease and enhance the communication between providers and patients about the risks and benefits of opioid therapy for chronic pain and improve the safety and effectiveness of pain treatment and also minimize the risks associated with long-term opioid therapy which includes opioid use overdose  and disorder. This Guideline is not intended for the patients who are in palliative care or end-of-life care, active cancer treatment.

There is nothing called as pharmacologic therapy and no opioid pharmacologic therapy that is preferred for chronic pain. If clinicians are using opioids then that should be combined with no pharmacologic therapy and no opioid pharmacologic therapy appropriately.Clinicians should opt for opioid therapy only if benefits expected for both pain and function anticipated to outweigh risks to the patient.

Previous to the start of opioid therapy for chronic pain, it is important for clinicians to establish treatment goals together with all patients, which includes realistic goals for pain and function, and should also take into consideration, how opioid therapy will not be continued if benefits do not outweigh risks. Clinicians should also continue with the opioid therapy only if the results are a clinically meaningful improvement in pain and function and that outweighs risks to patient safety.

Before starting and periodically during opioid therapy, clinicians should discuss with patients known risks and realistic benefits of opioid therapy and patients and clinician responsibilities for managing therapy.

Potency and Risks

Maximum opioids have similar side effects, also the risk of tolerance, dependence and the irreparable changes of opioid addiction, based on the dosage and the duration of use. Be aware that if you misuse or abuse opioids, the greater the risks of overdose and death.

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