Carfentanil is a painkiller and analgesic used on large animals such as elephants and is 10,000 times stronger than morphine. As such, it is not intended for use in humans, as there is no known safe dosage. In recent years, carfentanil, which is likely illicitly produced, has been used as a buffering agent in heroin and other drugs. As a result, it has been responsible for hundreds of deaths in the U.S. Just two milligrams of carfentanil is enough to sedate an elephant. Moreover, law enforcement and first responders have been warned that if bare skin touches even a small amount of carfentanil, severe effects may occur, including death.
In November 2018, the U.S. Food and Drug Administration (FDA) approved Dsuvia, a relatively new prescription opioid. It comes in the form of a sublingual tablet that is placed under the tongue where it dissolves. It induces pain relief rapidly in people (such as combat soldiers) who have experienced profound trauma, such as a gunshot wound or severely broken bone. Dsuvia contains the synthetic opioid sufentanil is five times to 10 times stronger than fentanyl itself, and 1,000 times more potent than morphine. Detractors of the drug claim that an opioid of this strength is unnecessary and will only provide more fuel to the ongoing U.S. opioid overdose crisis.
Fentanyl is a synthetic opioid up to 50 times more potent than heroin. Legally, fentanyl is a prescription drug prescribed to patients to manage severe pain after injury or surgery. It may also be prescribed to patients who suffer from chronic pain who do not respond well to less potent opioids or have built up a physical tolerance to them. Due to its strength and high potential for addiction, Fentanyl is classified as a schedule II drug and is considered to be extremely dangerous. Like carfentanil, just a two-milligram dose of Fentanyl can be lethal in humans.
Heroin is a semi-synthetic opiate derived from the opium alkaloid morphine. Heroin is not considered to have any legitimate medical purpose. Also, heroin’s potency is profoundly affected by other agents used as buffers, which may include fentanyl and other opioids. Heroin has a very high potential for abuse and addiction and can be administered by injecting, snorting, or smoking. It is typically found as a whitish powder or a black sticky substance (black tar heroin). When injected, heroin enters the brain and bloodstream more rapidly than many other opioids, converts back to morphine, and produces near immediate feelings of euphoria.
U-47700 or Pink
U-47700 is an illicit synthetic opioid about 7-8 times more powerful than morphine. It was developed in the 1970s by Upjohn and an intended painkiller but has remained inactive in the pharmaceutical industry. Recently, however, it has resurfaced on the streets, believed by the FDA to be imported from China and Eastern Europe. U-47700 (also known as Pink) is widely available on the black market, and due to its high potency and absence of government regulation, it has health officials very concerned as overdoses continue to increase.
Hydromorphone is another prescription opioid about four times more potent than morphine. It is commonly prescribed as a painkiller under the brand name Dilaudid. Because it has a high potential for abuse, and can quickly lead to both physical and psychological dependence, hydromorphone is classified as a schedule II drug. It has been frequently misused as a heroin substitute because it can be diluted in liquid and injected into the bloodstream, a method that helps the user to experience the effects more rapidly. Indeed, that is precisely how it is administered in hospitals (as an intravenous drip) to treat severe pain.
Oxymorphone is a prescription painkiller about three times as potent as morphine. It used to be found by the brand name Opana and was prescribed to treat moderate to severe pain. It was typically found in tablet form but was sometimes prescribed as an injectable solution. Oxymorphone is classified as a schedule II opioid with a high potential for both abuse and addiction. Its presence in the legal or illicit drug market currently appears to be scant. The makers of Opana, Endo International, has announced in the summer of 2017 that it would voluntarily remove Opana ER from the market, following the FDA’s request to withdraw the reformulated opioid pain medication.
Like oxymorphone, methadone is about three times as potent as morphine. Methadone is primarily used under strict medical supervision to treat addiction or withdrawal symptoms, and non-medical use is illegal. Even though methadone is somewhat chemically dissimilar to heroin and morphine, it still can induce similar effects of euphoria and sedation and lead to abuse, dependence, and addiction.
Oxycodone isn’t considered to be as powerful as the aforementioned opioids, it is still classified as schedule II substance with a high potential for abuse and dependence. It is only about 50% stronger than morphine. Found in brand names pharmaceuticals such as Oxycontin and Percocet, Oxycodone is commonly prescribed to relieve moderate to severe pain. Oxycodone is regularly prescribed in the U.S. and has been misused since the 1960s for its relaxing and euphoric effects.
Derived directly from the opium poppy, morphine is the only true opiate (natural versus synthetic) on the list and is included because the potency of opioids is most often compared to that of morphine. Like its human-made cousins, morphine is a schedule II controlled substance and has been used and misused as an injectable liquid, oral solutions, and ingestible tablets.
Hydrocodone is nearly as potent as morphine and is indicated for the treatment of moderate pain. Common brand names for Hydrocodone include Vicodin and Norco. Hydrocodone is currently the most frequently prescribed painkiller in the U.S. Hydrocodone is a schedule II drug and is an excellent example of how a relatively weak opioid can still be abused and pose significant health risks. In 2011, more than 82,000 emergency room visits were related to the misuse of hydrocodone.
Codeine has a relatively low potency, and is generally used to treat mild to moderate pain, and is frequently used in prescription cough and cold medications. It still has a potential for abuse and overdose, however – in recent years, it’s become popular in the hip hop community as Lean or Sizzurp, a drug cocktail that sometimes also includes Sprite and hard candy.
Meperidine (Demerol) was the first opioid ever synthesized. Meperidine is less potent than most other opioids but is still classified as a schedule II drug because of its potential for abuse. Meperidine is now widely considered to be relatively ineffective when compared to other opioids.
Tramadol’s potency is similar to that of meperidine. However, it is classified as a schedule IV drug and is therefore considered to have less potential for physical dependence, tolerance, and misuse. Nevertheless, tramadol (Ultram) can still be misused by those who suffer chronic pain.
Opioid Addiction Treatment Options
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