Pain Medication List: Most Dangerous to Safest

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The U.S. is in the midst of an opioid epidemic, fueled to a certain degree by the overprescription of pain medications by medical professionals. When viewed in this context, it’s hardly surprising that pain medications have become the Jekyll and Hyde of the medical landscape. Pain is debilitating and has the potential to limit your enjoyment of life. When prescribed appropriately, pain medications can minimize pain and restore quality of life.

Unfortunately, they have a dark side. Most pain medications are opioids. This means they are addictive. Tolerance levels wane after extended use, meaning higher doses are necessary to maintain a pain-free lifestyle. This increases the likelihood of developing a long-term addiction. Even if an addiction is treated successfully, the challenges remain. Few pain medications can ease severe pain that is not opiate-based. This leads to the question, what pain relief is appropriate if you are a recovering addict? The following list details the main pain medications, from most potent to least potent.

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An image of a nurse prescribing a pain medication list


The synthetic opioid carfentanil tops the list as the most potent pain medication in the U.S. today. It’s around 100 times stronger than fentanyl and 10,000 times more potent than morphine. The potency of carfentanil is such that it’s not approved for human use in any clinical capacity. The only clinical setting it has a place in is veterinary medicine, where it’s used as a large animal tranquilizer.

Despite this, carfentanil is available on the street, with law enforcement first aware of it in the early 2000s. Due to its potency, there are ongoing concerns regarding the limited effectiveness of naloxone in the event of an overdose. In most instances, multiple doses or an infusion are necessary to reverse the effects of carfentanil.


The next most potent pain medication is fentanyl, with research suggesting it’s more than 100 times stronger than morphine. Fentanyl is a synthetic opioid. Initially, fentanyl was only prescribed in a hospital setting. However, over time, it has become more common in the community, where it’s especially effective in the management of the severe pain associated with end-stage cancer.

At a street level, the use of fentanyl and the number of related overdose deaths have steadily increased over the last few years. In 2010, 14.3% of overdoses involved fentanyl. This increased to 59% in 2017. For many drug dealers, fentanyl is an opportunity to reduce costs, with only a small quantity necessary to produce a high. This has resulted in it being mixed with other drugs without the user’s knowledge.


Rounding out the top three most potent pain medications is buprenorphine. While it’s extremely effective in treating moderate to severe pain, buprenorphine is more commonly used in the treatment of opioid addiction, with small doses helping to ease the symptoms of withdrawal.

Although the strength of buprenorphine is similar to fentanyl, its overall potency is limited by what is known as the “ceiling effect.” This means its effectiveness plateaus, and additional dosing provides almost no additional benefit. Unfortunately, this can be dangerous, as it’s easy for someone unaware of this limitation to overdose in an attempt to experience a high.


Hydromorphone is more commonly known by its brand name, Dilaudid. It’s around five times more potent than morphine and is effective in managing both acute and chronic pain that is moderate to severe.

Addicts frequently “doctor shop” to obtain scripts for hydromorphone, presenting at different medical clinics and hospitals until they receive the script they are after.


Sitting below hydromorphone in the pain medication hierarchy is heroin. Despite being about four times as potent as morphine and efficacious in managing moderate pain, heroin is not used extensively in a medical setting.

Heroin is more well-known as an illicit substance and is one of the drugs at the heart of the current opioid crisis in the U.S. It’s easily accessible and relatively cheap, making it popular across all sectors of society.

Obtaining scripts for other medications to satisfy an addiction can be costly and time-consuming. Heroin is often the first substitute when those prescribed medications become unaffordable.


Although methadone sits at number seven in the pain management potency stakes, it’s more well-known for its role in the recovery and treatment of opioid addiction. Despite sharing many of the same properties as morphine, methadone has one notable point of difference: It limits the euphoric effects of other opioids.

This means methadone is a welcome addition to the addict’s toolkit for recovery and can assist them through the detoxification and rehabilitation process. Taking a small dose of methadone can help overcome the symptoms associated with withdrawal.


Oxycodone is around one and a half times more potent than morphine. It’s effective in alleviating moderate pain. Oxycodone is the first-line pain relief option of a number of medical professionals. It’s an extended-release medication, so the medication is released at a consistent rate, which helps keep pain levels under control.

Research has found oxycodone is one of the most over-prescribed drugs in the U.S. One study found that 78.6% of those who received an oxycodone script at the emergency department received the maximum dose the doctor could prescribe during the consultation.


Hydrocodone is marginally more potent than morphine, sitting immediately above it on the list. It’s the most frequently prescribed pain medication in the U.S., with many scripts stolen to meet the demand of addicts.


Most people have heard of morphine, with many believing it to be one of the most effective pain medications. Morphine is extremely effective in treating moderate pain. It can be prescribed in a short-acting (or immediate-release) and a long-acting (or extended-release) form, meaning dosing can be manipulated to ensure 24-hour pain coverage is available.


Codeine sits at the foot of the opioid pain medication hierarchy. It’s generally prescribed for mild to moderate pain. Don’t be deceived regarding the addictive qualities of codeine. Codeine is still an opioid and has the same addictive qualities as the other medications on the list.

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Pain Medication Addiction Treatment at California detox

Understanding the role of each of these medications in pain management is vital if you have struggled with addiction. Being an addict does not mean you are condemned to a life with pain in the future. Talking to your treating medical professional and support team at California Detox in Laguna Beach is essential.

Call our team at (949) 694-8305 today to get started on your recovery journey.


Generally, non-opioid pain relievers such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are safer options for older adults.
Doctors typically prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, and acetaminophen for mild to moderate pain. For severe pain, doctors may prescribe opioids such as morphine, oxycodone, or hydrocodone.


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