The Ultimate Opioid Comparison Guide

Every day, 41 people die from an opioid overdose. Death rates related to opioid addiction have nearly doubled in the last ten years. Keep reading to learn more about the 13 most common opioids and their individual characteristics.

Opioid Overdose and Death Rates

In 2016, 62 people per 100,000 visited the emergency room because of an opioid overdose. In the same year, the hospitalization rate for non-fatal opioid overdoses was 27 people per 100,000. Sadly, the overdose death rate that year was 13 people per 100,000. Death rates more than doubled in a 10-year period from 2006 to 2016.

The dangers of opioid use are evident in the above statistics provided by the Centers for Disease Control and Prevention (CDC). More importantly, it is critical to understand the distinctions between the various types of opioids and their strengths and severity.

Most Common Opioids

Even those prescribed opioids for pain relief are at risk of misuse, but some of the most commonly misused opioids are illicitly manufactured synthetic opioids. The opioids we feature in this guide are ordered from the lowest strength to the highest strength:

  1. Codeine
  2. Demerol
  3. Tramadol
  4. Morphine
  5. Vicodin
  6. Percocet
  7. Methadone
  8. Heroin
  9. Hydromorphone
  10. Oxymorphone
  11. Suboxone
  12. Fentanyl
  13. Carfentanil

Are you dependent on or addicted to one or more of the 13 most common opioids? Begin your opioid addiction recovery today by calling Asheville Recovery Center at (828) 518-6996.

Opioid Comparison Charts

In this ultimate opioid comparison guide, we examine more closely each of the opioids and compare the following characteristics:

  • Commercial, generic, and street names
  • Forms
  • Methods of use
  • Strength as compared to morphine
  • Fatal dosages
  • Short-term side effects
  • Long-term side effects
  • Overdose symptoms
  • Withdrawal symptoms
  • Withdrawal timelines

Commercial, Generic, and Street Names of Opioids

Do you know the language surrounding opioids and what they look like?

With the exception of heroin, the majority of opioids begin in a pill form because they are manufactured by pharmaceutical companies and prescribed by physicians. Widely available opioids such as morphine are manufactured by many different companies, so the pills come in different shapes, colors, and doses.

To get specific information based on a pill you possess, use WebMD’s pill identifier.

Commercial NameGeneric NameStreet Names
FioricetCodeineCaptain Cody, Coties, Schoolboy
With soft drinks/candy: Lean, Sizzurp, Purple Drank
With hypnotic sedatives: Doors & Fours, Loads, Pancakes and Syrup
DemerolMeperidineDemmies, Pain Killer
UltramTramadolChill Pills, Trammies, Ultras
DuramorphMorphineDreamer, First Line, Joy Juice, Morpho, Miss Emma, Monkey, White Stuff, Mister Blue, Unkie
VicodinHydrocodoneVikes, Veeks, Idiot Pills, Scratch, 357s, Lemonade, Bananas, Dones, Droco, Lorries
With valium and vodka: Triple V
PercocetOxycodone30s, 40s, 512s, Oxy, Beans, Blues, Buttons, Cotton, Kickers, Killers, Percs, Roxy
DolophineMethadoneAmidone, Biscuits, Fizzies , Jungle Juice, Maria, Wafer
With MDMA: Chocolate Chip Cookies
HeroinN/ABrown sugar, China White, Dope, H, Horse,
Junk, Skag, Skunk, Smack, White Horse
With OTC cold medicine and antihistamine: Cheese
DilaudidHydromorphoneD, Dillies, K4, Needle Candy
OpanaOxymorphoneBiscuits, Blue Heaven, Blues, Mrs. O, O Bomb, Octagons, Stop Signs
SuboxoneBuprenorphineBig Whites, Buse, Oranges, Small Whites, Sobos, Stops, Strips, Sub, Subs
DuragesicFentanylApache, Blonde, Blue Diamond, Blue Diamond, China Buffet, China White, Snowflake, Humid, Jackpot, Murder 8, Tango and Cash, TNT, White Ladies,
With heroin: Birria
WildnilCarfentanilDrop dead, Serial killer, Gray death, TNT

However, once the opioid becomes a powder, it is very difficult to know what you are getting into. In fact, oftentimes, dealers will disguise or combine multiple opioids to increase earning potential. Unfortunately, this also increases the potential for overdose.

Opioid Forms and Strengths

We continue to order the 13 most common opioids from weakest to strongest. Many opioids are derivatives of morphine; therefore, the strength of each one is compared to the strength of morphine itself. Also included is the potentially fatal dose of each opioid.

DrugForms and MethodsStrength (compared to Morphine)Potentially Fatal Dose (approx)
CodeineTablet, capsule, liquid
Injected, swallowed (often mixed with soda and flavorings)
mildest500 milligrams
DemerolTablet, liquid
Swallowed, snorted, injected
7 to 10 times less600 milligrams
TramadolTablet, capsule, liquid
Swallowed, oral drops, injectioned
one tenth300 milligrams
MorphineTablet, liquid, capsule, suppository
Injected, swallowed, smoked
N/A200 milligrams
VicodinCapsule, liquid, tablet
Swallowed, snorted, injected
similar325 milligrams
PercocetCapsule, liquid, tablet
Swallowed, snorted, injected
2 times more325 milligrams
MethadoneTablet, dispersible tablet, liquid
Swallowed, injected
3 times more30 milligrams
HeroinWhite or brownish powder, or black sticky
substance known as “black tar heroin”
Injected, smoked, snorted
2 to 5 times more30 milligrams
HydromorphoneLiquid, suppository
Injected, rectal
2 to 8 times more25 milligrams
OxymorphoneTablet
Swallowed, snorted, injected
3 to 10 times more40 milligrams
SuboxoneTablet, oral film (tongue, cheek)25 to 100 times more12 milligrams
FentanylLozenge, sublingual tablet, film, buccal tablet
Injected, smoked, snorted
50 to 100 times more3 milligrams
CarfentanilLiquid, powder
Injected, smoked, snorted
10,000 times more2 milligrams (10 mg is used to sedate elephants)

Keep in mind that any powder form you obtain could be a combination of several opioids, so it is difficult to know the strength and danger unless you know the exact composition. Fentanyl is often sold as “more potent” heroin, but fentanyl is nearly ten times stronger than heroin and only 3 milligrams is a potentially fatal dose.

Opioid Short-Term and Long-Term Side Effects

In the table below, you will see similar side effects across all opioids provided by the National Institute on Drug Abuse (NIDA). Depending on the individual, some short-term side effects may be more severe. The long-term effects, however, lead to horrific outcomes.

DrugShort-term Side EffectsLong-Term Side Effects
CodeineNausea and vomiting; Excessive drowsiness, dysphoria or confusion; Dry mouth; Constipation; Allergic skin reaction or rash.Insomnia; Nightmares; Pain when not using the drug; Liver damage secondary to acetaminophen toxicity; Seizures.
DemerolDrowsiness; Confusion; Nausea; Constipation; Low blood pressure; Low body temperature; Pinpoint pupils; Slurred speech; Slowed movement; Slowed pulse rate; Slowed breathing.Hypoxia (inadequate oxygenation of blood and tissues); Brain damage; Psychological problems such as anxiety and depression.
TramadolNausea; Vomiting; Constipation; Lightheadedness or dizziness; Drowsiness; Headache; Loss of appetite; Dry mouth.Anxiety; Insomnia; Seizures.
MorphineNausea; Vomiting; Itchy skin; Appetite loss; Constricted, or pinpoint pupils; Urinary retention; Constipation; Shallow or slowed breathing; Altered or irregular heart rate and rhythm; Chest pain; Cyanosis (blue tint to skin, lips, fingernails, etc); Dizziness; Confusion; Agitation; Seizures.Chronic constipation; Poor appetite; Reflux; Bloating; Stomach pain; Dry mouth; Weight loss.
VicodinNausea; Constipation; Slowed breathing; Dizziness or lightheadedness; Impaired judgment; Confusion; Profound drowsiness; Loss of consciousness.Hearing Loss; Chronic Constipation; Liver Damage; Kidney Failure; Cardiovascular Damage; Brain Damage; Reproductive Problems.
PercocetMood changes; Drowsiness; Headache; Dizziness; Dry mouth; Flushing; Sweating; Itching; Stomach pain; Nausea; Vomiting; Constipation; Loss of appetite; Weakness.Liver damage; Kidney failure; Severe constipation; Urinary retention; Slightly decreased testosterone levels in men.
MethadonePinpoint pupils; Respiratory depression; Nausea; Lethargy; Mood swings.Impaired Judgement; Heart problems.
HeroinDry mouth; Itching; Nausea; Vomiting; Analgesia; Slowed breathing and heart rate.Collapsed veins; abscesses (swollen tissue
with pus); infection of the lining and valves in the
heart; constipation and stomach cramps; liver or
kidney disease.
HydromorphoneHeadache; Pinpoint pupils; Stomach cramps; Constipation; Nausea; Vomiting; Muscle aches and pains; Dry mouth; Appetite loss; Dizziness/lightheadedness; Drowsiness; Anxiety; Itchiness; Rash; Hoarse voice; Loss of consciousness; Blood pressure changes; Slowed breathing; Seizures.Infections and diseases from needle sharing (HIV, hepatitis, etc.); Track marks on arms and/or legs; Frequent mood swings; Anxiety; Depression.
OxymorphoneLight-headedness; Sleepiness; Slowed respiratory rate; Headache; Dizziness; Fainting; Abdominal pain; Nausea; Vomiting; Constipation.Chronic constipation; Weight loss due to stomach upset and appetite changes; Low heartbeat and low blood pressure; Brain damage due to lack of oxygen in the bloodstream from respiratory depression; Thyroid changes, which can change mood and weight; Muscle weakness or atrophy; Memory loss.
SuboxoneConstipation; Nausea and vomiting; Muscle aches; Insomnia; Irritability; Fever.Confusion; Dizziness; Pupil constriction; Hallucinations; Low blood pressure; Respiratory depression; Seizure; Coma.
FentanylNausea; Vomiting; Constipation; Altered heart rate; Slowed breathing rate; Confusion; Hallucinations; Weakness; Sweating; Itchy skin; Constricted pupils; Seizures.Increase your risk for anoxic injury (damage due to significantly decreased oxygen in the body tissues) and multiple organ system damage; Initiate, or worsen, mental health conditions.
CarfentanilNausea; Drowsiness; Restlessness; Sweating; Runny nose; Insomnia; Difficulty concentrating; Depression; Muscle aches; Anxiety; Disorientation; Pinpoint pupils; Clammy skin; Sedation; Death.So dangerous, long-term effects have not been documented. Most users overdose and die if they make it through their first use.

Consequently, it doesn’t matter the length of time of use or the time since the last use, anyone who uses any type of opioid is at risk for long-term health complications, especially breathing problems.

The side effects of opioid use and withdrawal symptoms can be very unpleasant. Dial (828) 518-6996 to speak with an Asheville Recovery Center representative to learn more about how we can help.

Opioid Overdose and Withdrawal Symptoms

Similar to short-term side effects, an overdose on the various opioids present similar symptoms. Withdrawal symptoms are often worse than side effects. The peak of withdrawal of the majority of opioids will be 72 hours after the last use. However, the withdrawal timeline based on the type of opioid can vary widely.

DrugOverdose SymptomsWithdrawal SymptomsWithdrawal Timeline
CodeineCyanosis, or blue lips or skin; Loss of consciousness; Pinpoint pupils; Lack of a pulse; Shallow or halted breathing; Sluggish pulse or slowed heartbeat; Chest pain; Frequent vomiting; Extreme fatigue.Irritability; Anxiety and depression; Difficulty sleeping; Muscle aches; Sweating; Stomach cramps; Diarrhea; Nausea and vomiting.2 weeks
DemerolCold and clammy skin; Bluish tinge to lips, tongue and nail beds; Loss of muscle strength; Bradycardia (slow heart rate); Respiratory depression; Extreme fatigue, Blurry vision; Vertigo or dizziness; Syncope or fainting; Coma.Restlessness; Involuntary leg movements; Cold flashes; Insomnia; Anxiety; Agitation; Runny nose; Sweating; Dilated pupils; Dilated pupils; Gastrointestinal distress (nausea, vomiting, diarrhea).3 to 10 days
TramadolDecreased size of the pupils of the eyes (miosis); Slow breathing or difficulty breathing; Extreme drowsiness.
Cold, clammy skin; Slow or irregular heartbeat; Seizure; Loss of consciousness; Coma.
Gastrointestinal pain; Depression; Diarrhea; Agitation; Numbness in the extremities; Ringing in the ears; Hallucinations; Paranoia; Agitation; Confusion.2 weeks
MorphineA cold or clammy feel to the skin; Bluish hue in the fingertips and lips; Constricted (small) pupils; Blurry vision; Nausea; Vomiting; Severe constipation; Severely slowed or irregular breathing; Slow heartbeat; Limp muscles; Severe sleepiness; Loss of consciousness; Coma.Extreme drug cravings; Anxiety; Irritability; Sweating; Runny nose; Diarrhea; Decreased appetite; Cramping; Vomiting; Chills.5 to 7 days
VicodinNausea/vomiting; Constricted/pinpoint pupils; Hypotension (low blood pressure); Fatigue; Weak pulse; Slowed/shallow/difficult breathing; Respiratory arrest; Cyanosis (blue tint to lips and fingernails); Coma; Seizures.Pain in the muscles and bone; Difficulty sleeping; Restlessness and uncontrollable leg movements; Nausea and vomiting; Diarrhea; Feeling cold.7 to 10 days
PercocetAbnormally constricted or dilated pupils; Limp or weak muscles; Difficulty breathing; Slowed or stopped breathing; Slow or stopped heartbeat; Cyanosis (blue color of skin, fingernails, lips, or mouth area); Cold, clammy skin; Extreme drowsiness; Dizziness; Fainting; Loss of consciousness or coma.Irritability, anxiety, and depression; Difficulty falling asleep or staying asleep; Restlessness; Muscle or joint aches and pains; Muscle weakness; Stomach cramps; Nausea/vomiting; Loss of appetite; Diarrhea; Increased heart and breathing rate; Flu-like symptoms (sneezing, runny nose, watering eyes, sweating, chills).4 to 7 days
MethadoneDizziness; Drowsiness; Weak pulse; Low blood pressure; Muscle twitches; Confusion; Nausea and vomiting; Slowed heartbeat; Weak muscles; Clammy skin; Gray or bluish tint to the skin.Agitation and irritability; Anxiety; Aches and increased pain; Watery eyes and runny nose; Trouble sleeping; Sweating; Frequent yawning; Stomach cramps; Goose bumps; Diarrhea; Nausea; Vomiting.Up to 21 days
HeroinBluish nails or lips; Depressed breathing; Weak pulse; Pinpoint pupils; Disorientation or delirium; Extreme drowsiness; Repeated episodes of loss of consciousness; Coma.Restlessness; Muscle and bone pain; Insomnia; Diarrhea; Vomiting; Cold flashes with goose bumps
(“cold turkey”).
1 week
HydromorphoneCold, clammy skin; Blue tint to lips, tongue, fingernails, toenails, etc; Decreased muscle strength; Markedly constricted or pinpoint pupils; Dilated, non-reactive pupils indicating brain injury from lack of oxygen; Bradycardia (slowed heart rate); Hypotension (low blood pressure); Fatigue; Dizziness; Fainting; Stupor; Respiratory depression; Respiratory collapse; Coma.Loss of appetite; Runny nose; Teary eyes; Yawning; Restlessness; Fast breathing; Increased heart rate; Sweating; Chills; Stomach pain; Diarrhea; Nausea; Vomiting; Muscle or joint pain; Insomnia.1 to 2 weeks
OxymorphoneRespiratory depression or arrest; Cold and clammy skin; Pupil constriction or dilation; Cyanosis (bluish tint to fingernails, skin, and lips); Muscle weakness; Extreme drowsiness; Loss of consciousness.Anxiety; Restlessness; Insomnia; Fast heartbeat; Watery eyes; Sweating; Chills; Diarrhea; Nausea; Vomiting.5 to 7 days
SuboxoneProfound drowsiness; Intermittent loss of consciousness; Lack of coordination; Slurred speech; Vision problems; Slowed breathing; Sluggish reflexes.Irritability; Anxiety; Body aches and cramping; Insomnia.
Sweating; Dilated pupils; Nausea; Diarrhea; Vomiting; Intense opioid cravings.
1 week to 1 month
FentanylDifficulty swallowing; Extreme fatigue; Dizziness and fainting; Shallow, difficult breathing / respiratory arrest; Cardiac arrest; Non-responsiveness to painful stimuli; Severe confusion; Obtundation (altered level of consciousness).Loss of appetite; Tremors; Agitation; Anxiety/panic; Fever and chills; Sweating; Nausea / vomiting; Runny nose; Diarrhea; Intense drug cravings.5 to 7 days
CarfentanilMost often, death; Respiratory depression or arrest; Drowsiness, Disorientation; Sedation; Pinpoint pupils; Clammy skin. Insomnia; Irritability; Low energy; Anxiety; Fever; Sweating; Teary eyes; Muscle aches and pain; Diarrhea; Abdominal cramping; Nausea and vomiting; Yawning2 weeks

Expect the physical symptoms of withdrawal from any opioid to last at least one week. Unfortunately, weeks, months, or even years after use, psychological symptoms from opioid withdrawal such as depression and anxiety will linger.

Opioid Interactions with other Drugs

Consistent across most opioids, alcohol use will increase the severity of side effects. Provided by Frontiers in Pharmacology, below is a list of other types of drugs that will also increase the dangers of opioid use.

  • Anticholinergics (dicycloverine)
  • Antihistamines (hidroxycine, prometazine, diphenhydramine, chlorphenyramine, doxylamine)
  • Antiinflammatory or analgesic drugs (Ibuprofen, acetaminophen, salicylic acid, naproxen)
  • Antidepressants (fluoxetine, mirtazapine, citalopram, sertraline, amitriptyline, venlafaxine)
  • Antipsychotics (clorprormazine, risperidone, quetiapine, olanzapine, doxepin, promethazine)
  • Anticonvulsants (pregabalin, clonazepam, gabapentin, carbamazepine)
  • Barbiturates (phenobarbital)
  • Benzodiazepines (diazepam, alprazolam, nordiazepam, chlordiazepoxide, etizolam, lorazepam)
  • Stimulants (ephedrine, cocaine, amphetamine, nicotine, mephedrone)

Sometimes combining opioids with particular medications can lead to death. Before mixing, be sure to contact a pharmacist for recommendations.

Explore your opioid addiction treatment options today. Dial (828) 518-6996 to speak with an Asheville Recovery Center representative to begin your journey.

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