{{Short description|Comparison of equivalent doses of pain medications}} {{cs1 config|name-list-style=vanc}} An '''equianalgesic''' chart is a conversion chart that lists equivalent doses of analgesics (drugs used to relieve pain). Equianalgesic charts are used for calculation of an equivalent dose (a dose which would offer an equal amount of analgesia) between different analgesics.{{sfn|Joishy|1999}} Tables of this general type are also available for NSAIDs, benzodiazepines, depressants, stimulants, anticholinergics and others.
When using oral morphine as a baseline, the comparison of strengths of opioid analgesics is referred to as '''oral morphine equivalent'''.
==Format== Equianalgesic tables are available in different formats, such as pocket-sized cards for ease of reference.{{sfn|Joishy|1999}} A frequently-seen format has the drug names in the left column, the route of administration in the center columns and any notes in the right column.{{sfn|McPherson|2009|loc=p. 5}}{{sfn|Natusch|2012}}
==Purpose== There are several reasons for switching a patient to a different pain medication. These include practical considerations such as lower cost or unavailability of a drug at the patient's preferred pharmacy, or medical reasons such as lack of effectiveness of the current drug or to minimize adverse effects. Some patients request to be switched to a different narcotic due to stigma associated with a particular drug (e.g. a patient refusing methadone due to its association with opioid addiction treatment).{{sfn|McPherson|2009|loc=p. 3}} Equianalgesic charts are also used when calculating an equivalent dosage of the same drug, but with a different route of administration.{{citation needed|date=February 2022}}
==Precautions== An equianalgesic chart can be a useful tool, but the user must take care to correct for all relevant variables such as route of administration, cross tolerance, half-life and the bioavailability of a drug.{{sfn|McPherson|2009|loc=p. 4}} For example, the narcotic levorphanol is 4–8 times stronger than morphine, but also has a much longer half-life. Simply switching the patient from 40 mg of morphine to 10 mg of levorphanol would be dangerous due to dose accumulation, and hence frequency of administration should also be taken into account.
There are other concerns about equianalgesic charts. Many charts derive their data from studies conducted on opioid-naive patients. Patients with chronic (rather than acute) pain may respond to analgesia differently. Repeated administration of a medication is also different from single dosing, as many drugs have active metabolites that can build up in the body.{{sfn|McPherson|2009|loc=p. 8}} Patient variables such as sex, age, and organ function may also influence the effect of the drug on the system. These variables are rarely included in equianalgesic charts.{{sfn|McPherson|2009|loc=p. 9}}{{sfn|Natusch|2012}}{{sfn|Anderson et al|2001}}
{{anchor | Table}}
==Opioid equivalency table== Opioids are a class of compounds that elicit analgesic (pain killing) effects in humans and animals by binding to the μ-opioid receptor within the central nervous system. The following table lists opioid and non-opioid analgesic drugs and their relative potencies. Values for the potencies represent opioids taken orally unless another route of administration is provided. As such, their bioavailabilities differ, and they may be more potent when taken intravenously.<ref name="Oral vs IV bioavailability">{{cite journal |last1=Cyriac |first1=JM |last2=James |first2=E |title=Switch over from intravenous to oral therapy: A concise overview. |journal=Journal of Pharmacology & Pharmacotherapeutics |date=April 2014 |volume=5 |issue=2 |pages=83–7 |doi=10.4103/0976-500X.130042 |pmid=24799810 |doi-access=free |pmc=4008927}}</ref>
===Nonlinearities=== This chart measures pain relief versus mass of medication. Not all medications have a fixed relationship on this scale. Methadone is different from most opioids because its potency can vary depending on how long it is taken; acute use (1–3 days) yields a potency about 1.5× stronger than that of morphine and chronic use (7 days+) yields a potency about 2.5 to 5× that of morphine.<ref name="Approximate opioid potency">{{cite journal |title=Table A6.2, Approximate potency of opioids relative to morphine; PO and immediate-release formulations unless stated otherwise |journal=WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents |date=2018 |url=https://www.ncbi.nlm.nih.gov/books/NBK537482/table/appannex6.tab2/ |access-date=14 April 2025 |publisher=World Health Organization}}</ref><ref name="Methadone long half-life">{{cite journal |last1=Talal |first1=Andrew H. |last2=Ding |first2=Yuxin |last3=Venuto |first3=Charles S. |last4=Chakan |first4=Lindsay M. |last5=McLeod |first5=Anthony |last6=Dharia |first6=Arpan |last7=Morse |first7=Gene D. |last8=Brown |first8=Lawrence S. |last9=Markatou |first9=Marianthi |last10=Kharasch |first10=Evan D. |title=Toward precision prescribing for methadone: Determinants of methadone deposition |journal=PLOS ONE |date=17 April 2020 |volume=15 |issue=4 |article-number=e0231467 |doi=10.1371/journal.pone.0231467 |pmid=32302325 |doi-access=free |pmc=7164646|bibcode=2020PLoSO..1531467T }}</ref> This is called a dose-dependent potency curve and makes methadone somewhat unique among opioids, thought to be caused by the NMDA receptor activity of the drug then altering the behaviour of the opioid receptors<ref>https://www.tandfonline.com/doi/full/10.3402/jchimp.v2i4.19541#d1e252</ref> that other opioids might target. Similarly, the effect of tramadol increases after consecutive dosing due to the accumulation of its active metabolite and an increase of the oral bioavailability in chronic use.<ref name="Tramadol pharmacology">{{cite journal |last1=Dayer |first1=Pierre |last2=Desmeules |first2=Jules |last3=Collart |first3=Laurence |title=Pharmacologie du tramadol |journal=Drugs |date=1997 |volume=53 |issue=Supplement 2 |pages=18–24 |doi=10.2165/00003495-199700532-00006 |pmid=9190321 |language=French}}</ref><ref name="Ultram">{{Cite web|url=http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020281s032s033lbl.pdf|archive-url=https://web.archive.org/web/20140901191017/http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020281s032s033lbl.pdf|archive-date=September 1, 2014|title=ULTRAM® (tramadol hydrochloride) Tablets Full Prescribing Information|date=March 2008|website=Food and Drug Administration|publisher=Ortho-McNeil Pharmaceutical, Inc.|page=4|access-date=December 28, 2016|quote=The mean terminal plasma elimination half-lives of racemic tramadol and racemic M1 are 6.3 ± 1.4 and 7.4 ± 1.4 hours, respectively. The plasma elimination half-life of racemic tramadol increased from approximately six hours to seven hours upon multiple dosing.}}</ref>
{{Warning|Just looking at our own pages on some of these, the equivalency, even factoring in delivery, are off - e.g. what the chart lists as the 2 most potent. R-30490 is more and less potent than carfentanyl? No.|reason=Some of the data in this table has not been properly sourced and may well be unreliable.}}<!-- Please place drugs by relative strength, in opioid or non-opioid section. -->
{{sticky table start}} {| class="wikitable sortable sticky-table-row1" style="background: #FFFFFF; border: 2px #FFFFFF solid; border-collapse: collapse; font-size: 95%;" |+ colspan="9" style="background:#3A5274; color: #FFFFFF; text-align: center; border: 5px #ffffff solid;" | '''Comparison to oral morphine{{efn|Approximate. There is a wide range of values in controlled trials.{{sfn|Pereira et al|2001}}}}''' |- ! Analgesic ! Strength<br /><small>(relative)</small> ! Equivalent dose<br /><small>(10 mg oral morphine)</small>{{efn| 10 mg oral morphine is equivalent to n mg analgesic drug x, e.g. 10 mg morphine is equivalent to 3600 mg paracetamol or 1.5 mg hydromorphone}} ! Bioavailability ! Half-life of active metabolites<br /><small>(hours)</small> ! Oral-to-parenteral ratio ! Speed of onset ! Duration |- style="background: #F2F7F3" |Paracetamol<ref name="Non-opioid analgesic potency" /> (non-opioid) |data-sort-value="0.0027777778"|{{frac|1|360}} |3600 mg |63–89% |1–4 | |37 min (PO); 8 min (IV) |5–6 hours |- style="background: #F2F7F3" | Aspirin<ref name="Non-opioid analgesic potency" /> (NSAID, non-opioid) |data-sort-value="0.0027777778"|{{frac|1|360}} | 3600 mg | 80–100% | 3.1–9 | | | |- style="background: #F2F7F3" | Ibuprofen<ref name="Non-opioid analgesic potency">{{cite web|url=http://www3.us.elsevierhealth.com/PAIN/pdf/Chart2a.pdf|title=Dosing Guidelines for Acetaminophen and Selected NSAIDs|publisher=Mosby|website=Elsevier Health|access-date=2022-11-22|language=en|date=1999}}</ref> (NSAID, non-opioid) |data-sort-value="0.0045045045"|{{frac|1|222}} | 2220 mg | 87–100% | 1.3–3 | | | |- style="background: #F2F7F3" | Diflunisal<ref name="Non-opioid analgesic potency" /> (NSAID, non-opioid) |data-sort-value="0.0062500000"|{{frac|1|160}} | 1600 mg | 80–90% | 8–12 | | | |- style="background: #F2F7F3" | Naproxen<ref name="Non-opioid analgesic potency" /> (NSAID, non-opioid) |data-sort-value="0.0072463768"|{{frac|1|138}} | 1380 mg | 95% | 12–24 | | | |- style="background: #F2F7F3" |Indomethacin<ref>{{cite book |author1=Akul Munjal |author2=Abdallah E. Allam |title=Indomethacin |date=28 May 2024 |publisher=StatPearls Publishing |pmid=32310396 |url=https://www.ncbi.nlm.nih.gov/books/NBK555936/ |access-date=23 March 2025}}</ref><ref name="Indomethacin">{{cite journal |last1=El-Mashad |first1=Abd El-Rahman |last2=El-Mahdy |first2=Heba |last3=El Amrousy |first3=Doaa |last4=Elgendy |first4=Marwa |title=Comparative study of the efficacy and safety of paracetamol, ibuprofen, and indomethacin in closure of patent ductus arteriosus in preterm neonates |journal=European Journal of Pediatrics |date=February 2017 |volume=176 |issue=2 |pages=233–240 |doi=10.1007/s00431-016-2830-7 |pmid=28004188 }}</ref> (NSAID non-opioid) |data-sort-value="0.0156250000"|{{frac|1|64}} | | | | | | |- style="background: #F2F7F3" | Diclofenac<ref name="Non-opioid analgesic potency"/><ref>{{Cite web |title=Diclofenac (Voltaren®) vs Naproxen (Aleve®, Naprosyn®) - eMedExpert.com |url=https://www.emedexpert.com/compare-meds/diclofenac-vs-naproxen.shtml |access-date=2022-11-22 |website=www.emedexpert.com}}</ref> (NSAID, non-opioid) |data-sort-value="0.1000000000"|{{frac|1|10}} | 100 mg (est.) | 50–60% | 1–4 | | | |- style="background: #F2F7F3" |Ketorolac<ref>Pharma Guide Pre-Work 3rd Edition</ref><ref name="Ketorolac 1">{{cite journal |last1=O'Hara |first1=Dorene A |last2=Fragen |first2=Robert J |last3=Kinzer |first3=Mary |last4=Pemberton |first4=Donna |title=Ketorolac tromethamine as compared with morphine sulfate for treatment of postoperative pain |journal=Clinical Pharmacology and Therapeutics |date=May 1987 |volume=41 |issue=5 |pages=556–561 |doi=10.1038/clpt.1987.71 |pmid=3568540 }}</ref> (NSAID, non-opioid) |data-sort-value="0.3333333333"|{{frac|1|3}} |30 mg IM (est.)<ref name="Ketorolac 2">{{cite journal |last1=Yee |first1=James P. |last2=Koshiver |first2=John E. |last3=Allbon |first3=Carolyn |last4=Brown |first4=Colin R. |title=Comparison of Intramuscular Ketorolac Tromethamine and Morphine Sulfate for Analgesia of Pain After Major Surgery |journal=Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy |date=10 September 1986 |volume=6 |issue=5 |pages=253–261 |doi=10.1002/j.1875-9114.1986.tb03485.x |pmid=3540877 }}</ref> |80–100% |5–7 | | | |- style="background: #F2F7F3" | Nefopam<ref name="Nefopam">{{cite journal |last1=Sunshine |first1=Abraham |last2=Laska |first2=Eugene |title=Nefopam and morphine in man |journal=Clinical Pharmacology & Therapeutics |date=November 1975 |volume=18 |issue=5part1 |pages=530–534 |doi=10.1002/cpt1975185part1530 |pmid=1102231 }}</ref> (Centrally-acting non-opioid) |data-sort-value="0.6250000000"|{{frac|5|8}} | 16 mg IM (est.) | | Nefopam: 3–8, Desmethylnefopam 10–15 | | | |- style="background: #F2F7F3" | Piroxicam<ref name="Piroxicam potency">{{cite journal |last1=Moore |first1=R Andrew |last2=Edwards |first2=Jayne |last3=Loke |first3=Yoon Kong K |last4=Derry |first4=Sheena |last5=McQuay |first5=Henry J |title=Single dose oral piroxicam for acute postoperative pain |journal=Cochrane Database of Systematic Reviews |date=23 October 2000 |volume=2019 |issue=5 |article-number=CD002762 |doi=10.1002/14651858.CD002762 |pmid=11034755 |pmc=4176623}}</ref><ref name="Piroxicam duration">{{cite journal |last1=Brogden |first1=R.N. |last2=Heel |first2=R.C. |last3=Speight |first3=T.M. |last4=Avery |first4=G.S. |title=Piroxicam: A Review of its Pharmacological Properties and Therapeutic Efficacy |journal=Drugs |date=September 1981 |volume=22 |issue=3 |pages=165–187 |doi=10.2165/00003495-198122030-00001 |pmid=7021122 }}</ref><ref name="Piroxicam onset">{{cite book |title=Management of Pain & Anxiety in the Dental Office |chapter=Therapeutic Uses of Non-Opioid Analgesics |date=2002 |pages=97–113 |doi=10.1016/B0-7216-7278-7/50011-3 |isbn=978-0-7216-7278-6 | vauthors = Dionne RA, Berthold C, Cooper SA }}</ref> (NSAID non-opioid) |3 |6.66 mg | | | |2–4 hours |40 hours |- | Dextropropoxyphene<ref name="dea.gov">{{cite book |chapter=Ch. 4 Narcotics: Synthetic Narcotics: Dextropropoxyphene |chapter-url=http://www.dea.gov/pubs/abuse/4-narc.htm#Dextropropoxyphene |title=Drugs of Abuse |publisher=Drug Enforcement Administration, U.S. Department of Justice |year=2005 |url=http://www.dea.gov/pubs/abuse/index.htm |archive-url=https://web.archive.org/web/20061102144639/http://www.dea.gov/pubs/abuse/index.htm |archive-date=2006-11-02 }}</ref> |data-sort-value="0.0500000000"|{{frac|1|20}} | 130–200 mg | | | | | |- | Codeine<ref name="Common opioid equivalents">{{cite journal |last1=Knotkova PhD |first1=Helena |last2=Fine MD |first2=Perry G. |last3=Portenoy MD |first3=Russell K. |title=Opioid Rotation: The Science and the Limitations of the Equianalgesic Dose Table |journal=Journal of Pain and Symptom Management |date=September 2009 |volume=38 |issue=3 |pages=426–439 |doi=10.1016/j.jpainsymman.2009.06.001 |pmid=19735903 |doi-access=free }}</ref> |data-sort-value="0.1500000000"|{{frac|1|10}}<ref name="Approximate opioid potency" /> | 100–120 mg (PO) | ~90% | 2.5–3 (C6G 1.94;<ref>{{cite journal |author=KuKanich B |title=Pharmacokinetics of acetaminophen, codeine, and the codeine metabolites morphine and codeine-6-glucuronide in healthy Greyhound dogs |journal=J. Vet. Pharmacol. Ther. |volume=33 |issue=1 |pages=15–21 |date=February 2010 |pmid=20444020 |pmc=2867071 |doi=10.1111/j.1365-2885.2009.01098.x }}</ref> morphine 2–3) | |15–30 min (PO) |4–6 hours |- | Tramadol<ref name="Common opioid equivalents" /> |data-sort-value="0.1000000000"|{{frac|1|10}} | ~100 mg | 75% (IR), 85–90% (ER) | 6.0–8.8<ref name="Ultram" /> (M1) | | | |- | Opium<ref name="Raw opium">{{cite book |title=Opium Consumption |date=2021 |publisher=International Agency for Research on Cancer |isbn=978-92-832-0165-6 |edition=IARC Working Group on the Identification of Carcinogenic Hazards to Humans |url=https://www.ncbi.nlm.nih.gov/books/NBK586388/ |access-date=23 March 2025 |chapter=126}}</ref> (oral) |data-sort-value="0.1000000000"|{{frac|1|10}} | ~100 mg | ~25% (morphine) | 2.5–3.0 (morphine, codeine) | | | |- | Tilidine<ref name="Tilidine">{{cite journal |last1=Jasinski |first1=Donald R. |last2=Preston |first2=Kenzie L. |title=Evaluation of tilidine for morphine-like subjective effects and euphoria |journal=Drug and Alcohol Dependence |date=November 1986 |volume=18 |issue=3 |pages=273–292 |doi=10.1016/0376-8716(86)90059-1 |pmid=3803198 }}</ref> | data-sort-value="0.1000000000"|{{frac|1|10}} | 100 mg | 6% (parent drug), 99% (active metabolite)<ref name="Tilidine Pharmacokinetics">{{cite journal |last1=Vollmer |first1=KO |last2=Thomann |first2=P |last3=Hengy |first3=H |title=Pharmacokinetics of tilidine and metabolites in man. |journal=Arzneimittel-Forschung |date=October 1989 |volume=39 |issue=10 |pages=1283–8 |pmid=2610722 }}</ref> | nortilidine 3.3 (PO) & 4.9 IV, bisnortilidine 5 (PO) & 6.9 (IV)<ref name="Tilidine Pharmacokinetics" /> | 2.2:1 | 10–15 minutes (oral) 25–50 minutes (peak analgesic effect) | 3–4 hours |- | Dihydrocodeine<ref name="Dihydrocodeine 1">{{cite book |title=Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions |chapter=Dihydrocodeine |date=2006 |page=1125 |doi=10.1016/B0-44-451005-2/00181-9 |isbn=978-0-444-51005-1 }}</ref><ref name="Dihydrocodeine 2">{{cite journal |title=Highlighting the hidden dangers of a 'weak' opioid: Deaths following use of dihydrocodeine in England (2001–2020) |journal=Drug and Alcohol Dependence |date=2022 |volume=233 |article-number=109376 |doi=10.1016/j.drugalcdep.2022.109376 |pmid=35248998 | vauthors = Rock KL, Reynolds LM, Rees P, Copeland CS |doi-access=free }}</ref> |data-sort-value="0.1000000000"|{{frac|1|10}}<ref name="Approximate opioid potency" /> | 100 mg | 20% | 4 | | | |- | Anileridine<ref>{{cite web |title=Anileridine |work=DrugBank Version: 3.0 |publisher=DrugBank |url=http://www.drugbank.ca/drugs/DB00913}}</ref> |data-sort-value="0.2500000000"|{{frac|1|4}} | 40 mg | | | | | |- | Alphaprodine<ref>{{cite web |title=Alphaprodine |url=https://www.britannica.com/science/alphaprodine |website=Britannica.com |publisher=Encyclopedia Britannica |access-date=15 June 2025}}</ref> |data-sort-value="0.2000000000"|{{frac|1|5}} | 40–60 mg | | | | | |- | Tapentadol{{sfn|Cupp|2012}} |data-sort-value="0.3000000000"|{{frac|3|10}}<ref name="Approximate opioid potency" /> | 32 mg | 32% (fasting) | | | | |- | Pethidine (meperidine)<ref name="Pethidine">{{cite book |title=A Practice of Anesthesia for Infants and Children |chapter=Pharmacokinetics and Pharmacology of Drugs Used in Children |date=2019 |pages=100–176.e45 |doi=10.1016/B978-0-323-42974-0.00007-0 |isbn=978-0-323-42974-0 | vauthors = Anderson BJ, Lerman J, Coté CJ }}</ref> |data-sort-value="0.3333333333"|{{frac|1|3}}<ref name="Approximate opioid potency" /> | 30 mg SC/IV/IM 300 mg (PO) | 50–60% Orally, 100% SC/IV/IM | 3–5 | |5–15 sec if IV, 15–25 min if orally | |- |Dipipanone<ref>{{cite journal | pmc=1381337 | date=1992 | title=Pharmacokinetics of dipipanone after a single oral dose | journal=British Journal of Clinical Pharmacology | volume=33 | issue=4 | pages=449–450 | doi=10.1111/j.1365-2125.1992.tb04066.x | pmid=1349495 | vauthors = Paterson S }}</ref> |data-sort-value="0.4000000000"|{{frac|2|5}} |25 mg (PO) | |3.2–3.8 hours | | | ±4 hours |- |Benzylfentanyl<ref>{{cite web |title=Correction of Code of Federal Regulations: Removal of Temporary Listing of Benzylfentanyl and Thenylfentanyl as Controlled Substances |url=http://www.deadiversion.usdoj.gov/fed_regs/rules/2010/fr06292.htm |website=DEA - Diversion Control Division |publisher=Drug Enforcement Administration |date=2010 |access-date=2025-06-15 |archive-date=2022-10-18 |archive-url=https://web.archive.org/web/20221018081443/https://www.deadiversion.usdoj.gov/fed_regs/rules/2010/fr06292.htm |url-status=dead }}</ref><ref>{{cite journal |last1=Chen |first1=Zhao Rong |last2=Irvine |first2=Rodney J. |last3=Somogyi |first3=Andrew A. |last4=Bochner |first4=Felix |title=Mu receptor binding of some commonly used opioids and their metabolites |journal=Life Sciences |date=January 1991 |volume=48 |issue=22 |pages=2165–2171 |doi=10.1016/0024-3205(91)90150-A |pmid=1851921 }}</ref> |data-sort-value="0.5000000000"|{{frac|1|2}} | | | | | | |- |AH-7921<ref>{{cite journal |title=Brain disposition, metabolism and behavioral effects of the synthetic opioid AH-7921 in rats |journal=Neuropharmacology |date=2018 |volume=133 |pages=51–62 |doi=10.1016/j.neuropharm.2018.01.023 |pmid=29366664 | vauthors = Lucchetti J, Marzo CM, Passoni A, Moro F, Di Clemente A, Bagnati R, Cervo L, Gobbi M }}</ref> |data-sort-value="0.8000000000"|{{frac|4|5}} | | | | | | |- | SR-17018<ref name="SR-17018">{{cite journal |last1=Pantouli |first1=Fani |last2=Grim |first2=Travis W. |last3=Schmid |first3=Cullen L. |last4=Acevedo-Canabal |first4=Agnes |last5=Kennedy |first5=Nicole M. |last6=Cameron |first6=Michael D. |last7=Bannister |first7=Thomas D. |last8=Bohn |first8=Laura M. |title=Comparison of morphine, oxycodone and the biased MOR agonist SR-17018 for tolerance and efficacy in mouse models of pain |journal=Neuropharmacology |date=March 2021 |volume=185 |article-number=108439 |doi=10.1016/j.neuropharm.2020.108439 |pmid=33345829 |pmc=7887086}}</ref> | data-sort-value="0.8000000000"|{{frac|4|5}} | 10–12 mg | 100% IV (Presumably) Unknown (researches are still being made) | | | 5–10 seconds if used IV and 15–25 min orally (PO) | |- | Nalbuphine<ref name="Nalbuphine">{{cite journal |last1=Beaver |first1=WT |last2=Feise |first2=GA |title=A comparison of the analgesic effect of intramuscular nalbuphine and morphine in patients with postoperative pain. |journal=The Journal of Pharmacology and Experimental Therapeutics |date=February 1978 |volume=204 |issue=2 |pages=487–96 |doi=10.1016/S0022-3565(25)31162-6 |pmid=340643 }}</ref> | data-sort-value="0.9000000000"|{{frac|9|10}} | 10–11 mg | ~33% (PO), 76% (SC), 81% (IM)<ref name="Nalbuphine bioavailability">{{cite book |last1=Bissonnette |first1=Bruno |last2=Dalens |first2=Bernard J. |title=Pediatric anesthesia: principles & practice |date=2002 |publisher=McGraw-Hill, Medical Publ. Division |location=New York |isbn=978-0-07-135454-7 |page=398 }}</ref> | 3–6 | | 3 minutes, 10 minutes (peak effect) | 3–6 hours<ref name="Nalbuphine onset & duration">{{cite journal |last1=Deslandes |first1=Marvin |last2=Deicke |first2=Martin |last3=Grannemann |first3=Julia Johanna |last4=Hinkelbein |first4=Jochen |last5=Hoyer |first5=Annika |last6=Kalmbach |first6=Matthias |last7=Kobiella |first7=André |last8=Strickmann |first8=Bernd |last9=Plappert |first9=Thomas |last10=Jansen |first10=Gerrit |title=Effectiveness and safety of prehospital analgesia with nalbuphine and paracetamol versus morphine by paramedics - an observational study |journal=Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |date=10 May 2024 |volume=32 |issue=1 |page=41 |doi=10.1186/s13049-024-01215-z |doi-access=free |pmid=38730453 |pmc=11084095 }}</ref> |- | Hydrocodone<ref name="Hydrocodone">{{cite book |title=Practical Management of Pain |chapter=Minor and Short-Acting Analgesics, Including Opioid Combination Products |date=2014 |pages=508–529.e6 |doi=10.1016/B978-0-323-08340-9.00037-2 |isbn=978-0-323-08340-9 | vauthors = Stanos SP, Tyburski MD, Parikh SS }}</ref> | 1<ref name="Approximate opioid potency" /> | 10 mg | 70%<ref name="pmid19118954">{{cite journal | vauthors = Zacny JP, Gutierrez S | title = Within-subject comparison of the psychopharmacological profiles of oral hydrocodone and oxycodone combination products in non-drug-abusing volunteers | journal = Drug Alcohol Depend | volume = 101 | issue = 1–2 | pages = 107–14 | date = April 2009 | pmid = 19118954 | doi = 10.1016/j.drugalcdep.2008.11.013 | url = https://zenodo.org/record/896375}}</ref> | 3.8–6 (Instant Release; PO) | |10–30 min (Instant Release; PO) |4–6 |- | Pentazocine lactate (IV)<ref name="mono">{{ cite web | url = https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=1d225639-c326-4d9e-bc8d-e380e7958b8f | title = TALWIN (pentazocine lactate) injection, solution | work = DailyMed | publisher = National Institute of Health | access-date = 2011-12-10 }}</ref> | 1 | 10 mg SC/IV/IM, 150 mg (PO) | | | | | |- |- style="background: #FCFC97" |''' Morphine (oral)''' |''' 1''' |''' 10 mg''' |''' ~25%''' | 2–4 |3:1 |30 min (PO) |3–6 hours |- | Oxycodone (oral)<ref name=Converter>{{cite web|title=Equianalgesic Conversion|url=http://globalrph.com/narcoticonv.htm|publisher=GlobalRPH}}</ref> | 1.5<ref name="Approximate opioid potency" /> | 6.67 mg | (60–87 / ±75% PO) / 78.2%<ref name=":5">{{cite journal | pmc=4006196 | date=2011 | title=Pharmacokinetics of intranasal Crushed OxyContin and Intravenous Oxycodone in Nondependent Prescription Opioid Abusers | journal=Journal of Clinical Pharmacology | volume=52 | issue=4 | pages=600–606 | doi=10.1177/0091270011401620 | pmid=21610203 | vauthors = Lofwall MR, Moody DE, Fang WB, Nuzzo PA, Walsh SL }}</ref> (IN) / 100% (IV/IM) or other parenteral administrations apart from spinal administration | 2–3 hours (Instant Release)(PO); 4.5 hours (Controlled Release)(PO) | |10–30 min (Instant Release)(PO); 1 hour (Controlled Release)(PO) |3–6 hours (Instant Release)(PO); 10–12 hours (Controlled Release)(PO)<ref name="sunshine1996">{{cite journal |title=Analgesic Efficacy of Controlled-Release Oxycodone in Postoperative Pain |journal=The Journal of Clinical Pharmacology |date=1996 |volume=36 |issue=7 |pages=595–603 |doi=10.1002/j.1552-4604.1996.tb04223.x |pmid=8844441 | vauthors = Sunshine A, Olson NZ, Colon A, Rivera J, Kaiko RF, Fitzmartin RD, Reder RF, Goldenheim PD }}</ref> |- |Spiradoline<ref name="Spiradoline">{{cite journal |last1=Kunihara |first1=M. |last2=Ohyama |first2=M. |last3=Nakano |first3=M. |last4=Hayashi |first4=S. |title=Analgesic activity of spiradoline mesylate (U-62,066E), a kappa opioid agonist in mice |journal=Life Sciences |date=January 1989 |volume=45 |issue=13 |pages=1191–1198 |doi=10.1016/0024-3205(89)90508-0 |pmid=2796604 }}</ref> |1.5–7.0<ref name="Spiradoline 1">{{cite journal |last1=Kunihara |first1=M. |last2=Ohyama |first2=M. |last3=Nakano |first3=M. |last4=Hayashi |first4=S. |title=Analgesic activity of spiradoline mesylate (U-62,066E), a kappa opioid agonist in mice |journal=Life Sciences |date=January 1989 |volume=45 |issue=13 |pages=1191–1198 |doi=10.1016/0024-3205(89)90508-0 |pmid=2796604 }}</ref> | | | | | | |- | Nicomorphine<ref>{{cite journal |last1=Koopman-Kimenai |first1=PM |last2=Vree |first2=TB |last3=Booij |first3=LH |last4=Dirksen |first4=R |last5=Nijhuis |first5=GM |title=Pharmacokinetics of intravenously administered nicomorphine and its metabolites in man. |journal=European Journal of Anaesthesiology |date=March 1993 |volume=10 |issue=2 |pages=125–32 |pmid=8462537 }}</ref> | 2–3<ref>{{cite journal |last1=Floresta |first1=Giuseppe |last2=Gavrilović |first2=Ivana |last3=Devey |first3=Scarlett |last4=Harris |first4=Rhian |last5=Cowan |first5=David |last6=Abbate |first6=Vincenzo |title=Towards Identifying Nicomorphine Administration in Doping Control: Synthesis of Metabolites |journal=Bioanalysis |date=September 2021 |volume=13 |issue=18 |pages=1415–1425 |doi=10.4155/bio-2021-0076 |pmid=34528849 |url=https://kclpure.kcl.ac.uk/portal/en/publications/towards-identifying-nicomorphine-administration-in-doping-control |access-date=15 June 2025}}</ref> | 3.33–5 mg | 20% | 4 | | | |- | Butorphanol<ref name="Butorphanol">{{cite journal |last1=Tavakoli |first1=M. |last2=Corssen |first2=G. |last3=Caruso |first3=F. S. |title=Butorphanol and Morphine: A Double-Blind Comparison of Their Parenteral Analgesic Activity |journal=Anesthesia & Analgesia |date=May 1976 |volume=55 |issue=3 |pages=394–401 |doi=10.1213/00000539-197605000-00025 |pmid=776040 }}</ref> | 2.3 | 4.3 mg | ~12% (PO), 25–35% (SL), 70% (NAS)<ref name="Butorphanol Pharmacokinetics">{{cite book |title=Pain Management |chapter=Opioid Analgesics |date=2011 |pages=890–912 |doi=10.1016/B978-1-4377-0721-2.00122-7 |isbn=978-1-4377-0721-2 | vauthors = Koyyalagunta D, Waldman SD }}</ref> | 3 (IM/IV) 4.5–5.5 (NAS) | 5.8:1 | 15 minutes | 3–4 hours |- | Metopon<ref>{{cite journal |last1=Schmidhammer |first1=Helmut |last2=Spetea |first2=Mariana |title=Development of 5-Substituted N -Methylmorphinan-6-ones as Potent Opioid Analgesics with Improved Side-Effect Profile |journal=International Journal of Medicinal Chemistry |date=17 June 2012 |volume=2012 |pages=1–10 |doi=10.1155/2012/208039 |doi-access=free |pmid=25954525 |pmc=4412049 }}</ref> | 3 | 3.5 mg | | | | | |- | Oxycodone (IV/IM) or other parenteral administrations apart from spinal administration<ref name="Silvasti et al">{{cite journal |last1=Silvasti |first1=M |last2=Rosenberg |first2=P |last3=Seppälä |first3=T |last4=Svartling |first4=N |last5=Pitkänen |first5=M |title=Comparison of analgesic efficacy of oxycodone and morphine in postoperative intravenous patient-controlled analgesia |journal=Acta Anaesthesiologica Scandinavica |date=May 1998 |volume=42 |issue=5 |pages=576–580 |doi=10.1111/j.1399-6576.1998.tb05169.x |pmid=9605375 }}</ref> | 3–4 | 2.5–3.33 mg | (60–87 / ±75% PO) / 78.2%<ref name=":5" /> (IN) / 100% (IV/IM) or other parenteral administrations apart from spinal administration |1.5–3 (IV/IM) | |5 min (IV)<ref name="Silvasti et al" /> |2–4 hours |- style="background: #F5F5C4" | Morphine<ref name="Common opioid equivalents" /><ref name="Morphine IV">{{cite journal |last1=Hoskin |first1=Pj |last2=Hanks |first2=Gw |last3=Aherne |first3=Gw |last4=Chapman |first4=D. |last5=Littleton |first5=P. |last6=Filshie |first6=J. |title=The bioavailability and pharmacokinetics of morphine after intravenous, oral and buccal administration in healthy volunteers. |journal=British Journal of Clinical Pharmacology |date=April 1989 |volume=27 |issue=4 |pages=499–505 |doi=10.1111/j.1365-2125.1989.tb05399.x |pmid=2719903 |pmc=1379730}}</ref> (IV/IM) or other parenteral administrations apart from spinal administration | 3–4 | 2.5–3.33 mg | 100% | 3–4 |3:1/4:1 |Instantaneously (from 5 to 15 sec; IV); 5–15 min (IM) |3–7 hours |- | Clonitazene<ref>{{cite journal |last1=Esrick |first1=Josh |last2=Stuart |first2=Olivia |last3=Cohen |first3=Leah |editor1-last=Namm |editor1-first=Adam |editor2-last=Crowdy |editor2-first=Angela |title=THE EMERGENCE OF NITAZENES IN THE AMERICAS |journal=Inter-American Drug Abuse Control Commission |date=September 2024 |volume=Information Bulletin |page=7 |url=https://www.oas.org/ext/DesktopModules/MVC/OASDnnModules/Views/Item/Download.aspx?type=1&id=1045&lang=1 |publisher=Organization of American States}}</ref> | 2–3<ref>{{cite web |title=ACMD advice on 2-benzyl benzimidazole and piperidine benzimidazolone opioids |url=https://www.gov.uk/government/publications/acmd-advice-on-2-benzyl-benzimidazole-and-piperidine-benzimidazolone-opioids/acmd-advice-on-2-benzyl-benzimidazole-and-piperidine-benzimidazolone-opioids-accessible-version |website=Advisory Council on the Misuse of Drugs |publisher=United Kingdom National Archives |access-date=16 June 2025 |page=4 |date=29 January 2025}}</ref> | 3.33 mg | | | | | |- | Methadone (acute)<ref>[http://www.psicofarmacos.info/images/graficos/Tabla4_opiaceos.JPG Tabla de equivalencia opiáceos]</ref><ref name="jaoa.org">{{cite journal |author=Manfredonia JF |title=Prescribing methadone for pain management in end-of-life care |journal=J Am Osteopath Assoc |volume=105 |issue=3 Suppl 1 |pages=S18–21 |date=March 2005 |pmid=18154194 |url=http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=18154194 }}{{Dead link|date=January 2026 |bot=InternetArchiveBot }} [https://archive.today/20120911144851/http://www.jaoa.org/content/105/3_suppl/18S/T2.expansion.html Table 2: Conversion Ratio of Oral Morphine to Methadone].</ref> | 3–4 | 2.5–3.33 mg | 40–90% | 15–60 |2:1 | | |- | Methadone (chronic)<ref name="jaoa.org" /> | 2.5–5<ref name="Approximate opioid potency" /> | 2–4 mg | 40–90% | 15–60 |2:1 | | |- |Phenazocine<ref>{{cite journal |title=The Relative Analgesic and Respiratory Effects of Phenazocine and Morphine |journal=The Journal of Pharmacology and Experimental Therapeutics |date=1964 |volume=144 |issue=3 |pages=337–345 |doi=10.1016/S0022-3565(25)26797-0 | vauthors = Houde RW, Wallenstein SL, Bellville JW, Robers A, Escarraga LA }}</ref> |3.2–4.3<ref>{{cite book |title=Synthetic Analgesics |date=1966 |doi=10.1016/C2013-0-01842-7 |isbn=978-0-08-010895-7 }}</ref> |~2.5 mg | | | | 15 min (IV); 30 minutes (IM); 30–60 minutes (oral)<ref>{{cite web |title=What is Phenazocine Hydrobromide used for? |url=https://synapse.patsnap.com/article/what-is-phenazocine-hydrobromide-used-for |website=Synapse |publisher=PatSnap. |access-date=16 June 2025 |date=15 June 2024}}</ref> | 3–5 hours<ref>{{cite journal |last1=Khan |first1=Md Imdadul H. |last2=Sawyer |first2=Benjamin J. |last3=Akins |first3=Nicholas S. |last4=Le |first4=Hoang V. |title=A systematic review on the kappa opioid receptor and its ligands: New directions for the treatment of pain, anxiety, depression, and drug abuse |journal=European Journal of Medicinal Chemistry |date=December 2022 |volume=243 |article-number=114785 |doi=10.1016/j.ejmech.2022.114785 |doi-access=free |pmid=36179400 }}</ref> |- | Diamorphine (Heroin; IV/IM) or other parenteral administrations apart from spinal administration<ref>{{cite journal |vauthors=Reichle CW, Smith GM, Gravenstein JS, Macris SG, Beecher HK |title=Comparative analgesic potency of heroin and morphine in postoperative patients |journal=J. Pharmacol. Exp. Ther. |volume=136 |issue=1 |pages=43–6 |date=April 1962 |doi=10.1016/S0022-3565(25)26258-9 |pmid=14491157 }}</ref> | 4–5 (IV,IM) 2–2.5 (insufflated)<ref>{{Cite journal |last1=Cone |first1=E. J. |last2=Holicky |first2=B. A. |last3=Grant |first3=T. M. |last4=Darwin |first4=W. D. |last5=Goldberger |first5=B. A. |date=October 1993 |title=Pharmacokinetics and pharmacodynamics of intranasal 'snorted' heroin |journal=Journal of Analytical Toxicology |volume=17 |issue=6 |pages=327–337 |doi=10.1093/jat/17.6.327 |pmid=8271778}}</ref> | 2–2.5 mg | 100% | <0.6 (morphine prodrug)<ref name=":4">{{cite journal | vauthors = Sawynok J | title = The therapeutic use of heroin: a review of the pharmacological literature | journal = Canadian Journal of Physiology and Pharmacology | volume = 64 | issue = 1 | pages = 1–6 | date = January 1986 | pmid = 2420426 | doi = 10.1139/y86-001 }}</ref> | |Instantaneously (from 5 to 15 sec; IV); 2 to 5 min (IM) |3 to 7 hours (morphine prodrug)<ref name=":4" /> |- |6-MAM<ref>{{Cite journal |last1=Perekopskiy |first1=David |last2=Kiyatkin |first2=Eugene A. |date=2019-08-21 |title=6-Monoacetylmorphine (6-MAM), Not Morphine, Is Responsible for the Rapid Neural Effects Induced by Intravenous Heroin |journal=ACS Chemical Neuroscience |volume=10 |issue=8 |pages=3409–3414 |doi=10.1021/acschemneuro.9b00305 |pmid=31268284}}</ref> |6–7 (IV,IM) |1.25–1.6 |100% (IV,IM) |<0.6 (morphine prodrug)<ref name=":4" /> |presumably 2:1 |Instantaneously (from 5 to 15 sec; IV); 2 to 5 min (IM) |3 to 7 hours (morphine prodrug)<ref name=":4" /> |- | Dezocine<ref>{{cite journal |last1=Ye |first1=Rong-Rong |last2=Jiang |first2=Shuang |last3=Xu |first3=Xu |last4=Lu |first4=Yan |last5=Wang |first5=Yu-Jun |last6=Liu |first6=Jing-Gen |title=Dezocine as a potent analgesic: overview of its pharmacological characterization |journal=Acta Pharmacologica Sinica |date=4 November 2021 |volume=43 |issue=7 |pages=1646–1657 |doi=10.1038/s41401-021-00790-6 |pmid=34737418 |publisher=Acta Pharmacol Sin. |pmc=9253008}}</ref> | 7.7–13 | 0.76–1.29 mg | 97% (IM) | 2.2 | 4–6 hours<ref>{{cite journal |last1=Locniskar |first1=A. |last2=Greenblatt |first2=D. J. |last3=Zinny |first3=M. A. |title=Pharmacokinetics of dezocine, a new analgesic: Effect of dose and route of administration |journal=European Journal of Clinical Pharmacology |date=1986 |volume=30 |issue=1 |pages=121–123 |doi=10.1007/BF00614208 |pmid=3709625 }}</ref> | 5 min (IV); 5–15 min (IM/BUC); 6–8 hours (TD)<ref>{{cite book |title=Reference Module in Biomedical Sciences |chapter=Dezocine |date=2016 |doi=10.1016/B978-0-12-801238-3.97650-5 |isbn=978-0-12-801238-3 | vauthors = Bylund K }}</ref> | |- | Hydromorphone{{sfn|Toronto Surgery|2014}}{{sfn|Walker|2001}}{{sfn|Cupp|2012}} | 10 (SC, IV, IM)<br />3–3.75 (PO) | 0.5–0.75 mg (SC, IV, IM)<br />2.5 mg (PO)<ref name="Approximate opioid potency" /> | Orally: 30–35%, Intranasal: 52–58%, IV/IM: 100% 62% | 2–3 |5:1 | | |- | Oxymorphone<ref name=Converter/> | 10 (SC, IV, IM)<br />3–4(PO) | 3.33 mg (PO), 0.333 mg (IV,IM & Interlaminar) |PO: 10% Buccal: 28% Sublingual: 37.5% Intranasal: 43% IV, IM & IT: 100% | 7.25–9.43 | |35 min (PO), Instantaneously (from 5 to 15 sec)(IV) |6–8 hours orally 2–6 hours parenteral |- |U-47700<ref>{{cite journal |last1=Truver |first1=Michael T. |last2=Smith |first2=Christina R. |last3=Garibay |first3=Nancy |last4=Kopajtic |first4=Theresa A. |last5=Swortwood |first5=Madeleine J. |last6=Baumann |first6=Michael H. |title=Pharmacodynamics and pharmacokinetics of the novel synthetic opioid, U-47700, in male rats |journal=Neuropharmacology |date=October 2020 |volume=177 |article-number=108195 |doi=10.1016/j.neuropharm.2020.108195 |pmid=32533977 |pmc=7554234}}</ref> |7.5 |1.5 mg | |1.5–3 | | | |- | Levorphanol<ref name="redpoll">{{cite web |title=Levorphanol |work=DrugBank Version: 3.0 |publisher=DrugBank |url=http://www.drugbank.ca/drugs/APRD00764}}</ref> | 8 | 1.25 mg | 70% | 11–16 |1:1 | | |- |Desomorphine<ref>{{cite journal |last1=Haskin |first1=Alessandra |last2=Kim |first2=Noori |last3=Aguh |first3=Crystal |title=A new drug with a nasty bite: A case of krokodil-induced skin necrosis in an intravenous drug user |journal=JAAD Case Reports |date=March 2016 |volume=2 |issue=2 |pages=174–176 |doi=10.1016/j.jdcr.2016.02.007 |pmid=27222881 |pmc=4864092}}</ref> |8–10<ref>{{cite journal |last1=Alves |first1=Emanuele Amorim |last2=Grund |first2=Jean-Paul Cornelis |last3=Afonso |first3=Carlos Manuel |last4=Netto |first4=Annibal Duarte Pereira |last5=Carvalho |first5=Félix |last6=Dinis-Oliveira |first6=Ricardo Jorge |title=The harmful chemistry behind krokodil (desomorphine) synthesis and mechanisms of toxicity |journal=Forensic Science International |date=April 2015 |volume=249 |pages=207–213 |doi=10.1016/j.forsciint.2015.02.001 |pmid=25710781 }}</ref> |1–1.25 mg |~100% (IV) |2–3 | |Instantaneously (from 5 to 15 sec)(IV); 2–5 min (IM) |3–4 hours |- |N-Phenethylnormorphine<ref name="N-substitution">{{cite journal |last1=Ben Haddou |first1=Tanila |last2=Béni |first2=Szabolcs |last3=Hosztafi |first3=Sándor |last4=Malfacini |first4=Davide |last5=Calo |first5=Girolamo |last6=Schmidhammer |first6=Helmut |last7=Spetea |first7=Mariana |title=Pharmacological Investigations of N-Substituent Variation in Morphine and Oxymorphone: Opioid Receptor Binding, Signaling and Antinociceptive Activity |journal=PLOS ONE |date=11 June 2014 |volume=9 |issue=6 |article-number=e99231 |doi=10.1371/journal.pone.0099231 |doi-access=free |pmid=24919067 |pmc=4053365|bibcode=2014PLoSO...999231B }}</ref> |8–14 | | | | | | |- |Alfentanil<ref name="Alfentanyl">{{cite web |title=Relative Doses of Opioids |url=https://www.westmidspallcare.co.uk/wmpcp/guide/pain/relative-doses-of-opioids/ |website=West Midlands Palliative Care Physicians |publisher=West Midlands Palliative Care |access-date=23 March 2025}}</ref> |10–25 |0.1–0.4 mg | |1.5 (90–111 minutes) | |Instantaneously (from 5 to 15 sec); 4× more rapid than fentanyl |0.25 hr (15 min); up to 54 minutes until offset of effects |- |Trefentanil<ref name="Fentanyl analogs">{{cite journal |last1=Vardanyan |first1=Ruben S |last2=Hruby |first2=Victor J |title=Fentanyl-Related Compounds and Derivatives: Current Status and Future Prospects for Pharmaceutical Applications |journal=Future Medicinal Chemistry |date=March 2014 |volume=6 |issue=4 |pages=385–412 |doi=10.4155/fmc.13.215 |pmid=24635521 |pmc=4137794}}</ref> |data-sort-value="17.5"|10 | | | | | | |- |Brifentanil<ref name="Fentanyl analogs" /> |data-sort-value="17.5"|10–25 | | | | | | |- |Acetylfentanyl<ref name="Fentanyl analogs" /> |15<ref>{{cite journal |last1=Schueler |first1=Harold E. |title=Emerging Synthetic Fentanyl Analogs |journal=Academic Forensic Pathology |date=March 2017 |volume=7 |issue=1 |pages=36–40 |doi=10.23907/2017.004 |pmid=31239954 |pmc=6474477}}</ref> | | | | | | |- | 7-Hydroxymitragynine<ref>{{cite journal |last1=Todd |first1=D. A. |last2=Kellogg |first2=J. J. |last3=Wallace |first3=E. D. |last4=Khin |first4=M. |last5=Flores-Bocanegra |first5=L. |last6=Tanna |first6=R. S. |last7=McIntosh |first7=S. |last8=Raja |first8=H. A. |last9=Graf |first9=T. N. |last10=Hemby |first10=S. E. |last11=Paine |first11=M. F. |last12=Oberlies |first12=N. H. |last13=Cech |first13=N. B. |title=Chemical composition and biological effects of kratom (Mitragyna speciosa): In vitro studies with implications for efficacy and drug interactions |journal=Scientific Reports |date=5 November 2020 |volume=10 |issue=1 |page=19158 |doi=10.1038/s41598-020-76119-w |pmid=33154449 |pmc=7645423 |bibcode=2020NatSR..1019158T }}</ref> | 17 | ~0.6 mg | | | | | |- |Butyrfentanyl<ref>{{cite web |title=BUTYRFENTANYL |url=https://drugs.ncats.io/substance/07V1H7R6ZN |website=Inxight Drugs |publisher=National Center for Advancing Translational Sciences |access-date=16 June 2025}}</ref> |25 | | | | | | |- |Enadoline<ref>{{cite journal |last1=Pande |first1=Atul C. |last2=Pyke |first2=Robert E. |last3=Greiner |first3=Martha |last4=Wideman |first4=Gilder L. |last5=Benjamin |first5=Ronald |last6=Pierce |first6=Mark W. |title=Analgesic Efficacy of Enadoline Versus Placebo or Morphine in Postsurgical Pain |journal=Clinical Neuropharmacology |date=October 1996 |volume=19 |issue=5 |pages=451–456 |doi=10.1097/00002826-199619050-00009 |pmid=8889289 }}</ref> |25 |15 μg (threshold) and 0.160 mg/kg (dissociative effects) | | | | | |- | Buprenorphine (SL)<ref name="dea.gov"/> | 40–80<ref name="Approximate opioid potency" /> | 0.25 mg | 30% (SL);<ref name=":0">{{cite journal | doi=10.1177/009127009703700106 | title=Bioavailability of Sublingual Buprenorphine | date=1997 | journal=The Journal of Clinical Pharmacology | volume=37 | issue=1 | pages=31–37 | pmid=9048270 | vauthors = Mendelson J, Upton RA, Everhart ET, Iii PJ, Jones RT }}</ref> ~100% (TD); 65% (BUC);<ref name=":1">{{Cite web|url=https://www.pbm.va.gov/PBM/clinicalguidance/abbreviatedreviews/Buprenorphine_NX_Buccal_Film_BUNAVAIL_%20Abbreviated_Review.pdf|title=Buprenorphine / Naloxone Buccal Film (BUNAVAIL) C-III|date=September 2014|website=Pharmacy Benefits Management (PBM) Services|access-date=2020-02-10|archive-date=2020-10-20|archive-url=https://web.archive.org/web/20201020045302/https://www.pbm.va.gov/PBM/clinicalguidance/abbreviatedreviews/Buprenorphine_NX_Buccal_Film_BUNAVAIL_%20Abbreviated_Review.pdf|url-status=dead}}</ref><ref name=":2">''[https://web.archive.org/web/20140630095615/http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/205637s000lbl.pdf <nowiki>BUNAVAIL (buprenorphine and naloxone) buccal film, CIII [prescribing information online]</nowiki>]''. BioDelivery BioDelivery Sciences International, Inc. (BDSI), Raleigh, NC. Jun 2014.</ref> 48% (INS)<ref name=":3">Eriksen J, Jensen NH, Kamp-Jensen M, Bjarnø H, Friis P, Brewster D (1989). "The systemic availability of buprenorphine administered by nasal spray". ''J. Pharm. Pharmacol''. '''41''' (11): 803–5. doi:10.1111/j.2042-7158.1989.tb06374.x</ref> | 20–70, mean 37 |3:1 |45 min |12–24 hours |- |N-Phenethyl-14-ethoxymetopon<ref name="N-substitution" /> |60 |160 μg | | | | | |- | Furanylfentanyl<ref>{{cite journal |last1=Albores-García |first1=Damaris |last2=Cruz |first2=Silvia L. |title=Fentanyl and other new psychoactive synthetic opioids. Challenges to prevention and treatment |journal=Revista de Investigación Clínica |date=13 July 2023 |volume=75 |issue=3 |pages=93–104 |doi=10.24875/ric.23000109 |publisher=Department of Pharmacobiology, Center for Research and Advanced Studies (Cinvestav), National Polytechnic Institute |location=Mexico City |pmid=37441771 |doi-access=free }}</ref> | 50–100 | | | | | | |- |Phenomorphan<ref>{{cite journal |last1=Hernandez |first1=Delmis E. |last2=Luo |first2=Dan |last3=Prisinzano |first3=Thomas E. |last4=Negus |first4=S. Stevens |last5=Nassehi |first5=Nima |last6=Selley |first6=Dana E. |last7=Shah |first7=Pranav |last8=Kato |first8=Rintaro |last9=Xu |first9=Xin |last10=Talarico |first10=Carmine |last11=Graziani |first11=Davide |last12=Beccari |first12=Andrea R. |last13=Jacobson |first13=Arthur E. |last14=Rice |first14=Kenner C. |last15=Sulima |first15=Agnieszka |title=Transformation of a Potent C9-Substituted Phenylmorphan into MOR Partial Agonists with Improvement of Metabolic Stability: An In Vitro, In Vivo, and In Silico Study |journal=ACS Chemical Neuroscience |date=4 June 2025 |volume=16 |issue=11 |pages=2110–2127 |doi=10.1021/acschemneuro.5c00211 |pmid=40393055 |pmc=12136991}}</ref> |60–80 |0.13–0.16 mg | | | | | |- |N-Phenethylnordesomorphine<ref>{{cite book |last1=Casy |first1=Alan F. |last2=Parfitt |first2=Robert T. |title=Opioid analgesics: Chemistry and receptors |date=1986 |publisher=Springer |location=New York |isbn=978-0-306-42130-3 |pages=37–38 }}</ref> |85 | | | | | | |- |Phenaridine<ref>{{cite web |title=Phenaridine |url=https://go.drugbank.com/drugs/DB09178 |website=Drugbank.com |publisher=OMx Personal Health Analytics, Inc. |access-date=16 June 2025}}</ref> |data-sort-value="75"|50–100 | | | | | | |- | Fentanyl<ref name="Common opioid equivalents" /> | 50–100<ref name="Approximate opioid potency" /> | 0.1 mg (100 μg) IM/IV | 33% (SL); 92% (TD); 89% (INS); 50% (BUC) | 0.04 (IV); 7 (TD) | |5 min (TD/IV) |30–60 minutes (IV) |- |Metonitazene<ref name="Nitazene Alert">{{cite web |title=Drug Trend Alert: Nitazenes |url=https://hamiltoncountyhealth.org/wp-content/uploads/2024/07/DrugTrendAlert_June2024.pdf |website=Hamilton County Public Health |publisher=Hamilton County, Ohio |access-date=16 June 2025}}</ref> |100 |0.1 mg/100 μg | | | | | |- |Acrylfentanyl<ref name="Fentanyl analogs" /> |data-sort-value="75"|50–100+<ref>{{cite web |title=ACRYLFENTANYL AND NALOXONE EFFECTIVENESS |url=https://oasas.ny.gov/system/files/documents/2019/10/naloxoneeffectiveness2017.pdf |website=Office of Alcoholism and Substance Abuse Services |publisher=New York State Department of Health |access-date=16 June 2025 |location=Albany, New York |date=30 May 2017}}</ref> | | | | | | |- |Remifentanil<ref>{{cite book |title=Novel Psychoactive Substances |chapter=Novel synthetic opioids |date=2022 |pages=447–474 |doi=10.1016/B978-0-12-818788-3.00018-8 |isbn=978-0-12-818788-3 | vauthors = Abbate V, Moreno AS, Wiegand TJ }}</ref> |100 |100 μg |100% (IM/IV) |0.05 (3–6 min context-sensitive half-life; 7–18 min elimination half-life)<ref>{{cite journal |last1=Beers |first1=Richard |last2=Camporesi |first2=Enrico |title=Remifentanil Update: Clinical Science and Utility |journal=CNS Drugs |date=2004 |volume=18 |issue=15 |pages=1085–1104 |doi=10.2165/00023210-200418150-00004 |pmid=15581380 }}</ref> | |Instantaneously (from 5 to 15 sec) |15 minutes; rapid offset of effects necessitates continuous infusion for maintenance of anesthesia |- |Parafluorofentanyl (2-Fluorofentanyl)<ref name="Fentanyl analog potency">{{cite journal |last1=Varshneya |first1=Neil B. |last2=Hassanien |first2=Sherif H. |last3=Holt |first3=Melissa C. |last4=Stevens |first4=David L. |last5=Layle |first5=Nathan K. |last6=Bassman |first6=Jonathon R. |last7=Iula |first7=Donna M. |last8=Beardsley |first8=Patrick M. |title=Fentanyl analog structure-activity relationships demonstrate determinants of diverging potencies for antinociception and respiratory depression |journal=Pharmacology Biochemistry and Behavior |date=May 2023 |volume=226 |doi=10.1016/j.pbb.2023.173572 |pmid=37236405 |at=Table 4 |article-number=173572 |pmc=10326888}}</ref> |111 | | | | | | |- |Buprenorphine (Transdermal)<ref>{{cite journal | doi=10.2147/JPR.S85951 | doi-access=free | title=Buprenorphine – an attractive opioid with underutilized potential in treatment of chronic pain | date=2015 | journal=Journal of Pain Research | volume=8 | pages=859–870 | pmid=26672499 | pmc=4675640 | vauthors = Pillarisetti S, Khanna I }}</ref><ref>{{cite journal | doi=10.1111/pme.12386 | title=Sublingual Buprenorphine as an Analgesic in Chronic Pain: A Systematic Review | date=2014 | journal=Pain Medicine | volume=15 | issue=7 | pages=1171–1178 | pmid=24995716 | vauthors = Cote J, Montgomery L }}</ref> |100–115<ref name="Approximate opioid potency" /> |0.1 mg (100 μg) |30% (SL);<ref name=":0" /> ~100% (TD); 65% (BUC);<ref name=":1" /><ref name=":2" /> 48% (INS)<ref name=":3" /> | |3:1 |45–60 minutes |12–24 hours |- |14-Cinnamoyloxycodeinone<ref name="Buckett 14-cinnamoyloxycodeinone">{{cite journal |last1=Buckett |first1=W R |title=Some pharmacological studies with 14-cinnamoyloxycodeinone |journal=Journal of Pharmacy and Pharmacology |date=1 November 1965 |volume=17 |issue=11 |pages=759–760 |doi=10.1111/j.2042-7158.1965.tb07602.x |pmid=4379812 }}</ref> |177 (median potency) 101–310 (varied potencies among test subjects)<ref name="Buckett 14-cinnamoyloxycodeinone"/> |77 μg |2.8% (PO); 5.8% (SC) | |250:7 | | |- |Protonitazepyne<ref name="Nitazene Alert" /> |190–200<ref name="Nitazenes" /> |55–60 μg | | | | | |- |Protonitazene<ref name="Nitazene Alert" /> |200<ref>{{cite journal |title=Critical review report: Protonitazene |journal=Expert Committee on Drug Dependence |date=14 October 2022 |issue=45 |pages=8–10 |url=https://cdn.who.int/media/docs/default-source/controlled-substances/45th-ecdd/protonitazene_draft.pdf |access-date=20 June 2025 |publisher=World Health Organization |format=.pdf}}</ref> |50 μg | | | | | |- |Ocfentanil<ref name="Synthetic Opioids">{{cite journal |last1=Shafi |first1=Abu |last2=Berry |first2=Alex J. |last3=Sumnall |first3=Harry |last4=Wood |first4=David M. |last5=Tracy |first5=Derek K. |title=Synthetic opioids: a review and clinical update |journal=Therapeutic Advances in Psychopharmacology |date=10 December 2022 |volume=12 |article-number=20451253221139616 |doi=10.1177/20451253221139616 |pmid=36532866 |pmc=9747888}}</ref> |200 |40–80 μg | | | | | |- |Ro4-1539<ref name="Morphinan analogs">{{cite journal |last1=Eddy |first1=Nathan B. |last2=Besendorf |first2=Hedwig |last3=Pellmont |first3=Béla |title=Aralkyl substitution on nitrogen of morphinan |journal=United Nations Office on Drugs and Crime |date=1 January 1958 |volume=Bulletin on Narcotics |issue=Synthetic analgesics |pages=23–42 |url=https://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1958-01-01_4_page007.html |publisher=Erie Einar Ekstrand}}</ref> |240–480 |20–40 μg | | | | | |- |14-Methoxymetopon<ref>{{cite journal |title=14-Methoxymetopon, a very potent μ-opioid receptor-selective analgesic with an unusual pharmacological profile |journal=European Journal of Pharmacology |date=2003 |volume=459 |issue=2–3 |pages=203–209 |doi=10.1016/S0014-2999(02)02821-2 |pmid=12524147 | vauthors = King MA, Su W, Nielan CL, Chang AH, Schütz J, Schmidhammer H, Pasternak GW }}</ref> |500 (IV) |20 μg | | | | | |- |Isotonitazene<ref name="Nitazene Alert" /> |500<ref name="fentanyl and nitazene analogs">{{cite journal |title=In Vitro Functional Profiling of Fentanyl and Nitazene Analogs at the μ-Opioid Receptor Reveals High Efficacy for Gi Protein Signaling |journal=ACS Chemical Neuroscience |date=2024 |volume=15 |issue=4 |pages=854–867 |doi=10.1021/acschemneuro.3c00750 |pmid=38345920 |pmc=11890208 | vauthors = Tsai MM, Chen L, Baumann MH, Canals M, Javitch JA, Lane JR, Shi L }}</ref> |20 μg | | | | | |- | Sufentanil<ref name="Common opioid equivalents" /> | 500–1,000<ref name="Sufentanil Potency">{{cite book |title=Pain Management |date=2007 |doi=10.1016/C2009-1-59662-1 |isbn=978-0-7216-0334-6 }}</ref> | 10–20 μg | 9% (PO); 52–59% (SL); 78% (BUC); 100% (IM/IV)<ref name="Sufentanil bioavailability">{{cite web |title=Sufentanil: Uses, Interactions, Mechanism of Action |url=https://go.drugbank.com/drugs/DB00708 |website=Drugbank.com |publisher=OMx Personal Health Analytics, Inc. |access-date=16 June 2025 |date=13 June 2005}}</ref> | 4.4 | 2:1 | 1–3 min (IV); 5 min (IN); 10 min (EPD); 6–15 min (SL)<ref name="Sufentanil Onset of Action">{{cite journal |title=Oral Transmucosal Fentanyl and Sufentanil for Incident Pain |journal=Journal of Pain and Symptom Management |date=2001 |volume=22 |issue=2 |pages=627–630 |doi=10.1016/S0885-3924(01)00321-9 |pmid=11503630 | vauthors = Gardner-Nix J }}</ref> | 30 min (IV); 40–50 min (SL)<ref name="Sufentanil duration">{{cite book |last1=Shaw |first1=Leslie M. |editor1-last=Kwong |editor1-first=Tai C. |title=The Clinical Toxicology Laboratory: Contemporary Practice of Poisoning Evaluation |date=2001 |publisher=American Association for Clinical Chemistry |isbn=978-1-890883-53-9 |page=89 |url=https://books.google.com/books?id=pXvFGqz44pYC&pg=PA89 |access-date=16 June 2025}}</ref><ref>{{cite journal |last1=Reynolds |first1=Lowell |last2=Rauck |first2=Richard |last3=Webster |first3=Lynn |last4=DuPen |first4=Stuart |last5=Heinze |first5=Everett |last6=Portenoy |first6=Russell |last7=Katz |first7=Nathaniel |last8=Charapata |first8=Steven |last9=Wallace |first9=Mark |last10=Fisher |first10=Dennis M |title=Relative analgesic potency of fentanyl and sufentanil during intermediate-term infusions in patients after long-term opioid treatment for chronic pain |journal=Pain |date=July 2004 |volume=110 |issue=1 |pages=182–188 |doi=10.1016/j.pain.2004.03.024 |pmid=15275766 }}</ref> |- |BDPC<ref name="C-8813">{{cite journal |title=Opioid activity of C8813, a novel and potent opioid analgesic |journal=Life Sciences |date=2003 |volume=73 |issue=2 |pages=233���241 |doi=10.1016/S0024-3205(03)00263-7 |pmid=12738037 | vauthors = Liu Z, Jin W, Dai Q, Chen X, Zhang H, Chi Z }}</ref> |504 |~20 μg | | | | | |- |Orthofluorofentanyl<ref name="Fentanyl analog potency" /> |564 |~17 μg | | | | | |- |C-8813<ref name="C-8813" /> |591 |~15 μg | | | | | |- |4-Phenylfentanyl<ref>{{cite web |title=4-Phenylfentanyl |url=https://go.drugbank.com/drugs/DB09168 |website=Drugbank.com |publisher=OMx Personal Health Analytics, Inc. |access-date=20 June 2025 |location=University of Alberta |date=14 October 2015}}</ref> |800 | | | | | | |- | Etonitazene<ref>{{cite journal |title=Pharmacological evaluation and forensic case series of N-pyrrolidino etonitazene (Etonitazepyne), a newly emerging 2-benzylbenzimidazole 'nitazene' synthetic opioid |journal=Archives of Toxicology |date=2022 |volume=96 |issue=6 |pages=1845–1863 |doi=10.1007/s00204-022-03276-4 |pmid=35477798 |url=https://biblio.ugent.be/publication/01GS866C8Q94ZVNMPTG3CQCK3J | vauthors = Vandeputte MM, Krotulski AJ, Walther D, Glatfelter GC, Papsun D, Walton SE, Logan BK, Baumann MH, Stove CP }}</ref> | 1,000–1,500<ref>{{cite journal |last1=Vandeputte |first1=Marthe M. |last2=Glatfelter |first2=Grant C. |last3=Walther |first3=Donna |last4=Layle |first4=Nathan K. |last5=St. Germaine |first5=Danielle M. |last6=Ujváry |first6=István |last7=Iula |first7=Donna M. |last8=Baumann |first8=Michael H. |last9=Stove |first9=Christophe P. |title=Characterization of novel nitazene recreational drugs: Insights into their risk potential from in vitro µ-opioid receptor assays and in vivo behavioral studies in mice |journal=Pharmacological Research |date=December 2024 |volume=210 |article-number=107503 |doi=10.1016/j.phrs.2024.107503 |pmid=39521025 |pmc=11655282 }}</ref> | 6.6–10 μg | | | | | |- |3-Methylfentanyl<ref>{{cite web |title=3-Methylfentanyl |url=https://pubchem.ncbi.nlm.nih.gov/compound/3-Methylfentanyl |website=PubChem |publisher=National Library of Medicine |access-date=20 June 2025}}</ref> |1,000 (3-methylfentanyl, (trans)-(+-)-isomer; 6,600 (3-methylfentanyl, (cis)-(-)-isomer)<ref>{{cite journal |last1=Noble |first1=Carolina |last2=Papsun |first2=Donna M. |last3=Diaz |first3=Stephanie |last4=Logan |first4=Barry K. |title=Detection of two potent synthetic opioids carfentanil and 3-methylfentanyl in forensic investigations during a four-year period 2017‒2020 |journal=Emerging Trends in Drugs, Addictions, and Health |date=2021 |volume=1 |article-number=100022 |doi=10.1016/j.etdah.2021.100022 |doi-access=free }}</ref> | | | | | | |- |N-Desetylisotonitazene<ref>{{cite journal |title=New potent synthetic opioid— N-Desethyl Isotonitazene —proliferating among recreational drug supply in USA |url=https://www.drugsandalcohol.ie/38001/ |website=Health Research Board |date=January 2023 |publisher=HRB National Drug Library |access-date=20 June 2025 | vauthors = Krotulski AJ, Shinefield J, Teixeira Da Silva D, Mohr AL, Debord J, Walton SE, Logan BK }}</ref><ref name="Nitazene Alert" /> |2,000<ref>{{cite journal |title=Detection of N-desethyl etonitazene in a drug checking sample: Chemical analysis and pharmacological characterization of a recent member of the 2-benzylbenzimidazole "nitazene" class |journal=Journal of Pharmaceutical and Biomedical Analysis |date=2024 |volume=251 |article-number=116453 |doi=10.1016/j.jpba.2024.116453 |pmid=39216307 | vauthors = Monti MC, De Vrieze LM, Vandeputte MM, Persson M, Gréen H, Stove CP, Schlotterbeck G |hdl=1854/LU-01JD4BKWK2NQ195YBEAJ3AA9B6 |hdl-access=free }}</ref> |5–10 μg | | | | | |- |Etonitazepyne<ref name="Nitazenes">{{cite journal |last1=Vandeputte |first1=Marthe M. |last2=Krotulski |first2=Alex J. |last3=Walther |first3=Donna |last4=Glatfelter |first4=Grant C. |last5=Papsun |first5=Donna |last6=Walton |first6=Sara E. |last7=Logan |first7=Barry K. |last8=Baumann |first8=Michael H. |last9=Stove |first9=Christophe P. |title=Pharmacological evaluation and forensic case series of N-pyrrolidino etonitazene (etonitazepyne), a newly emerging 2-benzylbenzimidazole 'nitazene' synthetic opioid |journal=Archives of Toxicology |date=28 April 2022 |volume=96 |issue=6 |pages=1845–1863 |doi=10.1007/s00204-022-03276-4 |pmid=35477798 |bibcode=2022ArTox..96.1845V |url=https://biblio.ugent.be/publication/01GS866C8Q94ZVNMPTG3CQCK3J }}</ref><ref name="Nitazene Alert" /> |2,000<ref>{{cite journal |title=Critical review report: Etonitazepyne (N- pyrrolidino etonitazene) |journal=Expert Committee on Drug Dependence |date=10 October 2022 |issue=44 |pages=7, 8 |url=https://cdn.who.int/media/docs/default-source/controlled-substances/45th-ecdd/etonitazepyne_draft.pdf?sfvrsn=59b1de_1 |access-date=20 June 2025 |publisher=World Health Organization |format=.pdf}}</ref> |5 μg | | | | | |- | Etorphine<ref>{{cite book |title=Applied Pharmacology |chapter=Neurology and the Neuromuscular System |date=2011 |pages=325–365 |doi=10.1016/B978-1-4377-0310-8.00021-X |isbn=978-1-4377-0310-8 | vauthors = Bardal SK, Waechter JE, Martin DS }}</ref><ref name="Morphine-Thebaine Group">{{cite journal |title=Novel analgesics and molecular rearrangements in the morphine-thebaine group. III. Alcohols of the 6,14-endo-ethenotetrahydrooripavine series and derived analogs of N-allylnormorphine and -norcodeine |journal=Journal of the American Chemical Society |date=1967 |volume=89 |issue=13 |pages=3281–3292 |doi=10.1021/ja00989a032 |pmid=6042764 | vauthors = Bentley KW, Hardy DG }}</ref> | 500–2,000<ref>{{cite journal |last1=Jasinski |first1=Donald R. |last2=Griffith |first2=John D. |last3=Carr |first3=Carter B. |title=Etorphine in man. I. Subjective effects and suppression of morphine abstinence |journal=Clinical Pharmacology & Therapeutics |date=March 1975 |volume=17 |issue=3 |pages=267–272 |doi=10.1002/cpt1975173267 |pmid=1091396 }}</ref> | 3.3–10 μg | | | | | |- |Ohmefentanyl<ref>{{cite journal |last1=Wang |first1=Hong |last2=Pélaprat |first2=Didier |last3=Roques |first3=Bernard P. |last4=Vanhove |first4=Alain |last5=Chi |first5=Zhi Q. |last6=Rostène |first6=William |title=[3H]Ohmefentanyl preferentially binds to μ-opioid receptors but also labels σ-sites in rat brain sections |journal=European Journal of Pharmacology |date=February 1991 |volume=193 |issue=3 |pages=341–350 |doi=10.1016/0014-2999(91)90149-K |pmid=1647320 }}</ref> |6,300<ref>{{cite journal |last1=Jin |first1=WQ |last2=Xu |first2=H |last3=Zhu |first3=YC |last4=Fang |first4=SN |last5=Xia |first5=XL |last6=Huang |first6=ZM |last7=Ge |first7=BL |last8=Chi |first8=ZQ |title=Studies on synthesis and relationship between analgesic activity and receptor affinity for 3-methyl fentanyl derivatives. |journal=Scientia Sinica |date=May 1981 |volume=24 |issue=5 |pages=710–20 |pmid=6264594 }}</ref> | | | | | | |- |Acetorphine<ref name="Morphine-Thebaine Group" /> |8,700 |1.33 μg | | | | | |- | Dihydroetorphine<ref>{{Cite journal|last1=Ohmori|first1=Satoshi|last2=Morimoto|first2=Yasunori|date=2002|title=Dihydroetorphine: a potent analgesic: pharmacology, toxicology, pharmacokinetics, and clinical effects|journal=CNS Drug Reviews|volume=8|issue=4|pages=391–404 |pmid=12481194|pmc=6741694|quote=Dihydroetorphine (DHE) is one of the strongest analgesic opioid alkaloids known; it is 1000 to 12,000 times more potent than morphine. ... <br />{{in5}}MOR is the most commonly used opioid analgesic for pain relief, and its oral daily dose (20 to 1000 mg) is relatively high (44). On the other hand, DHE produces rapid analgesic effects at an extremely low dose, 20 ìg sublingually in humans (60, 78). ...|doi=10.1111/j.1527-3458.2002.tb00236.x}}</ref> | 12,000 | 0.83–10 μg (20–40 μg SL) | | | | | |- | Carfentanil<ref name="Carfentanil">{{cite web |title=Carfentanil |work=DrugBank Version: 3.0 |publisher=DrugBank |url=https://www.drugbank.ca/drugs/DB01535}}</ref> | 10,000 | 1.0 μg | | 7.7 | | | |- |Lofentanil<ref>{{cite web |title=What is the Strongest Opioid? |url=https://movingmountainsrecovery.com/opioids-strongest-to-weakest/ |website=Moving Mountains Recovery Center |date=18 April 2022 |publisher=©Moving Mountains Recovery |access-date=20 June 2025}}</ref><ref>{{cite journal |last1=Ramos-Gonzalez |first1=Nokomis |last2=Paul |first2=Barnali |last3=Majumdar |first3=Susruta |title=IUPHAR themed review: Opioid efficacy, bias, and selectivity |journal=Pharmacological Research |date=November 2023 |volume=197 |article-number=106961 |doi=10.1016/j.phrs.2023.106961 |pmid=37844653 |pmc=10713092 }}</ref> |10,000–11,000<ref>{{cite web |title=Lofentanil - C25H32N2O3 |url=https://pubchem.ncbi.nlm.nih.gov/compound/Lofentanil |website=PubChem |publisher=National Library of Medicine |access-date=20 June 2025}}</ref> | | | | | | |- |4-Carboethoxyohmefentanil<ref name="Stereoisomers of Carfentanil">{{cite journal |last1=Brine |first1=G. A. |last2=Carroll |first2=F. I. |last3=Richardson-Leibert |first3=T. M. |last4=Xu |first4=H. |last5=Rothman |first5=R. B. |title=Ohmefentanyl and Its Stereoisomers: Chemistry and Pharmacology |journal=Current Medicinal Chemistry |date=August 1997 |volume=4 |issue=4 |pages=247–270 |doi=10.2174/0929867304666220313115017 }}</ref> |30,000 | | | | | | |- |Ohmecarfentanil<ref>{{cite journal |title=Designer drugs: A medicinal chemistry perspective (II) |journal=Annals of the New York Academy of Sciences |date=2021 |volume=1489 |issue=1 |pages=48–77 |doi=10.1111/nyas.14349 |pmid=32396701 | vauthors = Carroll FI, Lewin AH, Mascarella SW, Seltzman HH, Reddy PA }}</ref><ref name="Stereoisomers of Carfentanil" /> |data-sort-value="30000"|30,000 | | | | | | |- |R-30490<ref>{{cite journal |last1=Maguire |first1=Patricia |last2=Tsai |first2=Nancy |last3=Kamal |first3=John |last4=Cometta-Morini |first4=Chiara |last5=Upton |first5=Christopher |last6=Loew |first6=Gilda |title=Pharmacological profiles of fentanyl analogs at μ, δ and κ opiate receptors |journal=European Journal of Pharmacology |date=March 1992 |volume=213 |issue=2 |pages=219–225 |doi=10.1016/0014-2999(92)90685-W |pmid=1355735 }}</ref> |data-sort-value="55000"|10,000–100,000 | | | | | | |- |14-Methoxymetopon<ref>{{cite journal |title=14-Methoxymetopon, a very potent μ-opioid receptor-selective analgesic with an unusual pharmacological profile |journal=European Journal of Pharmacology |date=2003 |volume=459 |issue=2–3 |pages=203–209 |doi=10.1016/s0014-2999(02)02821-2 | vauthors = King MA, Su W, Nielan CL, Chang AH, Schütz J, Schmidhammer H, Pasternak GW }}</ref> |data-sort-value="1000000"|1,000,000 (intrathecal & supraspinal) | 0.1 μg | | | | | |- class=sortbottom |colspan="9" style=" border: 1px solid #000000; text-align:center;" |<small>PO: oral • BUC: buccal • SL: sublingual • TD: transdermal • IV: intravenous injection • IM: intramuscular injection • SC: subcutaneous injection • EPD: epidural injection<br />"Strength" is defined as analgesic potency relative to oral morphine.<br />Tolerance, sensitization, cross-tolerance, metabolism, and hyperalgesia may be complex factors in some individuals.<br />Interactions with other drugs, food and drink, and other factors may increase or decrease the effect of certain analgesics and alter their half-life.<br />Because some listed analgesics are prodrugs or have active metabolites, individual variation in liver enzymes (e.g., CYP2D6 enzyme) may result in significantly altered effects.</small> |} {{Sticky table end}}
==See also == * Oripavine – for more on the comparative strength of oripavine derivatives
==References== === Explanatory notes === {{notelist}}
=== Citations === {{Reflist}}
=== Bibliography === ==== Books ==== {{refbegin|30em}} * {{Cite journal|last=Cupp|first=Melanie|title=Equianalgesic Dosing of Opioids for Pain Management. PL Detail-Document #280801|url=https://www.nhms.org/sites/default/files/Pdfs/Opioid-Comparison-Chart-Prescriber-Letter-2012.pdf|journal=Pharmacist's Letter|date=August 2012|access-date=2016-02-05|archive-date=2015-02-13|archive-url=https://web.archive.org/web/20150213072552/http://www.nhms.org/sites/default/files/Pdfs/Opioid-Comparison-Chart-Prescriber-Letter-2012.pdf}} * {{Cite book | last=Joishy | first=S. K. | title=Palliative medicine secrets |year=1999 | publisher=Hanley & Belfus | location=Philadelphia | page=97 | isbn=978-1-56053-304-7}} * {{cite book|last1=McCaffery|first1=Margo|last2=Pasero|first2=Chris|title=Pain: Clinical Manual|url=https://books.google.com/books?id=B5JtAAAAMAAJ|year=1999|publisher=Mosby|isbn=978-0-8151-5609-3|edition=2nd}}, ''[http://www3.us.elsevierhealth.com/PAIN/index.html Extra information, including printable charts]'' * {{Cite book | last=McPherson | first=Mary Lynn M. | title=Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing | url=https://books.google.com/books?id=6oBA9z5wl9wC | year=2009 | publisher=American Society of Health-System Pharmacists | location=Bethesda MD | page=5 | isbn=978-1-58528-297-5 }} {{refend}}
==== Articles ==== {{refbegin|30em}} * {{cite journal |last1=Anderson |first1=Robert |last2=Saiers |first2=Joseph H |last3=Abram |first3=Stephen |last4=Schlicht |first4=Christian |title=Accuracy in Equianalgesic Dosing |journal=Journal of Pain and Symptom Management |date=May 2001 |volume=21 |issue=5 |pages=397–406 |doi=10.1016/S0885-3924(01)00271-8 |pmid=11369161 |doi-access=free |ref={{harvid|Anderson et al|2001}}}} * {{cite journal |last1=Natusch |first1=Douglas |title=Equianalgesic doses of opioids – their use in clinical practice |journal=British Journal of Pain |date=February 2012 |volume=6 |issue=1 |pages=43–46 |doi=10.1177/2049463712437628 |pmid=26516465 |pmc=4590088 |doi-access=free}} * {{cite journal |last1=Pereira |first1=Jose |last2=Lawlor |first2=Peter |last3=Vigano |first3=Antonio |last4=Dorgan |first4=Marlene |last5=Bruera |first5=Eduardo |title=Equianalgesic Dose Ratios for Opioids |journal=Journal of Pain and Symptom Management |date=August 2001 |volume=22 |issue=2 |pages=672–687 |doi=10.1016/s0885-3924(01)00294-9 |doi-access=free |pmid=11495714 |ref={{harvid|Pereira et al|2001}}}} * {{Cite journal |last1=Shaheen |first1=Philip E. |last2=Walsh |first2=Declan |last3=Lasheen |first3=Wael |last4=Davis |first4=Mellar P. |last5=Lagman |first5=Ruth L. |date=September 2009 |title=Opioid equianalgesic tables: are they all equally dangerous? |journal=Journal of Pain and Symptom Management |volume=38 |issue=3 |pages=409–417 |doi=10.1016/j.jpainsymman.2009.06.004 |pmid=19735901 |doi-access=free}} {{refend}}
====Websites==== {{refbegin|30em}} * {{cite web |title=Opioid Equianalgesic Table |url=https://surgery.utoronto.ca/file/1330/download?token=AwhfeyiE |website=Lecture Notes |publisher=Department of Surgery, University of Toronto |access-date=26 February 2020 |date=November 2014 |ref={{harvid|Toronto Surgery|2014}} |archive-date=26 February 2020 |archive-url=https://web.archive.org/web/20200226183108/https://surgery.utoronto.ca/file/1330/download%3Ftoken%3DAwhfeyiE}} * {{cite web |last=Walker |first=Paul |title=Issue 17. Morphine vs Hydromorphone vs Oxycodone vs The Patch |website=Palliative Care Tips: Info for Health Professionals |publisher=Palliative & End of Life Care (PEOLC), Alberta Health Services |date=2001 |url=http://www.palliative.org/PC/ClinicalInfo/PCareTips/MorphineVSHydromorphine.html |archive-url=https://web.archive.org/web/20011224112255/http://www.palliative.org/PC/ClinicalInfo/PCareTips/MorphineVSHydromorphine.html |archive-date=December 24, 2001}} * {{cite web |title=Management of Opioid Therapy (OT) for Chronic Pain (2017) |url=https://www.healthquality.va.gov/guidelines/Pain/cot/VADoDOTCPG022717.pdf |department=VA/DoD Clinical Practice Guidelines |publisher=Department of Veterans Affairs |access-date=26 February 2020 |page=99 |ref={{harvid|VA|2017}}}} * [http://clincalc.com/Opioids Online opioid equianalgesia calculator] Electronic calculator that includes logic for bidirectional and dose-dependent conversions {{refend}}
{{Analgesics}} {{Opioid receptor modulators}}
Category:Anesthesia Category:Clinical pharmacology Category:Comparison of psychoactive substances Category:Medical terminology Category:Nociception Category:Opioids Category:Pain