Can someone give me a lowdown on different kinds of pills? - Pain Management Message Board

LouiseM · 10-26-2003, 02:54 PM

I just wanted to know from the lowest to the highest strength on pain killers? I am just clueless on it all?

Thanks a lot guys!!

Hope all is having a pain free day!

igy76 · 10-26-2003, 03:30 PM

LOUISE,

Well one thing to keep in mind is that there's still not an EXACT science as to what will truly be stronger, as everyone reacts differently to every pill.

But I think probably a safe, general rule of thumb would be that things like Ultracet/Ultram and Darvocet (propoxyphene is the generic) are the weakest prescription relievers you can get, while still being technically Schedule III narcotics. The next step up would be hydrocodone, which comes in many brand names like Vicodin, Lortab, Lorcet, Norco, etc. And it all comes in varying strengths. The weakest hydrocodone pill you can get is 5/325 (5mg of hydro & 325 of tylenol - although now that I think about it, I'm not 100% sure hydro comes in that exact strength - otherwise the weakest combo would be 5/500. There are several differnt combo amts, 10/325, 7.5/750, 10/500, 10/650... you get the idea

The next level up would be oxycodone, which also comes in varying brand names (Percocet, Percodan, OxyIR, Roxicodone, etc). Oxy is a Sched. II drug (stuff that's Sched I is only like heroin, cocaine, etc). And just like with the hydro, oxycodone comes in all the same varying strength combos.

Keep in mind all the examples I just gave you are all SHORT ACTING MEDS. Currently, that I know of, hydrocodone comes in no LONG ACTING FORM. When you're RX'd a LA med, there's no tylenol, because it's with the understanding that you're going to be taking it for awhile. (believe it or not, most people in America who are given Vicodin, it's only for a week or so, so that amount of tylenol is negliable to them). Oxycodone DOES come in a LA form, that's what OxyContin is. You may hear a lot of people on here talking about taking OxyContin as their base med, as they use some form of Percocet or OxyIR as their "break through" med. These people are taking the same exact drug both times, they're just taking it in two different forms. (The Contin sustains an even level of the drug in your system during the day - well, supposedly

and the regular oxycodone product gives them an immediate boost for acute pain a few times a day.) There are other LA meds that don't contain oxycodone, but it's up for debate which ones are stronger than others exactly. Like I said, it just depends what works for you. MSContin is a LA morphine product. I'm sorry, I feel like there are other LA pills that I'm forgetting right now. There ARE two other meds I can tell you about, but they're kind of different. For one there's Methadone, which is also what I'm on. Technically, this isn't a LA med in the same formulation as the OxyContin or MSContin is. It doesn't release an amount of its power after you take it, then slowly do that again at the 8 or so hour mark, like those other two do. Especially in my experience, it seems to work actually more like a short acting med, it just happens to work on you for a long time. Does that make sense?

The other one I was thinking about is the Duragesic, or Fentynal Patch. I've never used it, but is one of, if not the most potent opiate reliever RX'd. It's simply a patch you put on (like the 'quit smoking' patch, if you're familiar), and over the course of 48-72 hours it delivers you a steady constant dose of fentynal. You have to be in some serious pain for you doc to give you these. There are of course varying strengths.

Okay like I said, I decided to reply here because I wanted to, and thought, that I could help you, but now that I'm writing I feel like I'm forgetting others. But hopefully at least that'll give you a general idea of the sort of 'ladder' of painkillers there are. Good luck

wirry1422 · 10-26-2003, 04:37 PM

Sorry to correct again, but cocaine is actually schedule II as it does have some legit medical uses.

wirry1422 · 10-26-2003, 05:06 PM

From weakest to strongest, in my opinion, here is a brief list (oral meds taken orally only with exception of the patch).

Non-prescription- Tylenol (Acetomenophen), Aspirin, Naproxen, Ibuprofin.

Prescription Narcotics (not including NSAID's like Vioxx, or other non-narcotics used as presciption pain relievers such as elavil or neurontin):

Propoxyphene- Brand name darvocet, darvon compound, comes with APAP and/or caffeine, propoxyphene is not stronger than 60% of codeine, and in studies is equal to extra strength aspirin; overall very weak. Schedule IV.

Tramadol- This med either comes alone (Utram) or with tylenol (Ultracet). It is technically not a narcotic, but rather a completely synthetic drug which acts just like a narcotic,(so for all practical intents and purposes it is a narcotic) but a weak one which I would consider as being slightly less potent than codeine. Schedule IV

Codeine- Comes in pure codeine tablets, or in Tylenol #3 and #4. approximately 10% to 15% as strong as oral morphine. Usually first line of choice for doctor's starting someone on narcotics for the first time. Is noticeably stronger than any over-the-counter pain meds. Schedule III

Hydrocodone- Comes only compounded with tylenol or ibuprofin (vicoprofen). Approximately 4 to 5 times as strong as codeine. Probably the strongest med still in schedule III. Only slightly weaker than oral morphine. Comes in various dose combinations with tylenol. Schedule III (in most states).

Morphine (oral)- Oral morphine comes only by itself (no APAP combos) and also comes in long acting form (mscontin) This Medication is schedule II and is a very strong pain reliever. Schedule II.

Oxycodone- Comes with tylenol (percocet) with aspirin (percodan) or alone (oxy ir, long acting oxycontin). Oxycodone is approximately 50% more powerful than oral morphine and works very well in most chronic pain patients. Schedule II.

Methadone- Is a long acting narcotic, which builds up in the system over time. Only comes by itself, no tylenol etc. Is 3-4 times as potent as oral morphine. Doctors usually use this meds if oxycodone is not adequate to control severe pain. Schedule II.

Hydromorphone- Is a short acting narcotic (currently long acting form available only in canada.) Is extremely powerful, approximately 8-10 times as strong as oral morphine. Usually given for advanced chronic pain patients in extreme pain, who are tolerant to the other medications. Strongest oral med available. Brand name, Diluadid. Schedule II.

Fentanyl- Not available in pill form, only skin patch or injection. This is by far the most powerful narcotic known to man. Fentanyl is measured in micro-grams (1/1000th of a milligram), not milligrams. This med is given only as a last resort for chronic extreme pain patients and especially for terminal cancer patients. The brand name of this med is Duragesic which is a skin patch which comes in strength from 25 mcg to 100 mcg per hour released into the blood stream directly through the skin. Also available as a lolipop called Actiq for breakthrough pain in strengths from 200 mcg to 1600 mcg (probably enough to kill most opiate naive people very quickly). Fentanyl is 100 times as strong as morphine, so respect Fentanyl! Schedule II.

And that's about it for the non-injection and oral meds, in order of potency. When talking about IV meds things are totally different as some meds are not made in injectable form while others increase in potency relative to others so this is only for oral meds (again with the exception of the patch) and of course is completely subjective to my opinion, others' may have differing experiences/opinions.

[This message has been edited by wirry1422 (edited 10-27-2003).]

Shoreline · 10-27-2003, 01:25 PM

Hey Guys, Everyone did a great job expalining the meds, I thought I would just explain the scheduling system as some are not clear.
meds that have been considered by the DEA controlled drug act of '72 have been scheduled into 5 catagories. Drugs deemed to have no medical value like Heroin are considered schedule 1 or illegal narcotics like ecstacy or LSD. I never really thought of cocaine as being a scedule 11 drug as nobody is ever going to prescribe it.

Cocaine is used in liquid form in the surgical arena like Rhino plasty for it's vascular constricting ability along with numbing action. Marijauna at one time would have been considered a drug with no medical value but with marinol and states that have legalized MJ I suppose it would be a schedule 11.

The lower the number the higher the abuse potential. Schedule 11's have to have a written script each time it's dispensed and no refills are allowed.
C-11's are the stronger opiates and the free form opiates that could be diverted for IV use.Amphetamines and the older diet meds are included in this more likely to be abused group
C-111 are the meds that have some potential for abuse like the meds with Hydrocodone and tylenol.Vicodin, Lortab etc.
C-1V meds are usually meds like valium, mild tranquilizers,librium and such
C-V medication does not always require a written prescription, such as antibiotics and Robotussin with a minute amount of codeine can be obtained simply by signing a log.Same with Insulin

Hope this helps. And I would agree with the order of potency Wirry suggested, although methadone is vastly underestimated in potency and may be as potent as Dilaudid. Dilaudid is 7-8 times more potent than morphine on most charts where more recent articles about methadone have suggested it has the widest reponse of all meds ranging from 3x more potent than morphine to 10 times more potent.

So whether Dilaudid is more potent than methadone is certainly debatable. Not arguable but debatable. LOL

Fentanyl is by far the most potent opiate prescribed today in the states, there are other variations of Fentanyl used in the surgical arena, Suffentanyl, Affentanyl,and Carfentanyl. For the interested chemist.
Take care, Shore