The 211 Most Abused and Addictive Prescription Painkillers
"Nobody is safe from this epidemic that threatens young and old, rich and poor, urban and rural communities. Everybody is threatened. Drug overdose is now the leading cause of accidental death in the United States, and opioid overdose deaths have nearly quadrupled since 1999. It is a problem the likes of which we have not seen."
~ President Donald Trump
Between 1994 and 2015, more than 185,000 Americans died because of prescription drug overdoses.
That's more than the population of Vancouver, Washington.
ALL opioid painkillers carry a risk of dependence, misuse, addiction, and overdose. This is why the Centers for Disease Control and Prevention, the Food and Drug Administration, and the US Surgeon General all issued new guidelines in 2016 concerning opioid prescribing.
But if doctors are now being told that powerful opioid painkillers should only be prescribed as "last resort", what do YOU know about the medications you are taking?
Let's take a look at some of the most dangerously addictive opioid pain medications on the market.
First Things First – Common Side Effects Shared by All Opioids
"We know of no other medications routinely used for a nonfatal condition that kills patients so frequently. We hope to see fewer deaths from opiates. That's the bottom line. These are really dangerous medications that carry the risk of addiction and death."
~Dr. Thomas Frieden, MD, Director of the CDC
To varying degrees based on potency, all opioids affect the body in similar ways. Besides the ability to block pain messages in the body, all opioids - even when taken as prescribed - have the following potential side-effects:
- Drowsiness and Sedation
- Constipation - up to 95% of patients taking opioids long-term
- Weakened Immune System
- Respiratory Depression - this is what kills during an opioid overdose. Respiratory depression is greatly magnified when the person consumes other opioids, drinks alcohol, or takes benzodiazepine tranquilizers such as Xanax or Valium.
- A Euphoric High
These last two side effects are the biggest reasons why opioids are misused non-medically - to get high and/or to avoid painful symptoms of opioid withdrawal. And that misuse leads to addiction.
And the stronger an opioid is, the faster it works, and the shorter the duration of its effects, the easier it is to become addicted.
What Opioid Medications Are the Most Addictive?
Because of these factors, there are 5 types of commonly-prescribed opioids that are particularly dangerous. The mere fact that they are so available means a significant percentage of patients will abuse them.
Together, these six opioid classes account for over TWO HUNDRED MEDICATONS that could be given to you or your family.
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"Vicodin, I got addicted to that little pill. The reason I don't talk about it too much in the press is because it isn't funny, and I love to be funny in interviews. If you joke about that period in your life, it doesn't seem right."
Addiction Risk: Severe/High
Class: Semi-Synthetic, synthesized from codeine
Relative Strength: EQUAL to morphine
Onset of Action: 10-30 minutes
Duration: 4-6 hours
History: First synthesized in Germany in 1920, approved for sale in the US in 1943
Medical Uses: Hydrocodone medications are primarily prescribed to treat moderate-to-severe-pain, although it can also be given in liquid form as a cough suppressant.
Hydrocodone is found in the following medications:
- Single-Ingredient Extended-Release Hydrocodone
- Hysingla ER
- Vantrela ER
- Zohydro ER
- Immediate-Release with Acetaminophen
- Immediate-Release with Aspirin
- Alor 5/500
- Lortab ASA
- Panasal 5/500
- Immediate-Release with Ibuprofen
- Xylon 10
- Brompheniramine/Guaifenesin/Hydrocodone Liquid
- Brompheniramine/Hydrocodone/Phenylephrine Liquid
- VasoTuss HC
- BPM PE HC
- Canges-HC NR
- FluTuss HC
- Brompheniramine/Hydrocodone/Pseudoephedrine Liquid
- Anaplex HD
- Bromplex HD
- Chlorpheniramine/Hydrocodone Extended-Release Capsules
- Hydrocodone GF
- Tussionex Pennkinetic
- Chlorpheniramine/Hydrocodone/Phenylephrine Liquid
- Hydrocodone CP
- Hydrocodone HD
- A-G Tussin
- Cytuss-HC NR
- H-C Tussive-NR
- Histussin HC Syrup
- Dexchlorpheniramine/Hydrocodone/Phenylephrine Liquid
- Codimal DH
- Notuss PD
- Zotex HC
- Diphenhydramine/Hydrocodone/Phenylephrine Syrup
- Endal HD
- Rindal HPD
- Pneumotussin 2.5
- Guaifenesin/Hydrocodone/Phenylephrine Liquid
- Atuss G
- Levall 5.0
- Mintuss G
- MonteFlu HC
- Entuss-D JR
- Tussend Expectorant
- Vanex Expectorant
- Hydrocodone/Phenylephrine/Pyrilamine Liquid
- Hycomal DH
- PhendaCof Plus
- Hydrocodone/Potassium Guaiacolsulfonate Liquid
- Entuss Expectorant
- Marcof Expectorant
- Prolex DH
- P-V Tussin
Unique Side-Effects of Hydrocodone:
- The misuse of Vicodin-type formulations can result in progressive hearing loss in both ears.
- Formulations containing acetaminophen are associated with severe liver damage and failure, especially if they are used concurrently with alcohol.
- Hydrocodone/ibuprofen formulations avoid much of the liver damage, but still present a significant risk of respiratory depression.
Notes about Hydrocodone:
99% of the world's hydrocodone is consumed in the United States.
“To defeat the epidemic, we must stop creating new users, and part of that is making sure these highly addictive and dangerous drugs are marketed truthfully and without deception and in such a way as not to minimize addiction risks or overstate benefits to patients.”
~New Hampshire Deputy Attorney General Ann Rice, in a lawsuit against Purdue Pharma, the makers of OxyContin
Addiction Risk: High
Class: Semi-Synthetic, synthesized from thebaine
Relative Strength: 1.5-2 times STRONGER than morphine
Onset of Action: 10-30 minutes, reaching peak effect in 30-60 minutes. Controlled-release oxycodone starts to relieve pain in about one hour, reaching its peak at about 3 hours.
Duration: 3-6 hours for instant-release oxycodone, 12 hours for controlled-release
History: First synthesized in Germany in 1916, introduced in the US in 1939
Medical Uses: Oxycodone medications are prescribed for moderate-to-severe acute or chronic pain. It is considered a first-line alternative option for cancer pain.
Unlike most other opioids, oxycodone can be prescribed for children as young as 11 as an alternative to fentanyl.
Although some countries allow intramuscular or intravenous oxycodone use, in the United States, only oral oxycodone use is approved. Oxycodone is found in the following medications:
- Immediate-Release Single-Ingredient Oxycodone
- Controlled-Release Single Ingredient Oxycodone
- Xtampza ER
- Oxycodone Tamper-Resistant
- OxyContin OTR
- Immediate-Release Oxycodone with Acetaminophen
- Percocet 5/325
- Percocet 10/325
- Immediate-Release Oxycodone with Aspirin
- Immediate-Release Oxycodone with Ibuprofen
- Controlled-Release Oxycodone with Naloxone
- Targiniq ER
- Controlled-Release Oxycodone with Naltrexone
- Troxyca ER
Unique Side-Effects of Oxycodone:
- Opioid-Induced Constipation (23% of patients)
- Drowsiness (23%)
- Nausea (23%)
- Dizziness (13%)
- Itching (13%)
- Vomiting (12%)
- Oxycodone overdoses can cause suppressed breathing, resulting in hypoxia, brain damage, and spinal cord infarction.
Notes About Oxycodone:
OxyContin is the most-abused prescription opioid in America.
In 2007, Purdue Pharma – the manufacturer of OxyContin – was fined more than $600 million because the company’s sales representatives had intentionally misled both the public and doctors by misrepresenting OxyContin as less euphoric and less addictive than other opioids.
“Codeine addiction is something that is a bit of a hidden problem, unlike things like alcohol addiction or other drug addictions.”
~ Dr. David Outridge, Newcastle, New South Wales
Addiction Risk: High
Class: Natural, extracted from the opium poppy or synthesized from morphine
Relative Strength: 1/10th the strength of morphine
Onset of Action: 30 minutes, reaching peak effect in 2 hours
Duration: 4-6 hours
History: First identified in France in 1832
Medical Uses: Codeine medications are prescribed for mild-to-moderate pain and severe diarrhea, such as might be caused by Irritable Bowel Syndrome. Once considered the “gold standard” for cough suppression, newer studies suggest that it may, in fact, be no better than a placebo.
Codeine is found in the following medications:
- Single-Ingredient Codeine
- Fioricet with Codeine
- Phenilin with Caffeine and Codeine
- Tylenol with Codeine
- Tylenol with Codeine #3
- Tylenol with Codeine #4
- Aceta with Codeine
- Ammonium Chloride/Chlorpheniramine/Codeine/Phenylephrine
- Anhydrous Calcium Iodide/Codeine
- Ascomp with Codeine
- Fiorinal with Codeine
- Fiorinal with Codeine III
- Fiortal with Codeine
- Aspirin/ Carisoprodol/Codeine
- Soma Compound with Codeine
- Aspirin with Codeine
- Empirin with Codeine
- BroveX CB
- BroveX CBX
- Nalex AC
- Brompheniramine/Codeine/Phenylephrine Liquid
- BroveX PB C
- BroveX PB CX
- Poly-Tussin AC
- TL-Hist CD
- Dimetane DC
- Myphetane DC
- Poly-Histine CS
- M-End WC
- Mar-cof BP
- Mesehist WC
- Chlorcyclizine/Codeine/Pseudoephedrine Liquid
- Poly-Tussin D
- Statuss Green
- Tuxarin ER
- Tuzistra XR
- Z-Tuss AC
- Chlorpheniramine/Codeine/Phenylephrine Syrup
- Endal CD
- Chlorpheniramine/Codeine/Phenylephrine/Potassium Iodide
- Demi Cof
- Chlorpheniramine/Codeine/Pseudoephedrine Liquid
- Codehist DH
- Dihistine DH
- Tricode AR
- Zodryl DAC
- Codeine/Dexbrompheniramine/Pseudoephedrine Liquid
- M-End Max D
- Dexphen with C
- Pro Red AC
- Vanacof CD
- Codeine/Diphenhydramine/Phenylephrine Solution
- Cheratussin AC
- Guaiatussin AC
- Virtussin A/C
- Codeine/Guaifenesin/Phenylephrine Liquid
- Giltuss Ped-C
- Maxiphen CD
- Maxiphen CDX
- Alphen Expectorant
- Efasin Expectorant SF
- Endal Expectorant
- Enditussin Expectorant
- Codeine/Guaifenesin/Pseudoephedrine Liquid
- Cheratussin DAC
- Virtussin DAC
- Codeine/Pheniramine/Phenylephrine/Sodium Citrate
- Tussirex Sugar Free
- Codeine/Phenylephrine Liquid
- Ala-Hist AC
- Codeine/Phenylephrine/Promethazine Syrup
- Phenergan VC with Codeine
- Promethazine VC with Codeine
- Codeine/Phenylephrine/Pyrilamine Syrup
- Codimal PH
- Histex AC
- Codeine/Promethazine Syrup
- Generic Only
- Codar D
- Codeine/Pseudoephedrine/Pyrilamine Syrup
- Neo AC
- Codeine/Pseudoephedrine/Triprolidine Liquid
- Polyhst NC
- Pseudodine C
- Triacin C
- Trifed C
- Codeine/Pyrilamine Syrup
- Pro-Clear AC
Unique Side-Effects of Codeine:
- Codeine has been determined to be potentially-life-threatening to anyone under the age of 18.
- On April 20, 2017, the Food and Drug Administration issued its strongest warning concerning codeine.
- Codeine is now dispensed with warning labels alerting parents of possibly-fatal complications among certain groups of children or teenagers, including those who are or have:
- Still breast-feeding
- Recovering from adenoid or tonsil surgery
- Obstructive sleep apnea
- Any lung disease
- Certain ethnic groups have been determined to be "ultra-fast metabolizers" of codeine. This means that the drug breaks down in their body to rapidly, possibly resulting in toxic opioid buildups of up to 45-fold higher concentrations. Each ethnic group has a percentage of members that carry the ultra-fast metabolizer genotype:
- East Asians, less than 2%
- African-Americans, less than 4%
- Caucasians, just under 10%
- Puerto Ricans and people of Middle Eastern descent, over 10%
- Between 1969 and 2016, 88% of the children killed by acute codeine intoxication were under the age of 12.
Notes about Codeine:
Codeine is the most-used opioid in the world, and on the World Health Organization’s List of Essential Medicines.
Drinking excessive amounts of cough suppressant containing codeine – called “purple drank”, “lean”, or “syrup” – is the most-common method of abuse.
"She split two hydromorphone Dilaudid capsules. Her body just couldn't do it. She wasn't very big."
~ mother Dale Jollota, whose 15-year-old daughter died of acute hydromorphone intoxication while experimenting with drugs
Addiction Risk: Very High
Class: Semi-Synthetic, derived from morphine
Relative Strength: 4-8 times STRONGER than morphine
Onset of Action: 5 minutes intravenously, 30 minutes for oral instant-release formulations, reaching peak effect at 30-60 minutes
Duration: 2-3 hours
History: First synthesized in Germany in 1924
Medical Uses: Hydromorphone is prescribed for the treatment of moderate-to-severe acute or chronic pain. In some formulations, it is used to as a cough suppressant. In a nebulizer, it can treat shortness of breath.
Medications that include hydromorphone include:
- Single-Ingredient Hydromorphone
- Hydromorph Contin
Unique Side-Effects of Hydromorphone:
- Ambulatory patients or those not actually in pain may hallucinate when taking hydromorphone
- Hypoglycemia and sugar cravings
- Hypogonadism – diminished functionality of the testes or ovaries, possibly resulting in infertility
- Hormone imbalance
Notes about Hydromorphone:
Interestingly – or perhaps tellingly – hydromorphone is used as a backup execution drug in Ohio and Arizona.
Prescription Painkillers Containing Oxymorphone
"They never should have allowed Opana back on the market. We never needed it. We had plenty of opioid options."
~Andrew Kolodny, Codirector of the Opioid Policy Research Collaborative, Brandeis University
Addiction Risk: High
Class: Semi-Synthetic, derived from thebaine
Relative Strength: 3-7 times STRONGER than morphine
Onset of Action: 5-10 minutes intravenously, 15-30 minutes for suppository formulation
Duration: 3-4 hours for Immediate–Release tablets, up to 12 hours for Extended-Release tablets
History: First synthesized in Germany in 1914, introduced to the United States in 1959
Medical Uses: Oxymorphone is prescribed for moderate-to-severe pain, especially labor pain or dyspnea (shortness of breath) caused by pulmonary edema or left ventricular failure.
Medications that include oxymorphone include:
- Opana ER
Unique Side-Effects of Oxymorphone:
- Increased Intracranial Pressure
- Reduced Cardiac Output
- Concentration Buildups in patients with impaired liver function
Notes about Oxymorphone:
In June 2017, the Food and Drug Administration sought to remove Opana from the market, saying that the potential risks outweighed the benefits. If successful, this would be the second time the drug has been recalled.
“If you're using heroin or opioid drug and you have fentanyl cut into your drug unknowingly, you can be subject to sudden death. These can be kill pills.”
~ Jeff Duchin, Public Health Seattle & King County.
Addiction Risk: Very High
Relative Strength: 50-100 times STRONGER than morphine, while some fentanyl analogues are 10,000 times stronger
Onset of Action: 5 minutes
Duration: 30-60 minutes
History: First synthesized in Belgium in 1959
Medical Uses: Fentanyl is prescribed for severe or chronic pain, especially for postoperative or cancer patients. It is also used as an anesthetic during surgery, and as a sedative during certain medical procedures.
Fentanyl is found in the following medications:
- Single-Ingredient Fentanyl
- Abstral, as a Sublingual Tablet
- Actiq, as a Lozenge/Lollipop
- Durogesic, as a Transdermal Patch
- Fentora, as a Buccal Tablet
- Ionsys, dispensed from a Transdermal Device
- Lazanda, as a Nasal Spray
- Subsys, as a Sublingual Spray
Unique Side-Effects of Fentanyl:
- Fentanyl produces more sudden and more prolonged respiratory depression than other opioids.
- Use of fentanyl is also associated with aphasia – the loss of the ability to use language. Aphasia affects speech, visual, and even sign language.
- Fentanyl causes less itching and less nausea than morphine.
Notes about Fentanyl:
Fentanyl abuse – and overdose deaths – are skyrocketing across the country. For example:
- 2015: 16% of fatal drug overdoses in New York City involved fentanyl.
- Fentanyl had never before accounted for more than 3% of deadly overdoses.
- January-June 2016: Fentanyl was involved in 39% of drug deaths in NYC.
- Ohio, 2013: 92 fentanyl-related deaths
- Ohio, 2015: 514 fentanyl-related deaths
- Maryland, 2013: 58 fentanyl-related overdoses
- Maryland, 2014: 185 fentanyl-related overdoses
- Florida, 2013: 185 fentanyl-involved deaths
- Florida, 2014: 397 fentanyl-involved deaths
- USA, 2012: 618 fentanyl seizures
- USA, 2014: 4585 fentanyl seizures
On August 11, 2017, 20 pounds of fentanyl were seized in a raid on an apartment across from Central Park. This was enough to kill “half the population of New York City,” according to Drug Enforcement Agency Special-Agent-in-Charge James Hunt.
What Are Some Alternatives to Prescription Opioids?
The FDA and the CDC now recommend that opioids should only be prescribed as a last resort, when the risks are outweighed by the benefits to “pain and function”. Even then, they should only be prescribed for the shortest duration and smallest dose possible, with frequent reevaluation.
Instead, other pain management methods should be offered as a first option:
- Diet and Weight Loss
- Nutritional Supplements
- Physical Therapy
- Chiropractic Manipulation
- Music Therapy
- Pet Therapy
- Over-the-Counter Medications
- Muscle Relaxants
If you are already prescribed an opioid drug your chronic pain, talk with your doctor about any other recommended options that might be right for you.
And, if you or someone you care about is currently struggling with painkiller dependence or addiction, contact a reputable local opioid treatment program to get the help you need to safely recover. In a very real way, your future and your life may depend upon it.
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