The 211 Most Abused and Addictive Prescription Painkillers

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
  • Lorcet
  • Lortab
  • Maxidone
  • Norco
  • Vicodin
  • Zydone
• Immediate-Release with Aspirin
  • Alor 5/500
  • Azdone
  • Damason-P
  • Lortab ASA
  • Panasal 5/500
• Immediate-Release with Ibuprofen
  • Ibudone
  • Reprexain
  • Vicoprofen
  • Xylon 10
• Brompheniramine/Guaifenesin/Hydrocodone Liquid
  • Tusnel-HC
• Brompheniramine/Hydrocodone/Phenylephrine Liquid
  • VasoTuss HC
  • BPM PE HC
  • Canges-HC NR
  • FluTuss HC
• Brompheniramine/Hydrocodone/Pseudoephedrine Liquid
  • Anaplex HD
  • Bromplex HD
  • Drocon-CS
  • M-END
• Chlorpheniramine/Hydrocodone Extended-Release Capsules
  • Hydrocodone GF
  • Novasus
  • TussiCaps
  • Tussionex Pennkinetic
• Chlorpheniramine/Hydrocodone/Phenylephrine Liquid
  • Hydrocodone CP
  • Hydrocodone HD
  • Relasin-HC
  • Triant-HC
• Chlorpheniramine/Hydrocodone/Pseudoephedrine
  • A-G Tussin
  • Notuss
  • Tussend
  • Zutripro
• Dexbrompheniramine/Hydrocodone/Phenylephrine
  • Cytuss-HC NR
  • H-C Tussive-NR
  • Histussin HC Syrup
• Dexchlorpheniramine/Hydrocodone/Phenylephrine Liquid
  • Codimal DH
  • EndaCof-Plus
  • Notuss PD
  • Zotex HC
• Diphenhydramine/Hydrocodone/Phenylephrine Syrup
  • Endal HD
  • Hydro-DP
  • Rindal HPD
  • Tussinate
• Guaifenesin/Hydrocodone
  • Hydrocod-GF
  • Narcof
  • Pneumotussin 2.5
  • Vortex
• Guaifenesin/Hydrocodone/Phenylephrine Liquid
  • Atuss G
  • Levall 5.0
  • Mintuss G
  • MonteFlu HC
• Guaifenesin/Hydrocodone/Pseudoephedrine
  • Decotuss-HD
  • Entuss-D JR
  • Tussend Expectorant
  • Vanex Expectorant
• Homatropine/Hydrocodone
  • Hycodan
  • Hydromet
  • Hydrotropine
  • Tussigon
• Hydrocodone/Phenylephrine/Pyrilamine Liquid
  • Dicomal-DH
  • Hyco-DH
  • Hycomal DH
  • PhendaCof Plus
• Hydrocodone/Potassium Guaiacolsulfonate Liquid
  • Entuss Expectorant
  • Marcof Expectorant
  • Prolex DH
  • Protuss
• Hydrocodone/Pseudoephedrine
  • P-V Tussin
  • Rezira
  • Tussafin
  • Tussgen

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.

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
  • OxyFast
  • OxyIR
  • OxyNorm
  • Roxicodone
• Controlled-Release Single Ingredient Oxycodone
  • OxyContin
  • Xtampza ER
• Oxycodone Tamper-Resistant
  • OxyContin OTR
• Immediate-Release Oxycodone with Acetaminophen
  • Endocet
  • Percocet
  • Percocet 5/325
  • Percocet 10/325
  • Roxicet
  • Tylox
• Immediate-Release Oxycodone with Aspirin
  • Endodan
  • Oxycodan
  • Percodan
  • Roxiprin
• Immediate-Release Oxycodone with Ibuprofen
  • Combunox
• Controlled-Release Oxycodone with Naloxone
  • Targin
  • Targinact
  • 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.

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
• Acetaminophen/Butalbital/Caffeine/Codeine
  • Fioricet with Codeine
  • Phenilin with Caffeine and Codeine
• Acetaminophen/Chlorpheniramine/Codeine
  • Cotabflu
• Acetaminophen/Codeine
  • Tylenol with Codeine
  • Tylenol with Codeine #3
  • Tylenol with Codeine #4
  • Aceta with Codeine
• Ammonium Chloride/Chlorpheniramine/Codeine/Phenylephrine
  • Rolatuss
• Anhydrous Calcium Iodide/Codeine
  • Calcidrine
• Aspirin/Butalbital/Caffeine/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
• Bromodiphenhydramine/Codeine
  • Ambenyl
  • Ambophen
• Bromodiphenhydramine/Codeine
  • BroveX CB
  • BroveX CBX
  • EndaCof-AC
  • Nalex AC
• Brompheniramine/Codeine/Phenylephrine Liquid
  • BroveX PB C
  • BroveX PB CX
  • Poly-Tussin AC
  • TL-Hist CD
• Brompheniramine/Codeine/Phenylpropanolamine
  • Dimetane DC
  • Myphetane DC
  • Poly-Histine CS
  • Trihist-CS
• Brompheniramine/Codeine/Pseudoephedrine
  • M-End WC
  • Mar-cof BP
  • Mesehist WC
  • Rydex
• Chlorcyclizine/Codeine
  • Notuss-NX
  • Poly-Tussin
• Chlorcyclizine/Codeine/Phenylephrine
  • Nasotuss
• Chlorcyclizine/Codeine/Pseudoephedrine Liquid
  • Notuss-NXD
  • Poly-Tussin D
  • Statuss Green
• Chlorpheniramine/Codeine
  • Codeprex
  • Tuxarin ER
  • Tuzistra XR
  • Z-Tuss AC
• Chlorpheniramine/Codeine/Phenylephrine Syrup
  • CapCof
  • Endal CD
• Chlorpheniramine/Codeine/Phenylephrine/Phenylpropanolamine
  • T-Koff
• Chlorpheniramine/Codeine/Phenylephrine/Potassium Iodide
  • Demi Cof
  • Pediacof
  • Pedituss
• Chlorpheniramine/Codeine/Pseudoephedrine Liquid
  • Codehist DH
  • Dihistine DH
  • Tricode AR
  • Zodryl DAC
• Codeine/Dexbrompheniramine/Pseudoephedrine Liquid
  • M-End Max D
• Codeine/Dexchlorpheniramine/Phenylephrine
  • Dexphen with C
  • Pro Red AC
  • Vanacof CD
• Codeine/Diphenhydramine/Phenylephrine Solution
  • Airacof
• Codeine/Guaifenesin
  • Cheratussin AC
  • Guaiatussin AC
  • Robitussin-AC
  • Virtussin A/C
• Codeine/Guaifenesin/Phenylephrine Liquid
  • Giltuss Ped-C
  • Maxiphen CD
  • Maxiphen CDX
  • Tridal
• Codeine/Guaifenesin/Phenylpropanolamine
  • Alphen Expectorant
  • Efasin Expectorant SF
  • Endal Expectorant
  • Enditussin Expectorant
• Codeine/Guaifenesin/Pseudoephedrine Liquid
  • Cheratussin DAC
  • Robitussin-DAC
  • Ryna-CX
  • Virtussin DAC
• Codeine/Pheniramine/Phenylephrine/Sodium Citrate
  • Tussirex
  • Tussirex Sugar Free
• Codeine/Phenylephrine Liquid
  • Ala-Hist AC
  • Notuss-PE
• Codeine/Phenylephrine/Promethazine Syrup
  • M-Phen
  • Phenergan VC with Codeine
  • Promethazine VC with Codeine
• Codeine/Phenylephrine/Pyrilamine Syrup
  • Codimal PH
  • Dicomal-PH
  • Zotex-C
• Codeine/Phenylephrine/Triprolidine
  • Histex AC
• Codeine/Promethazine Syrup
  • Generic Only
• Codeine/Pseudoephedrine
  • Codar D
  • EndaCof-DC
  • Nucodine
  • Nucofed
• 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
  • Asthma
  • Any lung disease
  • Obese
• 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.

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
  • Dilaudid
  • Dilaudid-HP
  • Exalgo
  • 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
• Opana ER
• Numorphan

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.

Addiction Risk: Very High
Class: Synthetic
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.