A mounting number of opioid addicts are encountering a deadlier and deadlier supply of drugs. The resulting death toll continues to rise despite years of alarms and efforts to intervene.
The new, deadlier drugs are altered opioids that bind in more powerful ways to the brain’s receptors and get to the brain more quickly. The combination of factors can make them thousands of times more deadly.
All opioids connect to particular brain and nervous system receptors that exist for the body’s natural painkiller, endorphins. Although opium had been used in various forms for thousands of years, morphine was the first pure medication derived from the poppy plant (1803). In medicine and law enforcement, relative strength is compared to morphine.
1x Morphine
1x
Morphine
1x
Morphine
Non-opioid painkillers like aspirin, acetaminophen and ibuprofen use different mechanisms that don’t produce the euphoric effects of most opioids.
MORPHINE
(Opioid)
1x
The area of the square represents
how the strength of every drug
relates to morphine.
Ibuprofen
Aspirin
Acetaminophen
1/222
1/360
1/360
MORPHINE
(Opioid)
1x
The area of the square represents how the strength
of every drug relates to morphine.
Ibuprofen
Aspirin
Acetaminophen
1/222
1/360
1/360
MORPHINE
(Opioid)
1x
Morphine
The area of the square represents how the strength
of every drug relates to morphine.
Ibuprofen
Aspirin
Acetaminophen
1/222
1/360
1/360
Larger doses of these drugs are needed to kill comparable pain, but because they don’t produce a “high,” they are not targeted for recreational abuse. These and other painkillers are combined with opioids to create a treatment that uses multiple channels of blocking pain, and abuse of those combined drugs is common.
CODEINE
Morphine is three times
as strong as codeine.
1x morphine
CODEINE
Morphine is three times
as strong as codeine.
Morphine
1x
CODEINE
Morphine is three times
as strong as codeine.
0.3
1x
Morphine
Morphine changed the world of medicine and pain control. Chemists began creating other extracts, including codeine, which is only about one-tenth to one-third as strong (strength varies by individual). Codeine is widely used to treat coughs and diarrhea, but the syrups and other medicines are also widely subject to abuse.
HYDROCODONE
Hydrocodone is as strong
as morphine.
1x morphine
HYDROCODONE
Hydrocodone is as strong
as morphine.
1
1x morphine
HYDROCODONE
Hydrocodone is as strong
as morphine.
1
1x
Morphine
Hydrocodone is about the same strength as morphine but has become one of the most frequently prescribed opioids in mixture with other drugs, most often acetaminophen. It has also become one of the most frequently abused drugs.
OXYCODONE
Oxycodone is about
50 percent stronger
than morphine.
1x morphine
1.5
OXYCODONE
Oxycodone is about 50 percent
stronger than morphine.
1.5
1x morphine
OXYCODONE
Oxycodone is about 50 percent
stronger than morphine.
1.5
1x
Morphine
Oxycodone, the opioid in Oxycontin, Percocet and Percodan, as well as other medicines, is about 50 percent stronger than morphine. Oxycodone is commonly combined with non-opioid painkillers such as aspirin and acetaminophen. They are frequently prescribed for intense pain after surgery or other medical procedures and are used at higher doses for long-term intractable cancer pain.
METHADONE
Methadone is three
times stronger
than morphine.
1x morphine
3x
METHADONE
Methadone is three times stronger
than morphine.
1x morphine
3x
METHADONE
Methadone is three times stronger
than morphine.
1x
Morphine
3x
Methadone is about three times stronger than morphine, but it does not produce a strong euphoric effect. It also lasts much longer and can address physical dependence on other opioids, making it the most common choice for treating opioid addiction. Over time, methadone accumulates in the body, making its effect stronger. It is linked to very few deaths when compared with other opioids.
HEROIN
Heroin is
two to five
times stronger
than morphine.
2x to 5x
1x morphine
HEROIN
Heroin is two to five times stronger
than morphine.
1x
Morphine
2x to 5x
HEROIN
Heroin is two to five times stronger
than morphine.
2x to 5x
1x
Morphine
Marketed in the 1800s as a solution to morphine addiction, heroin ranges from twice as strong to five times as strong as morphine depending on the person and how it is used. Heroin can be smoked and snorted, but is most often injected. Heroin buyers often do not know what has been mixed into the powder, increasing the risk of unknowingly receiving even more powerful opioids or other toxic chemicals.
BUPRENORPHINE
(Subutex)
Buprenorphine is 40
times stronger
than morphine.
40x
1x morphine
BUPRENORPHINE
(Subutex)
Buprenorphine is 40 times stronger
than morphine.
40x
1x
Morphine
BUPRENORPHINE
(Subutex)
Buprenorphine is 40 times stronger
than morphine.
40x
1x
Morphine
Forty times stronger than morphine, buprenorphine does not create the powerful, acute painkilling or euphoric effect of other opioids, so it can be used for long-term chronic pain, but it is most often used to treat opioid addiction. Because it does create some euphoric effect and can be abused, it is still tightly controlled.
FENTANYL
Fentanyl is 50 to 100
times stronger
than morphine.
50x
to 100x
1x morphine
FENTANYL
Fentanyl is 50 to 100 times stronger
than morphine.
50x
1x
Morphine
to 100x
FENTANYL
Fentanyl is 50 to 100 times stronger
than morphine.
50x
1x
Morphine
to 100x
Fentanyl is about 50 to 100 times stronger than morphine, and is so potent that the normal treatment is with a patch on the skin as compared with morphine that is put directly into patients’ veins.
Lethal dose
Use a real penny to adjust the scale of the image in your device.
Unlike many opioids in which prescription medicine is diverted for abuse, the street supply of fentanyl comes primarily from illegal production.
It can be lethal at the 2-milligram range (amount of powder shown to scale next to a penny in the photograph), depending on route of administration and other factors.
Because fentanyl is so cheap and readily available, dealers mix it into heroin, making heroin deadlier. Officials in New York City warned in 2017 that it was being mixed into cocaine, as well.
CARFENTANIL
Carfentanil is 10,000
times stronger
than morphine.
Carfentanil, a painkiller for elephants and other large mammals, is not intended for humans.
1,000
Like fentanyl, it is being mixed into heroin, creating an extremely lethal street drug.
2,000
Law enforcement officers have been warned that even touching a small amount of carfentanil powder with bare skin can cause severe effects.
3,000
There is no known safe dosage of carfentanil for humans since it is not designed for people and has not been tested for use as a treatment.
4,000
Like with other opioids, overdose symptoms are slowed or stopped breathing, itching, nausea, drowsiness, constricted pupils, disorientation and clammy skin.
5,000
Naloxone is an antidote for opioid overdoses. Several doses of naloxone are often needed in cases of carfentanil overdose.
6,000
Drug dealers mix carfentanil into such drugs as cocaine and heroin because it is cheaper than the other drugs. Users do not know they are getting carfentanil, and officials have difficulty tracking the exact number of deaths because labs are not used to identifying it.
7,000
Two milligrams of carfentanil — equal to about 34 grains of salt — is enough to sedate an elephant.
8,000
Carfentanil aerosolized into a gas is suspected of being the weapon that Russians used to subdue Chechen terrorists who seized a Moscow theater and threatened to blow it up in 2002.
CARFENTANIL
Carfentanil is 10,000 times stronger
than morphine.
Carfentanil, a painkiller for elephants and other large mammals, is not intended for humans.
1,000
Like fentanyl, it is being mixed into heroin, creating an extremely lethal street drug.
2,000
Law enforcement officers have been warned that even touching a small amount of carfentanil powder with bare skin can cause severe effects.
3,000
There is no known safe dosage of carfentanil for humans since it is not designed for people and has not been tested for use as a treatment.
4,000
Like with other opioids, overdose symptoms are slowed or stopped breathing, itching, nausea, drowsiness, constricted pupils, disorientation and clammy skin.
5,000
Naloxone is an antidote for opioid overdoses. Several doses of naloxone are often needed in cases of carfentanil overdose.
6,000
Drug dealers mix carfentanil into such drugs as cocaine and heroin because it is cheaper than the other drugs. Users do not know they are getting carfentanil, and officials have difficulty tracking the exact number of deaths because labs are not used to identifying it.
7,000
Two milligrams of carfentanil — equal to about 34 grains of salt — is enough to sedate an elephant.
8,000
Carfentanil aerosolized into a gas is suspected of being the weapon that Russians used to subdue Chechen terrorists who seized a Moscow theater and threatened to blow it up in 2002.
CARFENTANIL
Carfentanil is 10,000 times stronger
than morphine.
Carfentanil, a painkiller for elephants and other large mammals, is not intended for humans.
1,000
Like fentanyl, it is being mixed into heroin, creating an extremely lethal street drug.
2,000
Law enforcement officers have been warned that even touching a small amount of carfentanil powder with bare skin can cause severe effects.
3,000
There is no known safe dosage of carfentanil for humans since it is not designed for people and has not been tested for use as a treatment.
4,000
Like with other opioids, overdose symptoms are slowed or stopped breathing, itching, nausea, drowsiness, constricted pupils, disorientation and clammy skin.
5,000
Naloxone is an antidote for opioid overdoses. Several doses of naloxone are often needed in cases of carfentanil overdose.
6,000
Drug dealers mix carfentanil into such drugs as cocaine and heroin because it is cheaper than the other drugs. Users do not know they are getting carfentanil, and officials have difficulty tracking the exact number of deaths because labs are not used to identifying it.
7,000
Two milligrams of carfentanil — equal to about 34 grains of salt — is enough to sedate an elephant.
8,000
Carfentanil aerosolized into a gas is suspected of being the weapon that Russians used to subdue Chechen terrorists who seized a Moscow theater and threatened to blow it up in 2002.
9,000
The gas pumped into the theater knocked out the rebels quickly but also killed 167 hostages. Many others were saved with the opioid antidote naloxone.
10,000
9,000
The gas pumped into the theater knocked out the rebels quickly but also killed 167 hostages. Many others were saved with the opioid antidote naloxone.
10,000
9,000
The gas pumped into the theater knocked out the rebels quickly but also killed 167 hostages. Many others were saved with the opioid antidote naloxone.
10,000
Sources
Centers for Disease Control and Prevention information, Drug Enforcement Administration, National Institute on Drug Abuse including Congressional testimony, Maryland Poison Center at University of Maryland School of Pharmacy, Department of Justice Diversion Control Division, Dance Safe and the Substance Abuse and Mental Health Services Administration.
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