Pain Killers & Heroin: A Quick Guide

Just a reminder: I am not encouraging anyone to take drugs. This blog (& podcast) is not meant to serve as medical advice. It is educational. And frankly, this is all stuff we should have known a long time ago.

Common opioids, listed from low to high potency...

Tramadol (pic) is a synthetic opioid. In addition to increasing dopamine levels, it also increases levels of serotonin and norepinephrine.

100 milligrams Tramadol = 10 milligrams Morphine

Half-Life: 6 hrs

Oral Bioavailability (How much of your dose survives digestion): up to 70%

Codeine is usually sold in compounds which contain other drugs. The addition of 325 milligrams of acetaminophen to the 30 milligrams of codeine in Tylenol 3 (pic) changes them from Schedule II to Schedule III—a less-restricted classification. There is also a theory that heavy users who might otherwise consume enough codeine or hydrocodone to overdose would not be able to do so, because they would blow their liver out from acetaminophen before they could consume a fatal dose of opioids, leaving the company immune to finger-wagging.

100 milligrams Codeine = 15 milligrams Morphine.

Half-Life: 3 hrs

Oral Bioavailability: 60-70%

Demerol (pic), also known as meperidine, is a synthetic opioid seldom prescribed anymore in the USA because it has a short half-life and because it metabolizes into a neural irritant called normeperidine, which can cause seizures in high doses.

100 mg Demerol = 15 mg Morphine.

Half-Life: 2-5 hrs

Oral Bioavailability: 50%

Hydrocodone is usually mixed with acetaminophen to remain classified as Schedule III. Vicodin (pic) and Norco both contain a small dose of hydrocodone—between 2-10 milligrams depending on the pill, and a 325 milligram dose of acetaminophen.

100 milligrams Hydrocodone = 100 milligrams Morphine.

Half-Life: 4 hrs

Oral Bioavailability: 25%

Oxycodone comes in drugs like Percocet, which has a 2-5 milligrams of oxycodone, and 325 milligrams of acetaminophen—again with the trick of adding generic Tylenol to drugs to get them classified as less dangerous per government standards. Oxycontin (pic) on the other hand has 10-80 milligrams of oxycodone and no additional pain killers, so it is classified as Schedule II. Oxycodone is metabolized into additional intoxicating chemicals by our bodies, including oxymorphone, an opioid approximately 10 times stronger than morphine.

100 milligrams Oxycodone = 150 milligrams Morphine.

Half-Life: 4-6 hrs

Oral Bioavailability: up to 75%

Methadone (pic) is a synthetic opioid with an incredibly long half-life: 48-72 hours, or even longer in some people. It is useful in treating heavy opioid addiction because its effects are not as intoxicating as heroin or fentanyl, but it still blocks out most of the detox symptoms heavy opioid users experience when coming off of these other opioids. Like Tramadol, it also boosts serotonin levels along with dopamine.

100 milligrams Methadone = 300 milligrams Morphine.

Half-Life: 48-72 hrs

Oral Bioavailability: up to 86%!

Dilaudid (pic) is hydromorphone—an opioid 10 times stronger than morphine which is produced in the body when hydrocodone and/or morphine are metabolized (around 2% of morphine becomes hydromorphone).

100 milligrams Dilaudid = 1000 milligrams Morphine.

Half-Life: 2-3 hrs

Oral Bioavailability: 40-50%

Buprenorphine, or Suboxone (pic), is a newer synthetic opioid that works sort of like methadone—it slow-burns to staves-off the nasty detox symptoms which characterize opioid withdrawal.

100 milligrams Buprenorphine = 250 milligrams Morphine.

Half-Life: 36 hours

Oral Bioavailability: 10%! (it is usually taken sublingually—dissolved beneath the tongue).

Oxymorphone (Opana) is 10 times stronger than morphine; in 2017 its extended release tablets were pulled from the US market because of so-called abuse potential—users were crushing and snorting or injecting the drug.

100 milligrams Oxymorphone = 1000 milligrams Morphine.

Half-Life: 8 hrs

Oral Bioavailability: 10%!

Heroin (pic) is just morphine processed one more step. Its shape and fat solubility make it penetrate the blood brain barrier much faster than morphine or most other opioids, and it hits users much harder and faster. Heroin is rapidly converted to morphine in the bloodstream, so the immediate buzz gives way to a more sustained feeling related to morphine and its metabolites, which are not so fat soluble and, therefore, cross the blood-brain barrier slower and with less ease.

100 milligrams Heroin = 200 milligrams Morphine

Half-Life: 3-15 minutes!

Oral Bioavailability: less than 30%.

Fentanyl (pic) is actually only one of a number of powerful synthetic opioids designed to kick in and wear off rapidly, like heroin. Users who take milligrams of morphine are prescribed micrograms of fentanyl. Unlike natural opiates, none of fentanyl’s byproducts have intoxicating properties. When it breaks down, the effects go away, unlike heroin, which are metabolized into morphine and other psychoactive chemicals. Fentanyl is metabolized into norfentanyl, which in nonpsychoactive.

100 MICROgrams Fentanyl = 100 milligrams Morphine.

Half-Life: 30 min acting time: 4 hrs blood levels.

Oral Bioavailability: 30%

Other similar synthetic opioids wear off even faster—remifentanil has a half-life of 12-30 minutes, making it ideal for outpatient surgeries when doctors want to evaluate the patient’s pain level before sending them home. But that also means that when it makes its way into the hands of addicted people, it wears off just as rapidly, leaving detox in its wake. Knowledge is power.

Check out these great resources for additional information on strength, bioavailability, and methods of consumption.

NHC Foundation potency chart

US National Library of Medicine: opioid boosters, inhibitors, and metabolism