Effects - Relative strength of opiods

[Richi]

I couldn't find an organized chart or summation of information on the potency of opioids compared to one another. Please post any scientific information about relative strengths of opioids.
For example:

Heroin - 2 times stronger than Morphine. Source.
Fentanyl - 80 times more potent than Morphine. Source.
Hydrocodone - 2 times stronger than Codeine. Source.

Then we can put one together.

Reputation Comments on this post:

Good idea for a useful/beneficial thread

[OsCarwild]

This is a list from The Little Book of Opium. All of the numbers tell how much of the drug is needed to be the equivalent of 10 mg of morphine. These numbers are assuming that the drug is taken orally.

(Example): "Buprenorphine - 1.2" means that 1.2 mg of buprenorphine is the equivalent of 10 mg of morphine.

Codeine - 200 mg
Fentanyl - 0.1 mg (this is for when Fentanyl is taken through IV, not sure about orally)
Hydrocodone - 25 mg to 30 mg
Hydromorphone- 7.5 mg
Methadone- 20 mg
Darvocet - 200 mg to 300 mg
Demerol - 150 mg to 250 mg
Oxycodone - 4.5 mg to 6 mg
Heroin - 5 mg
Oxymorphone - 1.25 mg to 1.6 mg
Levorphanol- 1.3 mg


If anyone else out there knows some opiates that SWIM forgot to put on the list, or that SWIM didn't know the morphine equivalent to, post it because a lot of people could benefit from reading this thread and learning the relative potency of opiates. SWIM thinks he got most of them, but there are probably a couple left out. So if anyone knows the equivalence of an opiate that has not already been listed, post it. And if someone knows about an opiate that has not already been listed, but does not know the equivalence, just post the name of the drug without the equivalence and maybe SWIM or someone else can put and equivalent to it.


Hope this was helpful

Reputation Comments on this post:

Useful data. Thank you.

[trannyboy]

This is an easy question because it is answered in many of the prescribing info packages. I will dig SWIM`s paperwork out again and add it later. However it is important to keep in mind that many people disagree on this subject... for instance at the least I have to disagree with the above poster`s comments on codeine and hydromorphone as they don`t add up with other sources including SWIM`s hydromorphone prescribing information sheet sitting in front of SWIM.

trannyboy

This is a prescribing infro sheet for morphine and among other things includes a reference for converting both oral and paternal dosages though it doesn`t include cross-tolerance adjustments- paladin-labs.com/our_products/pdf_files/monograph_statex.pdf

This is from British National formulary for converting varying opiates mtw.nhs.uk/formulary/?cid=55

This is from the Nation Library of Medicine- ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.table.33632

This is another reference with more information on how conversions are made with respect to a variety of individuals- www3.us.elsevierhealth.com/PAIN/pdf/Chart1b.pdf

This explains alot of the formulas for dosage conversions
http://vitualis.wordpress.com/2006/1...e-conversions/

Also here are a couple of opiate dosage conversion calculators for both oral and injection
Online- globalrph.com/narcotic.cgi
Download- epocrates.com/products/medtools/opioidanalgesicconverter.html


I have removed the www. part of these links to avoid causing any trouble with the moderators. Just add www. before any links.


trannyboy

[Solinari]

Surely 10mg of morphine taken orally is not equivalent to 20mg of methadone which has high bioavailability both orally and IV/IM, unlike morphine. I would have thought 10mg of IV morphine would be the same as 20mg oral methadone, is this benchmark of the 10mg of morphine taken orally or IV?

[jon-q]

It is difficult to accurately convert opiate dosages on an Equivalent-to-Equivalent basis; Route of administration, metabolism, tolerance and cross tolerance all have an effect on conversion, no doubt we’ll see this happen here, peeps will start to disagree with one another over various dose conversions that get posted.
Anyways Richi the idea to produce a conversion chart gets my vote and I’ll help any way I can.
Just noticed the first disagreement, Lol.
10mg oral Morphine would equal about 1-3mg of oral Methadone depending on Methadone usage (Chronic/long term or acute/short term)

Here’s a selection for you to mull over.
DRUG DURATION ROUTE EQUIANALGESIC DOSEAGE

Codeine 3-6hrs ORAL 160mg-200mg... IM/SC 120mg
Hydrocodone 4-8hrs ORAL 20-30mg
Hydromorphone 4-5hrs ORAL 7.5mg... IV/IM/SC 1.3-1.5mg
Methadone 4-8hrs ORAL 2-20mg...Short term 10-20mg ....Chronic 2-10mg
Morphine 3-6hrs ORAL 30-60mg...IV/IM 10mg
Oxycodone 4-6hrs ORAL 15-30mg
Oxymorphone 3-6hrs IV/IM/SC 1mg

That’s one list, it was in a proper table but it won’t copy correctly.
Here’s another conversion chart.

All these doses equal 10mg oral Morphine.

Codeine 100mg
Tramadol 100mg
Hydrocodone 16.6mg
Morphine 10mg
Oxycodone 4-6mg
Morphine IV 2.5mg
Hydromorphone 2mg
Oxymorphone 1.4mg
Buprenophine 0.25mg
Fentanyl 0.1-0.2mg

And finally..

Opioid Strength-Strength and Equivalent to Equivalent to
(Codeine) (Morphine) 30 mg Codeine 10 mg Morphine

Difusinal 0.0625 0.0063 480.00000 1600.0000
Codeine 1.0000 0.100 30.00000 100.0000
Tramadol 1.0000 0.1000 30.00000 100.0000
Demerol 3.6000 0.3600 8.33333 27.7778
Hydrocodone 6.0000 0.6000 5.00000 16.6667
Morphine 10.0000 1.0000 3.00000 10.0000
Oxycodone 17.5000 1.7500 1.71429 5.7143
Morphine IV/IM 40.0000 4.0000 0.75000 2.5000
Hydromorphone 50.0000 5.0000 0.60000 2.0000
Oxymorphone 70.0000 7.0000 0.42857 1.4286
Methadone ** 110.0000 11.0000 0.27272 0.9090
Fentanyl 750.0000 75.0000 0.04000 0.1333

Just shows how much certain conversions vary, i'll post another refined list later when they've all been checked and cross referenced.
Q

Reputation Comments on this post:

Provides a variety of information and assesses the nature of the thread very well.

[trannyboy]

I tried to make my post not link but it still went ahead and made functional links. Anyone know how I am supposed to do this properly?Should I pull down the links in my post? JonQ charts look good... I encountered the same problem with formatting errors when I tried to post charts/ tables, thats why I just added the links. Again good topic, just hard to pin down these things. The calculators I posted take into account most of the variables but that still doesn't promise that it will be a safe dosage. Whenever you are switching drug types and methods of delivery it is best to cut the dose in half at least and work your way up as needed because it really is dangerous to assume that just because the charts says one thing will mean it is the right dose for you. Good luck.

trannyboy

[Richi]

Having links is fine. Those are sources of information, not commercial websites.

Either way, to remove a link, high light it and click the 'Remove Link' button. You may have to click 'Go Advanced' when replying as well.

Jon-Q, where did you get that information from?
OsCarwild, did you type that out from The Little book of Opium?

[trannyboy]

The only reason I mention oscars post is that 7.5mg of hydromorphone is a hell of a dose for a lot of people and frankly would overdose most newbies to a dangerous level. SWIM took many months of tolerance to even tolerate 7.5mg orally and the only time SWIM needed that dose I.V. at the beginning was with extreme pain i.e. the worst SWIM has ever had and that was a combination of nerve pain and having compartmental syndrome in my genitals (that was just horrible, there are no words possible to describe that pain...)

Thanks for explaining the linking system to me Riche. I will leave the links for now (unless a mod tells me to pull them down) but in the future I will use your suggestions. Thanks again.

trannyboy

[jon-q]

These various web site charts and dose converting calculators.

http://www.promotingexcellence.org/files/public/grantee_tools/bog1.pdf
http://www.globalrph.com/narcoticonv.htm
http://www.medcalc.com/narcotics.html
http://www.rphworld.com/pharmacist/viewlink-23088.html
http://arthritis.about.com/od/analgesic/Analgesic_Drugs_Pain_Medications_Painkillers_Pain_ Relievers.htm

Q

Reputation Comments on this post:

Very helpful charts. Important tools.