Opiate and opioids are two terms often used interchangeably, though they are not the same. While opiates are naturally derived from opium, and opioids are synthetically made, both affect the brain similarly. Opiates and opioids bind to the opioid receptors in the central nervous system. In doing so, they change how the user perceives pain. In addition to pain relief, opiates and opioids can also create feelings of euphoria, or a high. These drugs trigger reward and emotion responses in the brain, which can lead to addiction.

Some opiates are stronger than others. For example, there are some opiates considered relatively mild, while others are so potent they can cause an almost instantaneous overdose in people who aren’t opioid-tolerant. The misuse of opioids has led to an epidemic in the United States, with more than two million people reportedly addicted to these drugs. So, which are the most potent opiates and opioids?


Carfentanil is one of the most worrisome opioids in the United States. This synthetic opioid is an analog of fentanyl, and it’s 100 times as potent. It’s 5,000 times as potent as heroin, and 10,000 times stronger than morphine. There has been a surge in drugs like heroin being laced with carfentanil, and this drug almost always leads to overdose and death. Carfentanil is often brought into the United States after being manufactured in China. This synthetic opioid is so strong that international governments are worried it could be used as a weapon of mass destruction.


Fentanyl is behind only carfentanil as the most potent opioid. It’s synthetic and believed to be anywhere from 30 to 50 times more potent than heroin. This prescription drug is intended to treat severe pain following surgery as well as in opioid-dependent people with chronic pain. The majority of opioid overdose deaths are related to fentanyl.


While other strong opioids are prescription medications, heroin is an illegal drug in the United States. This semi-synthetic opioid has no medicinal purposes, as defined by the DEA in the United States, and it’s the only schedule I opioid. This definition means that the DEA believes heroin is extremely addictive and has a high potential for being misused. Heroin enters the bloodstream very quickly and creates a rapid high, particularly when it’s injected or snorted. The instantaneous effects of heroin make it very powerful.

Hydromorphone and Oxymorphone

Hydromorphone and oxymorphone are among the strongest opioids. They are several times stronger than morphine and, as with other opiates and opioids, they have a high potential for abuse. Hydromorphone is available as the brand name prescription drug Dilaudid. Oxymorphone is sold under the brand name Opana.

Following the above strong opiates and opioids, they then go down in strength from there. Oxycodone isn’t as potent as the aforementioned drugs, but it is still very addictive. Oxycodone is found in brand-name drugs like Percocet and Oxycontin. Morphine is a natural opiate used in medicine, and it’s half as powerful as oxycodone. Hydrocodone’s potency is between morphine and oxycodone’s potency. Codeine is one of the weakest opioids and is usually given in cough medicines or to alleviate pain ranging from mild to moderate.

While the strength of opiates and opioids may vary, it’s important to realize they are all addictive and can cause physical dependence.

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Editor – Thomas Christiansen
With over a decade of content experience, Tom produces and edits research articles, news and blog posts produced for Advanced Recovery Systems. Read more
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Medically Reviewed By – Dr. Conor Sheehy, PharmD, BCPS, CACP
Dr. Sheehy completed his BS in Molecular Biology at the University of Idaho and went on to complete his Doctor of Pharmacy (PharmD) at the University of Washington in Seattle. Read more
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The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.