The Listing of Opioid Medications

Opioid medications are a class of drugs primarily used to manage pain by binding to opioid receptors in the brain, spinal cord, and other areas of the body. Below is a detailed list of common opioid medications, classified based on their strength and usage:

1. Natural and Semi-Synthetic Opioids

These are derived from the opium poppy or synthesized from natural opiates.

• Morphine
  • Brand Names: MS Contin, Kadian, Avinza
  • Indications: Moderate to severe pain, often post-surgery or in cancer pain.
  • Routes of Administration: Oral, intravenous, intramuscular, subcutaneous, and rectal.
• Codeine
  • Brand Names: Tylenol with Codeine, Fiorinal with Codeine
  • Indications: Mild to moderate pain, cough suppression.
  • Routes of Administration: Oral, intramuscular, subcutaneous.
• Oxycodone
  • Brand Names: OxyContin, Percocet (with acetaminophen), Roxicodone
  • Indications: Moderate to severe pain, often chronic or post-surgical.
  • Routes of Administration: Oral.
• Hydrocodone
  • Brand Names: Vicodin, Norco (both combined with acetaminophen), Zohydro ER
  • Indications: Moderate to severe pain, often for injuries or dental pain.
  • Routes of Administration: Oral.
• Hydromorphone
  • Brand Names: Dilaudid, Exalgo
  • Indications: Severe pain, often for cancer or major trauma.
  • Routes of Administration: Oral, intravenous, intramuscular, rectal.
• Oxymorphone
  • Brand Names: Opana, Numorphan
  • Indications: Severe pain, often in cases of long-term pain management.
  • Routes of Administration: Oral, intravenous, rectal.
• Thebaine
  • Not used as a medication itself but is a precursor for synthetic opioids like oxycodone and hydrocodone.

2. Synthetic Opioids

These opioids are fully synthesized in laboratories and are known for their high potency.

• Fentanyl
  • Brand Names: Duragesic (patch), Sublimaze (injectable), Actiq (lozenge), Fentora (buccal tablet)
  • Indications: Severe or chronic pain, often used in cancer pain or for anesthesia.
  • Routes of Administration: Transdermal, intravenous, lozenge, buccal, sublingual, intranasal.
• Sufentanil
  • Brand Names: Sufenta
  • Indications: Severe pain, anesthesia in surgery.
  • Routes of Administration: Intravenous, sublingual.
• Remifentanil
  • Brand Names: Ultiva
  • Indications: Used during surgeries for pain management and anesthesia.
  • Routes of Administration: Intravenous.
• Methadone
  • Brand Names: Dolophine, Methadose
  • Indications: Chronic pain, opioid use disorder (as part of detoxification or maintenance treatment).
  • Routes of Administration: Oral, intravenous, subcutaneous.
• Meperidine
  • Brand Names: Demerol
  • Indications: Moderate to severe pain, sometimes used in childbirth.
  • Routes of Administration: Oral, intravenous, intramuscular.
• Tramadol
  • Brand Names: Ultram, ConZip
  • Indications: Moderate to moderately severe pain, often in chronic conditions like arthritis.
  • Routes of Administration: Oral.
• Tapentadol
  • Brand Names: Nucynta
  • Indications: Moderate to severe acute or chronic pain.
  • Routes of Administration: Oral.
• Levorphanol
  • Brand Names: Levo-Dromoran
  • Indications: Severe pain, also used for cancer-related pain.
  • Routes of Administration: Oral, intravenous, intramuscular.

3. Mixed Agonist-Antagonist Opioids

These drugs activate some opioid receptors while blocking others, making them less likely to cause dependence.

• Buprenorphine
  • Brand Names: Subutex, Suboxone (with naloxone), Butrans (patch)
  • Indications: Opioid dependence, moderate to severe pain.
  • Routes of Administration: Sublingual, buccal, transdermal.
• Pentazocine
  • Brand Names: Talwin
  • Indications: Moderate to severe pain.
  • Routes of Administration: Oral, intramuscular, intravenous.
• Nalbuphine
  • Brand Names: Nubain
  • Indications: Moderate to severe pain, also used as an adjunct to anesthesia.
  • Routes of Administration: Intravenous, intramuscular.
• Butorphanol
  • Brand Names: Stadol
  • Indications: Moderate to severe pain, migraines, and anesthesia adjunct.
  • Routes of Administration: Intravenous, intramuscular, nasal spray.

4. Partial Agonist Opioids

These opioids partially activate opioid receptors, providing pain relief with a lower risk of respiratory depression.

• Buprenorphine
  • Also a mixed agonist-antagonist, as detailed above.

5. Opioid Antagonists (Used in Opioid Overdose)

These medications block opioid receptors, reversing the effects of opioids, particularly in overdose situations.

• Naloxone
  • Brand Names: Narcan, Evzio
  • Indications: Emergency treatment for opioid overdose.
  • Routes of Administration: Intravenous, intramuscular, subcutaneous, intranasal.
• Naltrexone
  • Brand Names: Revia, Vivitrol
  • Indications: Opioid and alcohol dependence treatment.
  • Routes of Administration: Oral, intramuscular.

6. Combination Medications

These combine opioids with other analgesics for enhanced pain relief and reduced opioid dosing.

• Percocet (Oxycodone + Acetaminophen)
• Vicodin (Hydrocodone + Acetaminophen)
• Tylenol with Codeine (Codeine + Acetaminophen)
• Lorcet (Hydrocodone + Acetaminophen)
• Combunox (Oxycodone + Ibuprofen)

7. Ultra-Short-Acting Opioids

These opioids are used in clinical settings for rapid onset and short duration, particularly in surgery.

• Alfentanil
  • Brand Names: Alfenta
  • Indications: Surgical anesthesia, pain during procedures.
  • Routes of Administration: Intravenous.
• Remifentanil
  • Detailed above under synthetic opioids.

8. Long-Acting/Extended Release (ER) Opioids

These formulations provide sustained pain relief over an extended period.

• OxyContin (Extended-release oxycodone)
• MS Contin (Extended-release morphine)
• Exalgo (Extended-release hydromorphone)
• Zohydro ER (Extended-release hydrocodone)

9. Weak Opioid Analgesics

Used for mild to moderate pain, often in combination with other medications.

• Dihydrocodeine
  • Brand Names: Synalgos-DC
  • Indications: Mild to moderate pain.
  • Routes of Administration: Oral.
• Propoxyphene
  • Brand Names: Darvon (withdrawn from the market in some countries due to safety concerns)
  • Indications: Mild pain.

Important Considerations

• Tolerance and Dependence: Chronic use of opioids can lead to tolerance (requiring higher doses for the same effect) and physical dependence.
• Addiction Potential: Many opioids carry a high risk for misuse and addiction, which is why they are tightly controlled substances.
• Overdose Risk: High doses or combining opioids with other depressants (like alcohol or benzodiazepines) can result in life-threatening respiratory depression.

How to Prevent Opioid Medication Abuse ?

Preventing opioid medication abuse requires a multifaceted approach, involving patients, healthcare providers, and policymakers. Below are several strategies and methods that can help reduce the risk of opioid abuse:

1. Patient Education and Awareness

• Understand the Risks: Patients should be informed about the potential for addiction and overdose associated with opioid use, even when taken as prescribed.
• Proper Use: Patients must follow the exact dosage and timing prescribed by their doctor. They should never take more than instructed, share their medication, or use opioids for non-pain-related conditions.
• Non-Opioid Alternatives: Discuss non-opioid pain management options with healthcare providers (e.g., NSAIDs, physical therapy, cognitive-behavioral therapy).

2. Healthcare Provider Responsibility

• Prescribing Guidelines: Doctors should follow the latest prescribing guidelines for opioids, such as those from the CDC or local health organizations, which emphasize limiting opioid prescriptions to the lowest effective dose and for the shortest duration.
• Opioid Monitoring Programs (PDMPs): Use Prescription Drug Monitoring Programs to track patients’ prescriptions, identifying those at risk of “doctor shopping” (visiting multiple providers to obtain opioids) or misuse.
• Screen for Abuse Risk: Providers should screen patients for personal or family histories of substance abuse, mental health issues, or other risk factors before prescribing opioids.
• Tapering Plans: For patients on long-term opioid therapy, providers should establish a plan to taper opioids when appropriate and encourage the use of non-opioid pain treatments.

3. Use of Abuse-Deterrent Formulations (ADFs)

• Some opioid medications come in abuse-deterrent formulations, which make it more difficult to crush, inject, or manipulate the medication for misuse. While they aren’t foolproof, ADFs reduce the likelihood of misuse via methods like snorting or injecting.

4. Safe Storage and Disposal of Medications

• Secure Storage: Keep opioids in a safe place, out of reach of others, particularly children or anyone at risk for misuse. Locking medicine cabinets can prevent unauthorized access.
• Proper Disposal: Dispose of unused opioids safely by taking them to drug take-back programs or using FDA-approved disposal methods (e.g., mixing them with substances like coffee grounds or cat litter before discarding them in a sealed bag).

5. Access to Naloxone

• Naloxone (Narcan) is a life-saving medication that can reverse opioid overdose. It should be available to individuals who are prescribed opioids, especially if they are at high risk for overdose (e.g., those taking high doses or combining opioids with other sedatives). Family members and friends of at-risk individuals should also know how to use naloxone.

6. Alternative Pain Management Approaches

• Non-Opioid Medications: For many pain conditions, non-opioid medications (acetaminophen, ibuprofen, antidepressants, anticonvulsants, etc.) can be just as effective.
• Physical Therapy and Rehabilitation: Physical therapy, exercise, acupuncture, and chiropractic care are effective for many types of chronic pain and reduce the need for opioid medications.
• Cognitive Behavioral Therapy (CBT): CBT and other psychological therapies help patients manage chronic pain by changing their thought patterns and behaviors related to pain.
• Interventional Pain Management: Injections, nerve blocks, or implantable devices can help reduce pain without relying on opioids.

7. Addressing Addiction Early

• Early Intervention: Identifying signs of opioid misuse early can prevent the escalation into dependence or addiction. Signs may include frequent requests for early refills, changes in mood or behavior, and increasing the dose without consulting a doctor.
• Addiction Treatment: For those showing signs of opioid addiction, early referral to treatment, including medication-assisted treatment (MAT), is essential. MAT includes drugs like methadone, buprenorphine, and naltrexone, which help manage withdrawal symptoms and cravings.

8. Regulation and Policy Efforts

• Prescription Limits: Laws in many areas now limit the duration and dosage of opioid prescriptions for acute pain (e.g., post-surgical pain or injury), often to a 3–7 day supply.
• Mandatory Prescription Monitoring: In some regions, prescribers must check the PDMP before prescribing opioids to ensure patients aren’t receiving opioids from multiple sources.
• Opioid Stewardship Programs: These programs promote safe and responsible opioid prescribing and usage within healthcare settings, improving education and monitoring of opioid prescriptions.

9. Patient Support and Mental Health Care

• Address Mental Health: Since mental health disorders (like depression and anxiety) can increase the risk of opioid misuse, comprehensive mental health care should be integrated into pain management. Counseling and psychiatric care are critical components of preventing opioid misuse.
• Support Groups: Connecting patients to support groups such as Narcotics Anonymous (NA) or pain support groups can help reduce feelings of isolation and provide a network of support.

10. Research and Innovation

• Developing Non-Addictive Analgesics: Continued research into non-opioid pain relievers and innovative pain treatments, such as nerve stimulation technologies, may reduce reliance on opioids in the future.
• Improving Pain Understanding: Understanding the science of pain and how different individuals experience it can lead to more personalized pain management strategies, lowering opioid prescription rates.

11. Public Awareness Campaigns

• Community Education: Public health campaigns can help raise awareness about the dangers of opioid misuse, the importance of proper medication disposal, and the availability of addiction treatment resources.