The most common prescription opioids come in four categories: hydrocodone, oxycodone, codeine, and fentanyl. The differences between these types of opioids are rooted in their chemical structure, which affects things like their potency and their ability to be combined with other compounds, such as acetaminophen (Tylenol). It also affects their price, their availability, and how addictive they are.

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Most Addictive Prescription Opiates

  1. Codeine

Codeine is an opioid that’s often found in cough syrups and can be used to treat mild to moderate pain. It’s often combined with nonaddictive pain medications like ibuprofen or acetaminophen in order to increase its effects and combat fever. It’s definitely the most accessible prescription opioid and can sometimes be purchased over the counter, though it’s often only available behind pharmacy counters to combat theft, and the amount purchased is monitored to prevent abuse.

Despite often being perceived as a safer and less addictive form of an opioid, codeine can still be highly addictive. A trend emerged recently of mixing cough syrups containing codeine with sodas and other drinks – a concoction known by the street name “purple drank.” Many people fell to addiction to codeine by ingesting these drinks. However, it can be hard to determine just how addictive this particular opioid is due to the fact that some people process it faster than others.

  1. Hydrocodone

Hydrocodone is the opioid component of drugs like Vicodin, Lortab, and Norco. Hydrocodone is often mixed with nonaddictive painkillers like acetaminophen, such as in Vicodin. These medications tend to be more available than oxycodone or fentanyl due to the fact that they’re cheaper and more often prescribed than the more potent fentanyl and the more addictive oxycodone drugs, though they have recently come under tighter regulation.

Drugs in the hydrocodone category are generally considered to have a moderate dependence liability, meaning that they create a moderate tolerance and produce withdrawal symptoms of moderate intensity on average. In terms of overall addiction, they are considered to be “highly addictive.”

More people abuse Vicodin than other prescription opioid medications, likely due to its high availability. According to one University of Michigan study, 4.8 percent of 12th graders in the US had used Vicodin recreationally in the past year in 2014, compared to 3.3 percent who had used OxyContin – a common trade name for oxycodone.

  1. Fentanyl

Fentanyl stands out from other opioids because of its potency. While the recommended dosage for both hydrocodone and oxycodone is 2.5-10 milligrams every 4-6 hours, fentanyl is measured in micrograms. It’s considered to be 50 times more potent than pure, pharmacy-grade heroin. Brand names for this drug include Abstral, Duragesic, Fentora, Lazanda, Onsolis, and Subsys.

This does not mean that fentanyl is 50 times more additive than heroin. Potency simply means that much smaller amounts are needed to create painkilling effects, produce a high, or trigger an overdose. Fentanyl’s addiction potential is also altered due to its typical mode of administration. Fentanyl must be highly controlled due to its potency. The illicit sale of fentanyl is very dangerous because if it isn’t formulated right, it can very easily cause a dangerous overdose.

In medical settings, fentanyl is often given as an injection by medical professionals only. It may be given for chronic pain in the form of transdermal patches that release a controlled stream of the drug through the skin over a long period of time. It’s difficult to abuse a drug in this form, though people have been known to tear open these patches to ingest the gel inside.

Fentanyl is definitely highly addictive but the prescription variation is more difficult to get than hydrocodone or oxycodone, and illicit formulas are likely to cause an overdose. It’s difficult to measure the precise potential for addiction when so many people who use it end up dying before too long.

  1. Oxycodone

Drugs of the oxycodone variety include OxyContin, Percocet, Percodan, and Tylox. These drugs are more expensive than hydrocodone drugs. They have a similar potency; however, oxycodone drugs tend to come with fewer side effects and produce a more intense and pleasurable high. Because of this, oxycodone is the preferred opioid among prescription opioid abusers.

These drugs are also considered to have a moderate to high dependence liability, compared to a moderate level in hydrocodone, while they’re both considered to be highly psychologically addictive. It can therefore be argued that oxycodone products are the most addictive prescription opioids.

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Additional Information About Prescription Opiates

Opiates make up a class of drugs that were originally derived from the opium poppy. This natural compound has sedative and pain-relieving properties that have been used, altered, and synthesized for centuries. The drug morphine was created from this plant in the 19th century and later used to create heroin, a potent and illicit drug known to be highly addictive.

Starting in the 20th century, medical scientists began creating synthetic and semisynthetic opioids that could be sold in pill form for moderate to severe pain control. They can be used as an immediate treatment for acute pain or in controlled-release form for long-term or chronic pain issues. Additionally, different prescription opioids are used to treat coughs, diarrhea, and shortness of breath.

One thing all opioids have in common is that they are addictive. They all produce a tolerance in users when they’re taken for an extended period of time. Due to they way they interact with receptors in the brain, people eventually need to take higher and higher doses to get the same effect. They can also all be used recreationally due to the fact that they can produce a euphoric high. Even without the euphoria, these drugs tend to create a feeling of peace and happy relaxation that many people enjoy. According to the National Institute on Drug Abuse, 2.1 million individuals in the US had an addiction disorder related to prescription opioids in 2012.

However, not every prescription opioid is equally addictive. Determining which of these medications are the most addictive must involve an understanding of addiction itself.

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Physical vs. Psychological Addiction

There are generally two different aspects of addiction: physical and psychological. Physical addiction, sometimes called dependence, refers to the physical ways that addiction affects the body and brain as opposed to emotional effects. A big part of this is the tolerance that results in the emergence of withdrawal symptoms when a user stops taking the drug. Not all people who develop a tolerance and resulting withdrawal symptoms can be considered to be addicted to a substance, and not all drugs produce these physical effects. This is why psychological addiction is such a big part of the disorder.

Psychological addiction refers to the emotional attachment people develop to the drug. This includes cravings and emotional distress experienced when the drug is not available. A significant part of this kind of addiction is the behavior-reward principal. The brain produces a number of different chemicals associated with pleasure that can be activated by certain behaviors, such as sexual activity or exercise, eating certain foods, or taking certain drugs. Technically, any behavior that can make a person happy can create a “reward” in the brain via the release of pleasure compounds. This is how people become addictive to things other than drugs, such as gambling, playing video games, or watching pornography.

When it comes to drug use, it can be very easy to make a connection between the behavior of taking the drug and the reward of the high. How likely this connection is to be made depends on aspects of the drug, such as how quickly the effects begin and how powerful and pleasurable the high is. Drugs that work fast and produce the best feelings tend to be more addictive, but this is not a guarantee. Addiction is a complex disorder that involves many factors, and it has affected around 23.5 million Americans.

Signs of Opiate Abuse and Addiction

Opioids are central nervous system depressants. Though each type has some unique effects, they all share certain key characteristics in terms of the high and side effects they produce that can be spotted if one is familiar with them.

Signs of prescription opioid abuse include:

  • Severe drowsiness
  • Nausea or vomiting
  • Constipation
  • Slowed breathing or heart rate
  • Constricted pupils
  • Inability to feel pain
  • Slurred speech
  • Confusion
  • Impaired judgment
  • Itching
  • Flushed skin

Drug abuse and addiction can also be spotted by becoming familiar with the withdrawal symptoms of the class of drug in question.

Opioid withdrawal symptoms include:

  • Yawning
  • Runny nose
  • Sweating
  • Anxiety
  • Irritability
  • Goosebumps
  • Loss of appetite
  • Vomiting
  • Diarrhea
  • Tremors
  • Abdominal cramps
  • Muscle pain
  • Confusion
  • Rapid breathing

Treatment for Opioid Addiction

Addiction to any opioid, no matter how addictive it is, is dangerous and difficult to overcome alone. Fortunately, there are many treatment centers around the world that can treat addiction to prescription opioids with a combination of medication, rehabilitation, and ongoing support. Addiction is a medical condition like any other, and it’s much easier to deal with if you have professional medical specialists behind you.