Painkiller Equivalency Chart
|Relative Potency||Drug||Names||Type||Legal Status|
|1/222||Ibuprofen||Advil, Motrin, Nurofen||NSAID||Few restrictions|
|1/10||Codeine||Opioid||Controlled; OTC in combinations|
Rx Only (de facto)
|1/5||Dihydrocodeine||Opioid||Controlled; OTC in combinations|
Rx Only (de facto)
|1/3||Tapentadol||Nucynta, Palexia, Tapal||Opioid||Controlled|
|1.5||Oxycodone||Oxycontin, Percodan*, Percocet*||Opioid||Controlled|
|40||Buprenorphine||Buprenex, Suboxone*||Opioid (atypical)||Controlled|
* indicates a combination product
1 maximum sale quantity is limited in some jurisdictions due to the risk of liver damage from overdose
2 prescribed only in limited circumstances
3 no longer prescribed
Cannabis extracts, such as tetrahydrocannabinol (THC) and cannabidiol (CBD), have substantial analgesic properties, but varying methods of administration, a lack of regulation and scientific research, and differences between individuals make the analgesic effects of these compounds difficult to quantify. The Oxford Handbook of Pain Management cites inhaled cannabis as having an analgesic effect comparable to 50 to 120 mg of codeine (5 to 12 mg of morphine).
Unlike classical opioids, the analgesic effect from cannabis does not increase linearly with regard to dose. A baseline analgesia may be achieved, but additional doses may not decrease pain; simultaneously, increased doses also lead to increased (non-harmful) side effects.
Terpenes such as myrcene, which is found in cannabis, are believed to stimulate natural endorphins through alpha receptor activation.
Kratom, as there is no standardized extract, and as a drug which is very atypical of the opioid class, does not have a reliably established equivalency to well-studied opioids.
Loperamide, an opioid which crosses the blood-brain barrier in small amounts (which can be increased via concurrent use of p-glycoprotein inhibitors), is not officially recognized as having central nervous system effects. The drug remains hypothetically viable as a painkiller, especially in areas where access to weak opioids such as codeine is limited.
Turmeric is well established to have analgesic properties, and is believed to contain natural NSAID-like compounds.
Ethanol has analgesic properties, and has historically been used as a pain reliever. This use continues in informal or improvised settings, but use in medical settings has been discontinued in the developed world. Studies have shown that two standard drinks of alcohol provide analgesia comparable to 10 to 15 mg of morphine (100 mg to 150 mg of codeine), but the analgesic effect quickly reaches a ceiling, making a quantitative comparison to morphine problematic and misleading.
OTC Drug Comparison
All products are instant-release. Opioids are not included in this chart because they are typically not available by themselves. Exceptions to this include products that include non-drug ingredients that act to limit the maximum consumption (e.g. Rikodeine), research chemicals not yet regulated, and kratom.
|Drug||Dose||Brand names||Morphine mg Equivalent||Codeine mg Equivalent|
|Aspirin||81 mg||"Baby aspirin"||0.23 mg||2.3 mg|
|Naproxen||200 mg||Aleve (normal dose)||1.45 mg||14.5 mg|
|Ibuprofen||200 mg x2||Advil, Motrin||1.80 mg||18.0 mg|
|Aspirin||325 mg x2||1.81 mg||18.1 mg|
|Acetaminophen||325 mg x2||Tylenol||1.81 mg||18.1 mg|
|Aspirin||325 mg x3||2.71 mg||27.1 mg|
|Acetaminophen||500 mg x2||Tylenol Extra Strength||2.78 mg||27.8 mg|
|Naproxen||200 mg x2||Aleve (max dose)||2.90 mg||29.0 mg|
|Ibuprofen||200 mg x4||Advil, Motrin||3.60 mg||36.0 mg|
Maxiumum Potency by Country
Following maximum dose guidelines