Medication Comparisons

Oxycodone sits near the middle of a crowded map. On one side are milder medicines like codeine, tramadol and the pain relievers you can buy at any drugstore. On the other side are hydromorphone, fentanyl and methadone, which work in very small doses or in unusual ways. This page lays out that territory so you can see oxycodone compared to other opioids and to non-opioid painkillers, then points you to the page that covers each pairing in depth.

On this page

1. The family tree of pain medicines
2. Master comparison table
3. Stronger, weaker, or just different?
4. Oxycodone vs each medicine
5. Choosing by situation
6. Comparing side effects across the class
7. Questions to ask before any switch
8. Frequently asked questions

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The family tree of pain medicines

Pain medicines are easier to compare once you know where each one comes from. Opioids are sorted by origin: some come straight from the opium poppy, some are made by chemically changing a poppy compound, and some are built entirely in a lab. Origin does not decide strength or safety, but it explains why some names sound alike. Non-opioids work through other pathways and form their own branches.

Natural opiates: morphine and codeine

Both are taken directly from the poppy plant. Morphine is the yardstick that every other opioid is measured against. Codeine is much milder, and it only works after the liver turns part of it into morphine.

Semi-synthetic opioids: oxycodone, hydrocodone, hydromorphone, oxymorphone

Each starts from a natural poppy compound (thebaine or codeine) that chemists then modify. This is oxycodone’s branch. That is why its closest relatives, hydrocodone and the two “-morphone” drugs, have such similar names.

Fully synthetic opioids: fentanyl, methadone, tramadol, tapentadol

These are made entirely in a lab and vary widely. Fentanyl is extremely potent and methadone lasts an unusually long time. Tramadol and tapentadol pair a weaker opioid action with effects on the brain chemicals norepinephrine (and, for tramadol, serotonin).

Partial agonist: buprenorphine

Buprenorphine attaches tightly to opioid receptors but only partly switches them on. That gives it a “ceiling”: past a certain point, more drug does not add much more effect on breathing. This is a big reason it is used to treat opioid use disorder.

Non-opioids: acetaminophen, NSAIDs, gabapentinoids

Acetaminophen (Tylenol) and NSAIDs such as ibuprofen and naproxen ease pain without touching opioid receptors, and NSAIDs also calm inflammation. Gabapentin and pregabalin quiet overactive nerves and are mainly used for nerve pain, not for a sprained ankle or a sore tooth.

Master comparison table

The table puts each medicine next to oxycodone using a common reference point: how much oral morphine it roughly matches, milligram for milligram. These numbers are the morphine milligram equivalent (MME) conversion factors that public health agencies and insurers use to add up a person’s total daily opioid exposure. The values below follow the conversion table in the CDC’s 2022 Clinical Practice Guideline for Prescribing Opioids for Pain, which raised hydromorphone to 5 and tramadol to 0.2 compared with the older 2016 table. Schedules come from the DEA’s alphabetical list of controlled substances.

Medicine	Type	Relative strength vs oral morphine (MME factor)	DEA schedule	Common brands	Main use	Read more
Oxycodone	Semi-synthetic opioid	1.5	II	Roxicodone, OxyContin, Percocet (with acetaminophen)	Moderate to severe pain	Strengths covered in our guide to oxycodone tablet strengths
Morphine	Natural opiate	1 (the reference)	II	MS Contin, generic tablets and liquid	Severe pain, hospital and cancer care	See card below
Codeine	Natural opiate	0.15	II alone; III in some combinations with acetaminophen	Tylenol with Codeine (Tylenol #3)	Mild to moderate pain, cough	See card below
Hydrocodone	Semi-synthetic opioid	1	II	Norco, Lortab, Vicodin (name now largely retired)	Moderate pain, often after procedures	See card below
Hydromorphone	Semi-synthetic opioid	5	II	Dilaudid	Severe pain, hospital care	See card below
Oxymorphone	Semi-synthetic opioid	3	II	Generic tablets (Opana ER was withdrawn in 2017)	Severe pain	Compared in Opana vs Dilaudid
Fentanyl	Synthetic opioid	Does not convert simply; skin patches have a separate per-hour factor	II	Duragesic (patch), plus hospital forms	Severe pain in opioid-tolerant patients; anesthesia	See card below
Methadone	Synthetic opioid	Does not convert in a straight line; builds up over days	II	Generic; Methadose	Chronic pain (specialist use); opioid use disorder	See card below
Tramadol	Synthetic opioid, dual action	0.2	IV	Ultram (name retired), ConZip	Moderate pain	See card below
Tapentadol	Synthetic opioid, dual action	0.4	II	Nucynta, Nucynta ER	Moderate to severe pain; diabetic nerve pain (ER)	See card below
Buprenorphine	Partial agonist	Not included in MME totals	III	Suboxone, Zubsolv (with naloxone); Belbuca	Opioid use disorder; some chronic pain	See card below
Acetaminophen, NSAIDs	Non-opioid	Not applicable	Not controlled	Tylenol, Advil, Motrin, Aleve	Mild to moderate pain, inflammation	See card below
Gabapentin, pregabalin	Non-opioid (gabapentinoid)	Not applicable	Gabapentin not federally scheduled; pregabalin V	Neurontin, Lyrica	Nerve pain, seizures	See the situation table

Stronger, weaker, or just different?

People often ask “what is stronger than oxycodone?” when they mean “what would work better for me?” Those are separate questions.

Potency is about milligrams, not results

Potency describes how many milligrams it takes to produce a given effect. Hydromorphone is more potent than oxycodone, so a smaller tablet does the same job. That does not mean it relieves pain better at the right dose. Prescribers pick tablet sizes to match potency, so a 2 mg tablet of one drug and a 10 mg tablet of another can be roughly comparable. Comparing the numbers printed on two bottles tells you very little.

Ceilings change the picture

Full opioid agonists such as oxycodone, morphine and fentanyl have no built-in limit on pain relief. Side effects are what stop the dose from going higher. Some other medicines do hit a ceiling, for different reasons:

• Buprenorphine levels off because it only partly activates the receptor.
• Tramadol and tapentadol are capped by daily maximums tied to seizure and serotonin risks.
• Combination tablets like Percocet and Norco are capped by their acetaminophen content, not by the opioid.
• Acetaminophen and NSAIDs reach a point where more medicine adds risk to the liver, stomach or kidneys without adding relief.

Why mg-for-mg comparisons mislead

Three things make simple ratios unreliable for any one person. First, genes affect how some drugs are processed. Codeine and tramadol both depend on the liver enzyme CYP2D6, which some people barely have and others have in overdrive. Second, long-acting drugs like methadone pile up over several days, so day one says little about day five. Third, tolerance is incomplete across drugs. Someone used to oxycodone may react much more strongly than expected to a new opioid. Prescribers therefore treat charts as a rough start and adjust slowly.

Oxycodone vs each medicine

Each card below is a short orientation, not the full story. When a pairing matters to you, follow the link at the end of the card to the dedicated comparison.

Oxycodone vs Percocet

This is less a comparison of two drugs than a comparison of one drug with and without a partner. Percocet contains oxycodone plus acetaminophen in one tablet, so the opioid part behaves identically. The acetaminophen adds a different kind of pain relief, but it also sets a daily cap and means the label needs extra attention if you have liver problems. The full breakdown is in our oxycodone vs Percocet guide.

Oxycodone vs OxyContin

Same molecule, different delivery. OxyContin releases oxycodone gradually over about 12 hours and is meant for steady, around-the-clock pain in people already used to opioids. It is not designed for short bursts of pain after an injury. These tablets must be swallowed whole: never crush, chew, split or dissolve them. For more on how the release design works, see how OxyContin differs from immediate-release oxycodone.

Oxycodone vs Roxicodone

Roxicodone is simply a brand name for immediate-release oxycodone with no added ingredients. If your bottle says “oxycodone HCl,” you are taking the generic of the same medicine. Generic and brand versions must deliver the same active drug, though the tablet’s color, shape or filler can differ. Our Roxicodone vs generic oxycodone page covers what changes and what stays the same.

Oxycodone vs hydrocodone (Vicodin, Norco)

These two are close cousins and are often prescribed for the same short-term pain. On the CDC scale, oxycodone counts as somewhat more potent per milligram (1.5 vs 1). In the United States, short-acting hydrocodone is sold only in combination products, most often with acetaminophen. In head-to-head studies of usual doses, the two give broadly similar relief. Start with the difference between oxycodone and hydrocodone. Then, depending on the name on your label, see oxycodone vs Vicodin or Norco vs oxycodone.

Oxycodone vs morphine

Morphine is the old standard and is still widely used in hospitals and in cancer and hospice care. Swallowed oxycodone reaches the bloodstream more completely than swallowed morphine, which helps explain its 1.5 rating. Morphine’s breakdown products leave the body through the kidneys and can build up when the kidneys are weak. That is one reason clinicians may choose between the two. Read oxycodone vs morphine for the details.

Oxycodone vs codeine

Codeine is at the mild end of the map. Its effect depends on how much of it your liver converts to morphine, so some people feel almost nothing and a few get far too much. Because of that unpredictability, the FDA restricts codeine in children. Most people meet it as Tylenol with Codeine. See oxycodone vs codeine.

Oxycodone vs hydromorphone (Dilaudid)

Hydromorphone is one of the most potent pills on this map. The CDC rates it at roughly five times morphine, which makes it the usual answer to “what is stronger than oxycodone?” among oral tablets. It is common in hospitals and for severe pain. Because the doses are small, a mix-up of even a couple of milligrams matters more than with other opioids. Compare them in oxycodone vs Dilaudid.

Oxycodone vs fentanyl

According to the DEA’s fentanyl fact sheet, fentanyl is roughly 100 times as potent as morphine. Prescription fentanyl usually comes as a skin patch for people who already tolerate opioids, or as an injection during surgery. A patch is never a starter medicine for someone switching from a few oxycodone tablets. Illegally made fentanyl is a separate problem and drives most overdose deaths. Our oxycodone vs fentanyl comparison explains both sides.

Oxycodone vs tramadol

Tramadol is often thought of as the “light” opioid, and it is the only opioid on this map in Schedule IV. That label hides some real risks. It can lower the seizure threshold. Combined with antidepressants and some other drugs, it can trigger serotonin syndrome. Like codeine, it depends on CYP2D6, so responses vary from person to person. Weigh it up in oxycodone vs tramadol.

Oxycodone vs tapentadol (Nucynta)

Tapentadol combines a moderate opioid effect with a boost in norepinephrine, a chemical messenger involved in how the spinal cord dampens pain signals. Some people report less nausea or constipation than with oxycodone, and the long-acting form is approved for diabetic nerve pain. It is Schedule II like oxycodone and is usually more expensive. We cover the generic name in tapentadol vs oxycodone and the brand in Nucynta vs oxycodone.

Oxycodone vs methadone

Methadone has two separate jobs: specialist-managed chronic pain, and daily treatment for opioid use disorder through licensed programs. It stays in the body far longer than its pain relief lasts. That mismatch makes dose changes risky, and it can affect heart rhythm. It is never something to try at home in place of oxycodone. Our oxycodone vs methadone guide walks through both uses.

Oxycodone vs buprenorphine (Suboxone)

Buprenorphine holds onto opioid receptors more tightly than oxycodone does, so taking it too soon after oxycodone can trigger sudden withdrawal. Its ceiling on breathing effects makes it a first-line option for opioid use disorder, and certain forms are also approved for chronic pain. MedlinePlus explains how the sublingual versions are used. To see how the forms differ, read buprenorphine vs Suboxone. To compare the two main treatment medicines, see Suboxone vs methadone.

Oxycodone vs non-opioids (ibuprofen, naproxen, acetaminophen)

For many kinds of short-term pain, this is a closer contest than most people expect. In a 2017 emergency department trial of 411 adults with arm or leg injuries, Chang and colleagues gave one dose of either ibuprofen plus acetaminophen or one of three opioid-acetaminophen combinations, including oxycodone. Pain dropped by similar amounts in every group at two hours (JAMA, 2017). The study had limits: it tested a single dose, followed patients for only two hours, and did not track side effects. It still fits the CDC’s finding that non-opioid medicines work at least as well as opioids for many common acute pains. You can find out how each one can be used alongside oxycodone in ibuprofen with oxycodone, naproxen with oxycodone and acetaminophen with oxycodone.

Choosing by situation

Clinicians rarely ask which drug is strongest. They ask what kind of pain it is, how long it will last, and what else is going on in the body. These are common starting points; your plan may differ.

Situation	What clinicians commonly consider	Where oxycodone fits	Related reading
Short pain after surgery or injury	Scheduled acetaminophen and/or an NSAID first; a few days of an immediate-release opioid if needed	A common short-course choice; long-acting forms are generally avoided	Preventing opioid constipation
Dental pain	NSAIDs, often combined with acetaminophen; CDC notes NSAIDs outperform opioids after dental surgery	Usually not first-line	Non-opioid card above
Kidney stone	NSAIDs, which CDC guidance finds more effective than opioids for this pain	Sometimes a backup for breakthrough pain	Oxycodone for kidney stones
Chronic back pain or arthritis	Exercise, physical therapy, NSAIDs, duloxetine; opioids only if benefits clearly outweigh risks	Sometimes, with regular check-ins and a written plan	Oxycodone for chronic pain
Cancer pain	Morphine, oxycodone, hydromorphone and fentanyl are all standard; chosen by kidney function, swallowing and preference	A mainstay, often as long- and short-acting forms together	OxyContin card above
Nerve pain	Gabapentinoids, certain antidepressants, topical agents; tapentadol ER for diabetic nerve pain	Limited and mixed evidence	Does oxycodone help nerve pain?
Kidney disease	Avoiding codeine and morphine where possible; dose and timing changes for tramadol and gabapentin	Usable with caution at lower doses	Oxycodone and kidney disease
Liver disease	Watching acetaminophen totals, avoiding NSAIDs in advanced disease, lower opioid doses	Lower doses and longer gaps between doses	Oxycodone and liver disease
Older adults	Topical NSAIDs, acetaminophen, the lowest effective opioid dose, fall prevention	Used, but started low and increased slowly	Oxycodone in older adults
Opioid use disorder	Buprenorphine, methadone or extended-release naltrexone	Not a treatment; acute pain needs a coordinated plan	Buprenorphine and methadone cards above

Gabapentin and pregabalin deserve a specific warning. In December 2019 the FDA warned about serious breathing problems when these nerve-pain drugs are taken by people who also use opioids, have lung disease such as COPD, or are older. If both are prescribed, everyone involved should know it. Our page on gabapentin with hydrocodone explains why the same caution applies to oxycodone.

Comparing side effects across the class

All full opioids share one core set of side effects, so switching rarely makes them disappear. The differences show up at the edges. In this grid, “shared” means the effect is about the same as with oxycodone at comparable doses.

Medicine	Constipation	Nausea	Drowsiness	Breathing risk	Distinctive flag
Oxycodone	Common	Common	Common	Serious at high doses or with sedatives	Itching in some people
Hydrocodone	Shared	Shared	Shared	Shared	Acetaminophen ceiling in combination products
Morphine	Shared	Often more	Shared	Shared	Metabolites build up in kidney disease; more itching
Codeine	Common	Common	Common	Unpredictable in ultra-rapid metabolizers	Restricted in children
Hydromorphone	Shared	Shared	Shared	Shared; small doses leave little room for error	Dosing mix-ups
Fentanyl patch	Shared	Shared	Shared	High in anyone not opioid-tolerant	Heat on the skin raises absorption
Methadone	Shared	Shared	Shared	Delayed; can peak days after a dose change	QT prolongation (heart rhythm)
Tramadol	Less	Common	Common	Present	Seizures; serotonin syndrome; low blood sugar
Tapentadol	Often less	Often less	Common	Present	Serotonin syndrome with some antidepressants
Buprenorphine	Present	Present	Present	Ceiling when taken alone; risky with sedatives	Can trigger sudden withdrawal if started too soon
NSAIDs	No	Stomach upset	No	No	Stomach bleeding, kidney strain, heart risk
Acetaminophen	No	Rare	No	No	Liver injury above daily limits

One row deserves extra emphasis. Any opioid becomes far more dangerous when combined with alcohol, benzodiazepines, sleep aids or gabapentinoids. Most serious breathing problems happen with these combinations, not with the opioid alone. Before adding anything new, check our oxycodone drug interactions overview.

Questions to ask before any switch

If oxycodone is not working well, or the side effects are wearing you down, a change of medicine may be worth talking about. Bring these questions to the appointment:

• What problem are we solving? Weak relief, side effects, cost and convenience each point toward different options.
• Could a non-opioid or non-drug option do part of the work? Adding an NSAID, acetaminophen or physical therapy sometimes reduces the need for an opioid.
• How will the new dose be chosen? Ask whether it will start below the calculated equivalent, which is standard practice, and how quickly it may go up.
• What about my kidneys, liver, lungs and heart? Each of these can rule certain medicines in or out.
• Does it interact with what I already take? Antidepressants, antifungals, some antibiotics, sleep aids and seizure medicines all matter.
• What do I do with my leftover oxycodone? Get rid of it promptly rather than keeping it “just in case.” Our page on disposing of unused oxycodone lists the options.
• Should someone at home watch me during the first few days? The first days after a switch carry the most risk. Family members can use our caregiver safety guide.
• Should I have naloxone at home? Many prescribers now recommend it for anyone on daily opioids.

If your current dose seems to be fading, the cause may not be the medicine itself. Read why oxycodone can stop working before assuming you need something stronger.

Frequently asked questions

What is the strongest pain medication?

By potency, fentanyl and its hospital relatives (such as sufentanil and remifentanil, which are used in anesthesia) are at the top. Among common prescription pills, hydromorphone and oxymorphone rank above oxycodone. “Strongest” is not the same as “best,” though. The right medicine is the one that controls your pain at the lowest risk, and for many people that is not the most potent one.

Is oxycodone the strongest painkiller?

No. It is stronger per milligram than morphine, hydrocodone, codeine, tramadol and tapentadol. It is weaker per milligram than hydromorphone, oxymorphone and fentanyl. That puts it in the upper middle of the opioids people commonly take at home.

Is there a non-opioid as strong as oxycodone?

For some acute pain, yes. Ibuprofen combined with acetaminophen matched low-dose oxycodone combinations in at least one large emergency room trial. NSAIDs also outperform opioids for dental and kidney stone pain, according to CDC’s review. For severe pain from major surgery, serious trauma or cancer, no over-the-counter medicine replaces an opioid. Even then, non-opioids often lower how much opioid is needed.

What is oxycodone’s closest equivalent?

Hydrocodone is the closest relative in everyday use. It belongs to the same semi-synthetic branch, is used for similar pain, and comes in similar short-acting tablets. Oxymorphone is closer chemically, since the body makes a small amount of it from oxycodone, but it is prescribed far less often.

What is the weakest opioid?

Of the pain opioids in the CDC table, codeine has the lowest conversion factor, followed by tramadol. “Weak” can be misleading here, because both depend on liver genetics. A small number of people turn them into active drug so fast that they effectively get a much higher dose. Neither one is safe to share or to treat casually.

Why would a doctor choose a weaker opioid over oxycodone?

Often to match the medicine to the pain. A moderate, short-lived pain may not need the higher potency, and a lower schedule (like tramadol’s Schedule IV) can mean easier refills. History, other medicines or a past reaction can also steer the choice. Weaker does not automatically mean safer.

Do all opioids show up the same way on a drug test?

No. Basic opiate screens are designed to catch morphine and codeine and may miss oxycodone, fentanyl, methadone, tramadol or buprenorphine. Those usually need their own specific tests. If you are tested at work or in a pain program, tell the lab or clinic about every prescription you take.

Can I keep two different opioids at home safely?

Only if both are currently prescribed and you have a written plan for when to take each one. Store them separately, in their original labeled bottles, locked away from children, visitors and pets. Get rid of whichever one you have stopped using. Our sibling guide on childproof oxycodone storage covers lock options that work.

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Other sources consulted for this guide: MedlinePlus on pain relievers, MedlinePlus on tramadol and the FDA’s opioid medications hub.