What Are the Differences between Oxycodone and Fentanyl?
Oxycodone and fentanyl are both classified as opioid medications.
Other opioids include heroin, morphine, codeine, and more. Natural opioids are derived from the poppy plant, and the synthetic opioids were created to have similar effects. The primary medical use of opioids is to control pain.
There are naturally occurring opioids in the body, called “endogenous opioids“, that bind to opioid receptors, including mu, delta, and kappa receptors. Opioid drugs, “exogenous opioids”, produce their effects by binding to those same receptors.
Both oxycodone and fentanyl are classified as Schedule II controlled substances by the United States Drug Enforcement Administration (DEA), meaning that while they do have medicinal uses, they also have a high risk for abuse and the development of dependence. These drugs can only be legally obtained with a prescription, and these prescriptions are monitored by the DEA.
Fentanyl is a synthetic opioid analgesic that is used for severe pain. Its potency is 50 to 100 times that of morphine. It is available in multiple forms, including patch, lozenge, injectable solution, nasal spray, sublingual tab (dissolved under the tongue), and buccal tab (dissolved between the cheek and gum).
There are several different brand versions of fentanyl, including Duragesic, Actiq, Fentora, Abstral, and Subsys.
The transdermal fentanyl patch is applied to dry, intact skin and is worn for 72 hours. It typically can provide potent pain relief for between 72 and 96 hours. Lozenges are slowly dissolved in the mouth. Sublingual tablets are slowly dissolved underneath the tongue. Buccal tablets are slowly dissolved between the upper gum and the cheek. The fentanyl nasal spray is sprayed in the nose towards the bridge. The fentanyl injection solutionis either injected into a muscle or vein or is infused into a vein.
Oxycodone is a semi-synthetic opioid that is used for moderate to severe pain. There are immediate-release forms (such as Oxaydo) that typically are effective for 3 to 6 hours, as well as extended-release/controlled-release versions that last up to 12 hours (such as Xtampza ER and OxyContin). Additionally, there are combination products of oxycodone and acetaminophen (such as Percocet), oxycodone and aspirin (such as Percodan), and oxycodone and ibuprofen (such as Combunox).
All of these are also available as generics. Oxycodone and oxycodone combination products are typically available as capsules or tablets.
Major Differences between Fentanyl and Oxycodone
Both drugs are similar since they are both opioids; however, there are some major differences.
- The most salient difference between the two drugs is their potency. Fentanyl is the most potent of all opioid drugs; it is 50 to 100 timesmore potent than morphine, and morphine is 1.5 times more potent than oxycodone. Both are easy to overdose on if taken inappropriately, but this makes fentanyl especially dangerous in illicit markets.
- According to provisional counts for 2017, over 29,400 overdose deaths involved synthetics opioids (not including methadone), and most of these involved fentanyl. Over 14,900 involved natural and semi-synthetic opioids, which would include oxycodone.
- While fentanyl is available as a transdermal patch, nasal spray, lozenge, sublingual tablet, buccal tablet, and solution for intramuscular or intravenous use, oxycodone is typically only available in tablet or capsule form to be taken orally.
- The drugs have different duration of actions (the amount of time the drug is effective for). This also depends on the formulation of the drug. Examples of typical durations include:
- Fentanyl injection solution: 30 minutes to 1 hour (IV) or 1 to 2 hours (IM)
- Fentanyl nasal spray: about 1 hour
- Fentanyl transmucosal (lozenge, sublingual tablet, buccal tablet): 1 to 2 hours
- Oxycodone immediate release: 3 to 6 hours
- Oxycodone controlled release: up to 12 hours
- Fentanyl transdermal patch: 72 to 96 hours
- Similarly, the drugs also have different onset of actions, depending on formulation. Onset of action is the amount of time after the drug is administered before a person begins feeling its intended effects. Examples of typical times until onset include:
- One study found that fentanyl and oxycodone provided comparable postop pain relief, but that oxycodone was less sedating than fentanyl. However, they found there were more side effects in patients who took oxycodone, although this difference was not statistically significant.
Both drugs can cause users to become dependent on opioids, even when not being misused. These individuals may need medical detox, possibly including medication-assisted treatment (MAT), to safely detox from opioids. Addiction to these drugs is also very common, but there are effective treatments for opioid use disorders. Treatment may include medications, individual therapy, group therapy, and other adjunctive treatments.
Fentanyl and oxycodone are drugs that belong to the same general class of drugs: opioid medications. Both drugs are used to treat significant pain.
However, both drugs are also highly prone to being drugs of abuse. Regular use of these drugs can result in the development of tolerance and physical dependence. Fentanyl is far more potent than oxycodone, and it is involved in more overdose deaths in the US.
There is help available for individuals who are dependent on opioids, including inpatient detox and outpatient detox. Medications can be used to lessen or eliminate withdrawal symptoms, and alternative methods of pain management can be used for those who need them. Addiction treatment programs can help those who struggle with opioid use disorders, whether they involve fentanyl, oxycodone, or other opioids.