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Opioid Drugs: Summary of Recommendations
Don't take an opioid painkiller to treat chronic pain until you have tried other, less risky, pain relievers—such as acetaminophen, or a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin, and generic) or naproxen (Aleve and generic).

Some kinds of chronic or periodic pain in particular—such as nerve pain, migraines, or fibromyalgia—are best treated with other types of drugs, not opioids. Talk with your doctor about non-drug measures, too. Studies show they can ease chronic pain, either alone or in combination with drugs. These include cognitive behavioral therapy, exercise, spinal manipulation, and physical rehab programs.

The weight of medical evidence indicates that while opioids are highly effective—and usually the drugs of choice—in relieving acute severe pain, they are only moderately effective in treating long-term chronic pain, and their effectiveness can diminish over time.

In addition, while the long-term use of opioids has not been well studied, it has been linked to a decrease in sex hormones leading to both a loss of interest in sex and impaired sexual function; a decline in immune function; and an increase in the body's sensitivity to pain.

Opioids can also be addictive and are prone to abuse and misuse. They are rarely addictive if you genuinely need one to control pain, however. If other options fail, your doctor may consider an opioid since controlling pain is always a medical priority.

 Taking effectiveness, safety, side effects, dosing flexibility, convenience, and cost into account, we have chosen the following opioid as a Best Buys for people with moderate to severe chronic pain when other pain relievers fail to bring adequate relief:
  • Generic morphine extended release

This medicine has a long track record and provides good value. It ranges widely in monthly cost, depending on dosing regimen. But most low-dose regimens will run you $101 or less per month.

High doses of this medicine can be quite expensive. If you need to take a high dose, we advise speaking with your doctor or pharmacist about which opioid has the lowest cost under your insurance plan. If you have to pay out-of-pocket, take care to avoid the high-cost versions of our Best Buy medicine, if possible.

Long Acting Opioids - Dosing and Costs
CR Best Buy Generic Name and Strength Brand Name(s)1 Frequency of Use Per Day2 Total Daily Dose3 Average Monthly Cost4
  Buprenorphine patches
  Buprenorphine patch 5 mcg/hour Butrans One patch every 72 hours 120 mcg $189
  Buprenorphine patch 10 mcg/hour Butrans One patch every 72 hours 240 mcg $276
  Buprenorphine patch 20 mcg/hour Butrans One patch every 72 hours 480 mcg $495
  Fentanyl patches
  Fentanyl extended-release 25 mcg/hour Duragesic One patch every 72 hours 600 mcg $303
  Fentanyl extended-release 25 mcg/hour Generic One patch every 72 hours 600 mcg $126
  Fentanyl extended-release 50 mcg/hour Duragesic One patch every 72 hours 1200 mcg $666
  Fentanyl extended-release 50 mcg/hour Generic One patch every 72 hours 1200 mcg $205
  Hydromorphone pills
  Hydromorphone sustained-release 8 mg Exalgo
1
8 mg $349
  Hydromorphone sustained-release 12 mg Exalgo
1
12 mg $520
  Hydromorphone sustained-release 16 mg Exalgo
1
16 mg $738
  Methadone pills
  Methadone 5 mg Generic
3
15 mg $17
  Methadone 10 mg Generic
3
30 mg $20
  Morphine pills
Morphine extended-release 15 mg Generic
2
30 mg $48
  Morphine extended-release 30 mg Avinza
1
30 mg $177
  Morphine extended-release 30 mg Kadian
1
30 mg $247
  Morphine extended-release 30 mg MS-Contin
2
60 mg $270
Morphine extended-release 30 mg Generic
2
30 mg $72
  Morphine extended-release 60 mg Avinza
1
60 mg $313
  Morphine extended-release 60 mg Kadian
1
60 mg $433
Morphine extended-release 60 mg Generic
2
120 mg $101
  Morphine extended-release 90 mg Avinza
1
90 mg $456
  Morphine extended-release 100 mg Kadian
1
100 mg $692
  Oxymorphone pills
  Oxymorphone sustained-release 10 mg Opana ER
2
20 mg $290
  Oxymorphone sustained-release 15 mg Opana ER
2
30 mg $343
  Oxymorphone sustained-release 15 mg Generic
2
30 mg $319
  Oxymorphone sustained-release 20 mg Opana ER
2
40 mg $509
  Oxymorphone sustained-release 40 mg Opana ER
2
80 mg $955
  Oxycodone pills
  Oxycodone sustained-release 10 mg OxyContin
2
20 mg $164
  Oxycodone sustained-release 20 mg OxyContin
2
40 mg $306
  Oxycodone sustained-release 40 mg OxyContin
2
80 mg $529
  Oxycodone sustained-release 80 mg OxyContin
2
160 mg $1,031
* Selected doses. There are dozens of pill strengths for most of the medicines listed in this table. For space reasons, we have limited our list to selected strengths of both brand and generics.

1. "Generic" indicates it's the generic version of this drug.

2. As typically and generally prescribed. Means number of pills unless otherwise noted.

3. Total daily dose of opioid only.

4. Prices reflect nationwide retail average for July 2012, rounded to the nearest dollar. They are derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Pharma Solutions, which is not involved in our analysis or recommendations.