Some kinds of chronic 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: (1) a decrease in sex hormones leading to both a loss of interest in sex and impaired sexual function; (2) a decline in immune function; and (3) an increase the body's sensitivity to pain.
Opioids also can be addictive and are prone to be abused and misused, though they are rarely addictive in people who genuinely need them to control pain.
If other options fail, your doctor may consider an opioid since controlling pain is always a medical priority. Taking effectiveness, safety and side effects, dosing flexibility and convenience, and cost into account, we have chosen the following opioids as Best Buys for people with moderate to severe chronic pain when other pain relievers fail to bring adequate relief:
- Generic codeine plus acetaminophen
- Generic morphine extended release
- Generic oxycodone extended release
- Generic oxycodone with acetaminophen
These four medicines have a long track record, provide good value. They range widely in monthly cost, depending on dosing regimen. But most low-dose regimens will run you less than $150 a month or so.
High doses and some extended release formulations of these medicines can be quite expensive. If you need to take high doses, we advise speaking with your doctor 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 Buys.
There is no reason to take the brand-name versions of our Best Buys, or any opioid for that matter. That includes well-known brands such as OxyContin, Percocet, and Vicodin.
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| CR Best Buy | Generic Name and Strength | Brand Name(s)1 | Frequency of Use Per Day2 | Total Daily Dose3 | Average Monthly Cost4 | Compare Prices |
Codeine plus acetaminophen - pills and liquid |
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| Codeine 30mg plus acetaminophen 300mg | Tylenol No. 3 | 4 | 120mg | $99 |  |
|
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Codeine 30mg plus acetaminophen 300mg | APAP with codeine | 4 | 120mg | $31 | |
| Codeine 60mg plus acetaminophen 300mg | Tylenol No. 4 | 6 | 360mg | $235 | |
|
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Codeine 60mg plus acetaminophen 300mg | APAP with codeine | 6 | 360mg | $38 | |
| Codeine 12 mg/5ml plus acetaminophen 120 mg/5 ml oral solution | Tylenol Elixir | 6 | 72mg | $156 | |
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Codeine 12 mg/5 ml plus acetaminophen 120 mg/5 ml oral solution | APAP with codeine Elixir or Generic Elixir | 6 | 72mg | $83 | |
Fentanyl patches |
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| Fentanyl extended release 25mcg/hour | Duragesic | One patch every 72 hours | 600mcg | $240 | |
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| Fentanyl extended release 25mcg/hour | Generic | One patch every 72 hours | 600mcg | $143 | |
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| Fentanyl extended release 50mcg/hour | Duragesic | One patch every 72 hours | 1200mcg | $426 | |
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| Fentanyl extended release 50mcg/hour | Generic | One patch every 72 hours | 1200mcg | $262 | |
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Hydrocodone plus acetaminophen - pills |
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| Hydrocodone 5mg plus acetaminophen 500mg | Lortab | 4 | 20 mg | $184 | |
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| Hydrocodone 5mg plus acetaminophen 500mg | Vicodin | 4 | 20mg | $180 | |
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| Hydrocodone 5mg plus acetaminophen 500mg | Co-Gesic | 4 | 20mg | $81 | |
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| Hydrocodone 5mg plus acetaminophen 325mg | Anexsia | 6 | 30mg | $146 | |
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| Hydrocodone 5mg plus acetaminophen 325mg | Generic | 6 | 30mg | $134 | |
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| Hydrocodone 7.5mg plus acetaminophen 500mg | Lortab | 4 | 30mg | $173 | |
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| Hydrocodone 7.5mg plus acetaminophen 500mg | Generic | 4 | 30mg | $59 | |
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| Hydrocodone 10mg plus acetaminophen 660mg | Vicodin HP | 4 | 40mg | $196 | |
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| Hydrocodone 10 mg plus acetaminophen 660 mg | Generic | 4 | 40mg | $79 | |
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| Hydrocodone 10mg plus acetaminophen 650mg | Generic | 4 | 40mg | $70 | |
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Hydromorphone - pills |
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| Hydromorphone 8mg | Dilaudid | 4 | 32mg | $228 | |
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| Hydromorphone 8mg | Generic | 4 | 32mg | $78 | |
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Levorphanol - pills |
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| Levorphanol 2mg | Generic | 4 | 8mg | $136 | |
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| Levorphanol 2mg | Generic | 6 | 12mg | $204 | |
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Meperidine - pills |
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| Meperidine 50mg | Demerol | 6 | 300mg | $290 | |
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| Meperidine 50mg | Meperitab | 6 | 300mg | $144 | |
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| Meperidine 50mg | Generic | 6 | 300mg | $164 | |
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| Meperidine 100mg | Demerol | 6 | 600mg | $537 | |
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| Meperidine 100mg | Meperitab | 6 | 600mg | $165 | |
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| Meperidine 100mg | Generic | 6 | 600mg | $240 | |
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Methadone - pills |
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| Methadone 5mg | "Methadose, Dolophine, or Generic" | 4 | 20mg | $23 | |
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| Methadone 10mg | "Methadose, Dolophine, or Generic" | 4 | 40mg | $28-$38 | |
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Morphine - pills |
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| Morphine extended release 30mg | Kadian | 1-2 | 30-60mg | $130-$266 | |
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| Morphine extended release 60mg | "Avinza, Kadian" | 1 | 60mg | $237-$250 | |
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| Morphine extended release 60mg | Kadian | 2 | 120mg | $499 | |
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| Morphine extended release 80mg | Kadian | 1-2 | 80mg-160mg | $336-$672 | |
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| Morphine extended release 100mg | Kadian | 1-2 | 100-200 mg | $450-$900 | |
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| Morphine extended release 200mg | Kadian | 1-2 | 200-400mg | $950-$1900 | |
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| Morphine extended release 15mg | MS-Contin | 1-3 | 15-45mg | $48-$144 | |
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Morphine extended release 15mg | Generic | 1-3 | 15-45mg | $26-$76 | |
| Morphine extended release 30mg | MS-Contin | 1-3 | 30-90mg | $78-$234 | |
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Morphine extended release 30mg | Generic | 1-3 | 30-90mg | $43-$129 | |
| Morphine extended release 60mg | MS-Contin | 1-3 | 60-180mg | $145-$435 | |
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Morphine extended release 60mg | Generic | 1-3 | 30-180mg | $75-$225 | |
Oxycodone - pills |
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| Oxycodone extended release 10mg | Oxyctonin | 2 | 20mg | $127 | |
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| Oxycodone extended release 20mg | Oxyctonin | 2 | 40mg | $227 | |
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| Oxycodone extended release 40mg | Oxycontin | 2 | 80mg | $395 | |
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| Oxycodone extended release tablet 80mg | Oxycontin | 2 | 160mg | $735 | |
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Oxycodone extended release 10mg | Generic | 2 | 20mg | $86-$1005 | |
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Oxycodone extended release 20mg | Generic | 2 | 40mg | $157-$175 | |
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Oxycodone extended release 40mg | Generic | 2 | 80mg | $270-$307 | |
| Oxycodone extended release tablet 80mg | Generic | 2 | 160mg | $522-$556 | |
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| Oxycodone 5mg plus acetaminophen 325mg | Percocet | 4 | 20mg | $391 | |
|
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Oxycodone 5mg plus acetaminophen 325mg | Generic | 4 | 20mg | $61 | |
| Oxycodone 7.5mg plus acetaminophen 500mg | Percocet | 4 | 30mg | $442 | |
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Oxycodone 7.5mg plus acetaminophen 500mg | Generic | 4 | 30mg | $139 | |
| Oxycodone 4.8mg plus aspirin 325mg | Percodan | 4 | 19mg | $208 | |
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| Oxycodone 4.8mg plus aspirin 325mg | Generic or Endodan | 4 | 19mg | $137 | |
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| Oxycodone 5mg | Roxicodone | 4 | 20mg | $61 | |
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| Oxycodone 15mg | Roxicodone | 4 | 60mg | $151 | |
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| Oxycodone 30mg | Roxicodone | 4 | 120mg | $290 | |
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| Oxycodone 5mg | Generic | 4 | 20mg | $45 | |
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| Oxycodone 15mg | Generic | 4 | 60mg | $86 | |
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| Oxycodone 30mg | Generic | 4 | 120mg | $147 | |
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Oxymorphone - pills |
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| Oxymorphone tablet 5mg | Opana | 4 | 20mg | $336 | |
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| Oxymorphone tablet 10mg | Opana | 4 | 40mg | $676 | |
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| Oxymorphone extended release 5mg | Opana ER | 2 | 10mg | $131 | |
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| Oxymorphone extended release 10mg | Opana ER | 2 | 20mg | $245 | |
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| Oxymorphone extended release 20mg | Opana ER | 2 | 40mg | $434 | |
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| Oxymorphone extended release 40mg | Opana ER | 2 | 80mg | $788 | |
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Propoxyphene - pills |
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| Propoxyphene 65mg | Darvon | 4 | 260mg | $133 | |
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| Propoxyphene 65mg | Generic | 4 | 260mg | $51 | |
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| Propoxyphene napsylate 100mg | Darvon-N | 4 | 400mg | $228 | |
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| Propoxyphene napsylate 100mg | Generic | 4 | 400mg | $30 | |
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Tramadol - pills |
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| Tramadol 50mg | Ultram | 4 | 200mg | $196 | |
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| Tramadol 50mg | Generic | 4 | 200mg | $62 | |
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| Tramadol extended release 100 mg | Ultram ER | 1 | 100mg | $128 | |
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| Tramadol extended release 200 mg | Ultram ER | 1 | 200 mg | $209 | |
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| Tramadol extended release 300 mg | Ultram ER | 1 | 300 mg | $290 | |
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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 August 2007, rounded to the nearest dollar. They are derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Health, a healthcare information company. Source® Pharmaceutical Audit Suite (PHAST). Wolters Kluwer Health is not involved in our analysis and recommendations.
5. Oxycodone extended release tablets in all strengths are made by many generic companies. We present the range of costs.
