Table 2: Recommended opioid agonist drugs
Drug	Route	Equivalent dose; mg	Duration; h	Comments
Morphine	Subcutaneous Oral	10 30	3-4 3-4	Standard for comparison
Codeine	Oral	200	2-4	Usually combined with a nonopioid
Oxycodone	Oral	20	2-4	Used for step 2* with a nonopioid. Used for step 3 as a single agent
Hydromorphone	Subcutaneous Oral	2 6	2-4 2-4
Diamorphine	Subcutaneous	5	3-4	Reserved for patients with local reaction to other opioids
Fentanyl transdermal	Approximately 100 to 200 times the potency of morphine in an acute pain context. Equivalence in chronic pain is not well established. Patches deliver 25, 50, 75 and 100 µg/h. Morphine subcutaneously every 4 h is approximately equivalent to a 25 to 50 µg/h patch.
Slow-release preparations of morphine, codeine, oxycodone and hydromorphine with a duration of action of approximately 12 h are available in Canada. *World Health Organization 3-step approach to the use of analgesics Return to Guideline 10