One example of an opioid that is stronger than fentanyl is carfentanil. Carfentanil is a synthetic opioid that is used primarily as a sedative for large animals such as elephants and bears. It is estimated to be 10,000 times stronger than morphine and 100 times stronger than fentanyl. Carfentanil is not approved for use in humans, but it has been found in the illicit drug supply and has been linked to a number of overdose deaths.

Another opioid that is stronger than fentanyl is sufentanil. Sufentanil is a synthetic opioid that is used primarily in anesthesia and pain management for surgery. It is estimated to be 5-10 times stronger than fentanyl and is considered one of the most potent opioids available for clinical use.

Remifentanil is another synthetic opioid that is used in anesthesia and pain management. It is estimated to be 3-4 times stronger than fentanyl and is known for its rapid onset and short duration of action.

Oliceridine is a newer synthetic opioid that was approved by the FDA in 2020 for the management of acute pain. It is estimated to be 1.5 times stronger than morphine and is considered to have a lower risk of respiratory depression compared to other opioids.

While these opioids are all stronger than fentanyl in terms of their potency, it is important to note that potency is not the only factor that determines the clinical usefulness of an opioid. Other factors such as the drug’s duration of action, side effect profile, and potential for abuse and addiction also need to be considered when choosing an opioid for pain management or other medical uses.

It is also worth noting that stronger opioids are not necessarily better at relieving pain. In fact, in some cases, using opioids that are too strong can actually increase the risk of adverse effects such as respiratory depression, sedation, and confusion. This is why doctors and other healthcare professionals typically start with lower doses of opioids and titrate the dose based on the patient’s response and side effects.

In addition to the opioids mentioned above, there are also a number of synthetic opioids that have been developed and are used primarily on the black market. These opioids are often even stronger than carfentanil and are used to produce highly potent and dangerous drugs such as “gray death,” which is a combination of heroin, fentanyl, and other synthetic opioids.

One example of a black market opioid that is stronger than fentanyl is W-18. W-18 is a synthetic opioid that was developed in the 1980s but has never been approved for use in humans. It is estimated to be 100 times stronger than fentanyl and is considered one of the most potent opioids ever synthesized. W-18 has been found in the illicit drug supply, and its use has been linked to a number of overdose deaths.

In conclusion, there are several opioids that are stronger than fentanyl, including carfentanil, sufentanil, remifentanil, and oliceridine. While these opioids are more potent than fentanyl, their clinical usefulness depends on a variety of factors, including their duration of action, side effect profile, and potential for abuse and addiction. In addition, it is worth noting that the use of highly potent opioids, whether in clinical or illicit settings, can increase the risk of adverse effects and overdose, and caution should always be exercised when using these drugs.