Like many medical drugs in the United States, their price is significantly influenced by factors such as health insurance, government regulations, overall market forces, and geography, which can dramatically alter the street price, insurance price, and market price of a drug.
Take four drugs:
- Hydrocodone / Acetaminophen (sometimes combined in varying doses to the same medication)
- Ibuprofen (Prescription-strength versions of Advil, Motrin, etc.)
- Meloxicam (Common for arthritis sufferers because of its lengthy release cycle)
- Tramadol (At times, the second most prescribed opioid, with significant impact)
These four are the most commonly prescribed painkillers in the United States. Within opioid-specific drugs, hydrocodone (Vicodin, Norco), Oxycodone (OxyContin, Percocet), and Morphine are the most common.
- 10mg of Hydrocodone is ~$70.06 for 10 pills, or about $7.06 per pill.
- 150mg of Ibuprofen is ~$21.23 for just 1 pill
- 15mg of Meloxicam is ~$9.93 for 10 pills, or about 99 cents per pill
- 50mg of Tramadol is ~$12.10 for 20 pills, or $6.05 for 10 pills at .60 cents per pill
The dosage varies widely, as 10 mg of one drug is not equivalent to 10 mg of another. And insurance varies significantly, too. Generic hydrocone costs as much as $113.80 for 10 pills without insurance and as little as $28 with insurance. Medicare also brings to bear much of its cost pressures for drugs like Meloxicam, which is more likely to be prescribed to elderly patients with arthritis.
(Prices calculated June 2025 by checking GoodRX for generic pills and averaging the cost across the leading eight U.S. pharmacies, including Meijer, Wal-Mart, Walgreens, Costco, CVS, Target, and Rite Aid).
Among top painkillers in the US, most are not opioids
None of these four drugs contains fentanyl from their original makeup, and Ibuprofen isn’t even an opioid drug like most people associate with illegal drugs and painkiller addiction.
Fentanyl is often prescribed as a patch to ensure it releases relatively slowly and controlled, sometimes over several days. Five patches at 25 mcg (that’s micrograms) is ~$36.03, or ~$7.20 a patch. To be clear, 25 mcg is a lot of it. That amount is incredibly lethal when misused.
Healthcare professionals use Morphine Milligram Equivalents (MMEs) to compare the potency of opioids and painkillers. Comparing costs per gram or milligram or comparing one drug’s effectiveness for a high is challenging and variable. But among these drugs, fentanyl’s potency is far and away the most powerful for the least cost.
A fentanyl patch at 25 mcg is roughly the same as 60-90 mg of oral morphine per day. Hydrocodone is roughly 1 MME per mg, so 10 mg is 10 MME, and Tramadol is ~.1 to .4 MME per mg. Meaning 50 mg of Tramadol is about 5-20 MME, depending on the dosage.
Straight fentanyl is the cheapest opioid drug you can buy when you factor in the cost per milligram, its potency, and the effects it gives the user. And cost matters a lot.
Fentanyl’s potency comes laced with other illicit drugs
Drug dealers lace other illicit drugs with fentanyl to increase their effect, save money, make more money, and generally provide buyers with an addictive high.
Among all the pills tested by law enforcement agencies in the United States, fentanyl doses can range from .02 to a whopping 5.1 mg in a single pill, often laced with other drugs. These counterfeit pills can contain as much as 2x the lethal dose, and 42% of all pills tested had at least 2 mg of fentanyl (also a lethal dose).
Illicit drugs are a problem, but illicit fentanyl is up as much as 55% YOY, and is the primary driver of overdose deaths, counterfeit pills, and the increase in activity amongst drug trafficking organizations and drug dealers on our streets. It comes as a pill, nasal sprays, injections, powders, and increasingly as “pressed pills”, which makes them look more like legitimate prescription drugs.
Naturally, these illicit drugs and illicit opioids lack quality control, are highly addictive, and require an increasing amount of them to ensure users get the same effect they expect.
Substance use disorder ratchets up costs
Because drug abusers need an increasing dosage to work against the body’s natural drug tolerance, low doses become high doses, and one pill often becomes two. Withdrawal symptoms develop quickly, and the process repeats, whether it’s with morphine, heroin, cocaine, or opioids. But the drugs laced with fentanyl, at any amount, are what drives overdose deaths.
In Indiana, synthetic opioid overdose deaths killed 2,682 Hoosiers in 2022. Fentanyl was involved in 72% of the cases.
To drug cartels and drug dealers, fentanyl is to pills what starch and trans fats are to junk food manufacturers: a fast, easy way to make an already hyper-palatable or potent substance cheaper, more addictive, more “filling”, and more profitable. We see the result on our neighborhoods in The Addict’s Wake, where law enforcement, EMS, fire and rescue, court systems, school teachers, churches, and businesses feel the impact every day. It’s the teenager who is asked by a friend to try something new, the uninsured farmer who hurt his back, the mother who is dealing with pain after a complicated pregnancy, and scores of people seeking pain treatment.
The stereotype is that methamphetamine (meth) is the most common drug of choice in rural areas, but the cost and market forces say otherwise. A gram of methamphetamine is about $10. An “8-ball” might sell for $40-$60, or as low as $5 a hit. But with fentanyl, which is far easier to conceal, the total cost can be as low as $1-$3 per pill. And the reach of fentanyl, as we see in The Addict’s Wake, has consumed nearly every far-reaching corner of this country.
You can schedule a screening, use The Addict’s Wake in your classroom, request a presentation, or as part of law enforcement training.
Watch The Addict’s Wake on PBSMore FAQs about illicit fentanyl and opioid overdose
Fentanyl is typically sold by weight, so it’s most often in grams or milligrams, and the dosage and variations are incredibly vast. In most communities, a lethal or near-lethal dose of fentanyl (almost always combined with some other illegal drugs), is about $1-$3 per pill.
The U.S. government classified fentanyl as a Schedule II controlled substance, and states add their own classifications to that, too. Charges are often decided based on the quantity, the intent (for use or sale), your prior record, and the expected resulting harm. Fines and jail are the most common charges, with ranges that can extend to the entire forfeiture of assets and 10 years to life in prison.
High-purity cocaine, heroin, and LSD are the most common high-cost drugs. There are some designer or research drugs that, due to supply and demand, can cost more. These drugs can cost as much as hundreds of dollars per dose and vary wildly across geography, mostly on supply and demand.
No, it is not. Not anywhere.
