Navigating Pain Management: What Is Replacing Opana?

October 8, 2025 •

3 min read

In July 2017, following an FDA request, the manufacturer of Opana ER voluntarily removed the brand-name drug from the market due to risks associated with its abuse. For patients wondering what is replacing Opana, the answer involves a range of other opioids, non-opioid medications, and alternative therapies.

Quick Summary

After the brand name Opana ER was removed from the market, patients and clinicians have turned to various alternatives for managing severe pain, including generic oxymorphone, other opioids like hydromorphone and tapentadol, and non-opioid treatments.

Key Points

Opana ER Discontinuation: The FDA requested the removal of brand-name Opana ER in 2017 due to risks from abuse, specifically a shift to injection use linked to disease outbreaks.
Generic Still Available: While the brand name is gone, generic immediate-release and extended-release oxymorphone are still available for prescription.
Primary Opioid Replacements: Common opioid alternatives include hydromorphone, tapentadol, morphine, and oxycodone, each with a distinct clinical profile.
Buprenorphine as a Safer Option: Buprenorphine, a partial opioid agonist, is an alternative with a lower abuse potential and a ceiling effect on respiratory depression.
Non-Opioid Alternatives: Effective pain management often involves non-opioid medications like NSAIDs, antidepressants (for nerve pain), and anticonvulsants.
Multimodal Approach: Current guidelines recommend a comprehensive strategy that includes non-drug therapies like physical therapy, mind-body practices, and interventional procedures alongside medication.
Individualized Treatment: The best replacement for Opana depends on the patient's specific type of pain, medical history, and response to different treatments.

The End of an Era: Why Was Opana ER Discontinued?

Opana ER, extended-release oxymorphone, was a potent opioid for moderate-to-severe chronic pain. Although a reformulated version was introduced to deter abuse, post-marketing data showed an increase in injection abuse, leading to outbreaks of HIV and hepatitis C. Based on this, the FDA requested its removal in 2017. While brand-name Opana ER is no longer available, generic oxymorphone in both immediate and extended-release forms is still on the market.

Opioid Alternatives to Opana

Several other long-acting opioids are used as alternatives for patients who previously took Opana ER. The selection depends on individual patient needs and medical factors.

Direct Replacements and Similar Opioids

Generic Oxymorphone ER: Generic extended-release oxymorphone is a direct replacement, but may lack abuse-deterrent features of the former brand-name product.
Hydromorphone (Dilaudid, Exalgo): Chemically similar to oxymorphone, hydromorphone is a common alternative. While less potent than oxymorphone, it undergoes a similar metabolic process.
Tapentadol (Nucynta ER): This opioid has a dual action as a mu-opioid receptor agonist and a norepinephrine reuptake inhibitor, potentially beneficial for certain pain types. It may cause fewer gastrointestinal side effects than oxycodone.
Other Strong Opioids: Morphine, oxycodone (OxyContin), and fentanyl are also options for severe pain management, each with varying effects and potencies.

Comparison of Common Opioid Alternatives


Medication	Brand Name(s)	Mechanism of Action	Key Considerations
Oxymorphone	Generic Available	Mu-opioid agonist	Potent opioid; brand version (Opana ER) discontinued. Take on an empty stomach.
Hydromorphone	Dilaudid, Exalgo	Mu-opioid agonist	Chemically similar to oxymorphone but may be more sedating. Can be taken with or without food.
Tapentadol	Nucynta ER	Mu-opioid agonist, norepinephrine reuptake inhibitor	Dual mechanism may be beneficial. Often has fewer GI side effects than oxycodone.
Buprenorphine	Butrans, Belbuca	Partial mu-opioid agonist, kappa-opioid antagonist	Lower abuse potential and ceiling effect on respiratory depression. Available as a patch or film.
Morphine	MS Contin, Kadian	Mu-opioid agonist	A standard for opioid comparison. Available in various formulations.
Oxycodone	OxyContin, Roxicodone	Mu- and kappa-opioid agonist	Widely prescribed potent opioid. Often compared to tapentadol for efficacy.

Broadening the Scope: Non-Opioid and Alternative Therapies

Following CDC guidelines, non-opioid therapies are often preferred for chronic pain and can be used alone or with opioids.

Non-Opioid Pharmacological Options

NSAIDs: Medications such as ibuprofen and naproxen reduce inflammation and are useful for conditions like arthritis.
Acetaminophen: Used for mild-to-moderate non-inflammatory pain.
Antidepressants: Certain types, including TCAs and SNRIs (like duloxetine), can help with neuropathic pain.
Anticonvulsants: Gabapentin and pregabalin are prescribed for nerve pain.
Topical Agents: Lidocaine and capsaicin patches offer localized pain relief with reduced systemic effects.

Non-Pharmacological and Interventional Approaches

Comprehensive pain management often includes therapies without medication.

Physical and Occupational Therapy: Helps improve function and reduce pain through exercise and training.
Mind-Body Practices: Techniques like yoga and mindfulness can assist in managing chronic pain.
Interventional Procedures: Options for persistent pain may include nerve blocks or spinal cord stimulation.
Acupuncture: This traditional therapy can be effective for some patients by targeting pain signals.

Conclusion

The discontinuation of brand-name Opana ER highlighted the complexities of managing pain and the ongoing opioid crisis. What replaces Opana depends on the individual, emphasizing a multimodal approach. While potent opioid alternatives remain important for severe pain, there is a focus on incorporating safer non-opioid medications and non-pharmacological therapies to improve patient outcomes and minimize risks.

For more information on non-opioid pain therapies, you can visit the CDC's resource page.

Frequently Asked Questions

The FDA requested the manufacturer remove Opana ER from the market in 2017. This was due to post-marketing data showing that its abuse-deterrent reformulation led to a significant increase in abuse via injection, which was associated with outbreaks of HIV and hepatitis C.

Yes, while the brand-name Opana ER was discontinued, generic versions of both extended-release (ER) and immediate-release (IR) oxymorphone are still manufactured and available with a prescription.

There is no single 'most common' alternative, but hydromorphone (Dilaudid, Exalgo) is a frequent choice due to its chemical similarity to oxymorphone. Other strong opioids like tapentadol, morphine, and oxycodone are also used.

No, studies suggest that oxymorphone is more potent than hydromorphone. One clinical study found oxymorphone to be approximately 2.3 to 2.8 times more potent than hydromorphone on several subjective measures related to abuse potential.

Yes, there are several non-opioid pharmacological options. For neuropathic (nerve) pain, anticonvulsants like gabapentin and antidepressants like duloxetine are used. For inflammatory pain, NSAIDs can be effective. These are used as part of a broader pain management strategy.

Buprenorphine is a partial mu-opioid agonist used for both chronic pain and opioid use disorder. It provides analgesia with a lower risk of respiratory depression and abuse compared to full agonists like oxymorphone. For pain, it is typically prescribed as a transdermal patch (Butrans) or a buccal film (Belbuca).

A comprehensive pain plan may include non-drug treatments such as physical therapy, acupuncture, massage, mind-body practices like yoga, and interventional procedures like nerve blocks or spinal cord stimulation.