Opiate vs opioid – opioid vs opiate: Are there really any differences? As it turns out, there are a few important distinctions between the two terms. And in today’s environment, with the continuing opioid epidemic, it behooves all of us to learn all we can about everything involved in what some are calling the greatest public health emergency in American history.
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First Things First – What Is the Definition of an Opiate?
An opiate is a drug that has been refined or extracted from natural plant matter – the fibers or sap of the opium poppy (Papaver somniferum). Most opiates are used to treat pain. One important characteristic of opiates that distinguishes them from other alkaloids derived from the poppy is the effect that they have on the central nervous system. They also affect the brain, altering mood, consciousness, perception, and behavior. For example, the cough medication noscapine, the anti-spasmodic papaverine, and approximately two dozen other alkaloids are found in the opium poppy, but because they do not affect the CNS, they are not considered opiates. The psychoactive opiates are:
- Opium – The oldest opiate, opium has been cultivated since 3400 BCE. The ancient Sumerians called it the “joy plant”. From the 16th century through the mid-1900s, laudanum, a 10% tincture of opium was used as a painkiller and cough suppressant. Today, it is still used to treat severe diarrhea.
- Morphine –Morphine was first isolated in Germany in 1804 —the first-ever isolation of an active ingredient from a plant. Although it is still used to treat acute and chronic pain, 70% of the world’s morphine supply is used to make other painkillers.
- Codeine – Codeine was first isolated in 1832 in France. Today, it is the most widely-used opiate in the world.
- Heroin – Originally known as diamorphine, heroin was first discovered in 1874 in London. Interestingly, this heroin went largely unnoticed, until it was independently re-discovered in Germany by the Bayer company in 1895. While today heroin is one of the most-addictive illicit drugs, it was originally advertised medicinally, as a “non-addictive morphine substitute”.
- Thebaine – Surprisingly, this opiate acts as a stimulant, rather than a depressant. Although thebaine has no therapeutic uses of its own, it is essential in the synthesis of many synthetic painkillers.
First things First #2 – What Is the Definition of an Opioid?
The term “opioid”, on the other hand, originally referred to opiate-like drugs that are not directly derived from natural plant matter. Instead, opioids are synthesized in a laboratory. For this reason, the term “synthetic opioid” is technically a misnomer, since ALL true opioids are at least partially synthetic. For classification purposes, however, a “semi-synthetic” opioid is one that has been synthesized from an opiate, while a “synthetic” opioid is completely laboratory-produced. Like opiates, most opioids are prescribed for pain management. Also like opiates, opioid drugs directly impact receptors within the brain, and thus affect the central nervous system. This means that they also have a psychoactive effect on the user’s mood, behavior, perception, and consciousness. Due to advances in chemical science, over 500 different opioids have been identified. Some of the most well-known include:
- Oxycodone (OxyContin) – First synthesized from thebaine in Germany in 1916, oxycodone is a semi-synthetic opioid given for moderate-to-severe pain. It is approximately 1.5 times as potent as morphine.
- Hydrocodone (Lorcet, Lortab, Vicodin, Zohydro) – First synthesized from codeine in Germany in 1920, hydrocodone is a semi-synthetic opioid given for severe pain or as a cough remedy. The United States uses 99% of the world’s hydrocodone supply.
- Hydromorphone (Dilaudid) – First synthesized from morphine in Germany in 1922, hydromorphone is a semi-synthetic opioid is given and as an analgesic and an anesthetic adjunct, to reduce side effects. Interestingly, hydromorphone is also used in a formulation intended as a backup execution method.
- Fentanyl – First synthesized in Belgium in 1960, fentanyl is an extremely-powerful, completely synthetic opioid that is approximately 75 times stronger than morphine, and some of its analogues are 10,000 times more potent. Typically given for severe, end-of-life cancer pain, fentanyl is the world’s most-widely used synthetic opioid.
Overdose deaths from illicit/counterfeit fentanyl have spiked sharply in recent years.
Opioid Vs Opiate – Blurring the Lines
In more modern usage, the term “opioid” has come to mean ANY drug that acts on the body’s opioid receptors to mimic the effects of morphine. Consequently, ALL opiates can now also be correctly referred to as opioids, with the earlier term used to distinguish their derivation from the opium plant. In other words, while all opiates are opioids, not all opioids are opiates. This is why the current drug crisis, which is largely being driven by the increase in overdose deaths caused by “natural” heroin, “semi-synthetic” prescription painkillers and “synthetic” fentanyl, can properly be called an opioid epidemic. The effects common to virtually all opioid-class drugs are:
- Pain relief – Currently, the “weakest” painkiller available in the US is the opiate codeine (1/10th the strength of morphine), while the most potent Schedule II drug in use is Sufenatil (500 times more potent than morphine)
- Respiratory depression – at higher doses, or when combined with other CNS depressants such as alcohol, benzodiazepines, or other opioids, this can be fatal
- Constipation – affecting up to 95% of users
- Hyperalgesia – This is a paradoxical reaction where opioids cause an increased sensitivity to pain, rather than providing relief. Hyperalgesia is typically seen when dosages are increased rapidly, rather than gradually.
- Hormone imbalance – The severity of this condition is dose-dependent, although up to 90% of long-term opioid users suffer hormonal imbalances. Specifically, opioids can interfere with the body’s sex hormones.
- Tolerance – reduced drug affects, creating a need for ever-increasing dosages
- Physical dependence
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Opiate Vs Opioid – Legal Classifications
Opiates and opioids – natural, semi-synthetic, and synthetic – are considered narcotics. While the term originally referred to any drug that could induce sleep, it now refers to substances or illicit use that violate the US drug control laws. With the exception of heroin, most opioids are Schedule II controlled substances, because they:
- Have a high potential for abuse.
- Have a legitimate medical use.
- Lead to severe physical or psychological dependence when abused.
Heroin, on the other hand, is a Schedule I controlled substance, meaning it is illegal to possess without a special license from the Drug Enforcement Administration. Substances in this class:
- Have a high potential for abuse.
- Have no currently-accepted therapeutic use in the United States.
- Lack established safety guidelines for use, even under medical supervision.
Etorphine, a semi-synthetic veterinary opioid that is up to 3000 times more potent than morphine, is also a Schedule I drug.
Opioids Vs Opiates – Abuse Potential
The misuse of prescription opioid painkillers and the abuse of illicit heroin and fentanyl analogues is widespread in the United States. According to a 2016 report released by the American Society of Addiction Medicine:
- 2 million people in America have a Substance Use Disorder (SUD) involving prescription opioid painkillers.
- Another 591,000 have an SUD involving illicit heroin.
- Roughly 1 out of every 4 people who use heroin eventually develop an addiction.
- Approximately 63% of US overdose deaths involve opioids. In 2017, that would account for an estimated 45,000+ opioid-related poisonings.
- 80% of heroin addicts started out by misusing prescription opioids.
Opioid-class drugs are so addicting because they profoundly affect the areas of the brain associated with pleasure, reward, learning, memory, and motivation. Because opioids, like other drugs of abuse, create a euphoric sense of well-being, the user’s brain quickly learns to associate the action of taking an opioid with a pleasurable reward. With long-term or heavy opioid use, however, two things happen that can lead to the development of a full-blown addiction. FIRST, a chronic opioid user develops a tolerance. This is when their body become so accustomed to the drug that they begin to experience diminishing returns. They begin to require more and more of the drug in order to realize the same effects. SECOND, the constant artificial over-stimulation of the brain’s reward pathways causes the natural production of feel-good neurotransmitters to shut down. The person then loses the ability to experience joy or pleasure – or even the capacity to feel “normal” – unless an opioid has been consumed. The person is now opioid-dependent.
What You Need to Know about Withdrawal
If the opioid drug is not available, the person rapidly begins to suffer severely-unpleasant symptoms of opioid withdrawal. Basically, their body is in shock because the accustomed-to drug is no longer there:
- Acute anxiety
- Extreme depression
- Inability to focus
- Mood swings
- Irresistible drug cravings.
- Sensitivity to pain
- Muscle cramps and spasms
- Joint pain
- Goose pimples
- A “skin-crawling” sensation
- Intolerance to heat
- Profuse sweating
- Runny nose
- Uncontrollable yawning
- Severe insomnia
- Flu-like symptoms
- Abdominal pain/cramps
Unlike abrupt withdrawal from alcohol or benzodiazepine tranquilizers – which can be fatal – opioid/opiate withdrawal is not especially dangerous. However, that does not mean that it is not a serious condition. On the contrary, quitting opioid-class substances can be so harshly painful that the person is compelled to seek drugs and resume use to escape the physical and mental distress.
What Does an Opioid or Opiate Withdrawal Timeline Look Like?
Withdrawal symptoms begin relatively quickly, following the last dose taken.
- People dependent on immediate-release opioids such as Vicodin, Percocet, or Dilaudid will begin experiencing symptoms within 6-12 hours.
- With long-acting or extended-release opioids such as OxyContin or methadone, withdrawal symptoms will begin at approximately 30 hours.
- Physical symptoms will gradually worsen, peaking at about 72 hours.
- At one week, physical symptoms will begin to lessen.
- The second week of opioid withdrawal is largely characterized by emotional and psychological symptoms.
- Depression and drug cravings can linger for a month or longer.
Opiates/Opioids and Post-Acute Withdrawal Syndrome (PAWS)
In some cases, particularly when the opioid abuse has been heavy and/or long-term, impairments may persist far beyond the withdrawal phase. These impairments may flare up occasionally for several months or even years, especially when triggered by stress. It is important to recognize and respond appropriately to symptoms of PAWS, because without appropriate coping skills, a recovering opioid abuser may be at risk of relapse.
- Severe generalized anxiety
- Profound depression
- Interpersonal dysfunction
- An inability to experience pleasure
- Cognitive impairment – confusion, inability to focus, memory problems
- Obsessive or compulsive behavior
- Emotional numbness; alternately, constant overreaction
- Loss of motivation or initiative
- Lingering drug cravings
- Clumsiness; poor physical coordination
- Sleep disturbances – insomnia, lack of restful sleep, wakefulness, dreams of resumed drug use
- Overwhelming feelings of guilt or shame
What Are Some Proven Opioid or Opiate Withdrawal Remedies?
The care for withdrawal from opioids or opiates typically takes two forms – supportive care and comfort and medication assistance. Supportive care during opioid detox and/or withdrawal is just that. In an accredited opioid detox program, clients are made as physically comfortable as possible during the withdrawal process. The biggest goal of supportive care is to ensure that the person is safely taken care of in a welcoming therapeutic environment free from outside stresses and temptations. Medication assistance, on the other hand, is the use of FDA-approved prescription medications and over-the-counter remedies to reduce cravings and ease other withdrawal symptoms.
- Acetaminophen/Tylenol for headaches
- Ibuprofen for muscle and joint pain
- Loperamide/Imodium for diarrhea
- Hydroxyzine/Vistaril for nausea
- Clonidine for anxiety, restlessness and muscle cramps. Clonidine can lessen the severity of withdrawal symptoms by up to 75%.
Cravings are usually helped by Opioid Replacement Therapy, or ORT. This is when the strong opioid of abuse is replaced with another weaker, less-euphoric, and less-dangerous medication. Eventually, the ORT medication dosage can be gradually tapered until the patient can resist cravings on their own.
- Methadone – A long-lasting opioid that is a good option for high-dose opioid addicts
- Buprenorphine – A long-lasting opioid with a “ceiling” of effects that limits its abuse potential
- Naloxone – A deterrent medication that triggers instant withdrawal with any opioid use; available in a once-a-month shot
The main purpose of ORT is harm reduction, because it lessens many of the collateral risks associated with opioid abuse:
One of the biggest benefits of ORT is it allows the patient in recovery to achieve a large degree of stability and productivity. Because they are no longer actively drug-seeking, they can live at home, hold down a job, interact with their families, and participate in a structured opioid rehab program.
“We accept many health insurance plans. Get your life back in order, take a look at our residential program.”
How Is Opioid/Opiate Addiction Treated?
Effectively treating an Opioid Use Disorder requires a cooperative effort between the patient and their necessary service providers. These are some of the qualities shared by the top drug rehab programs:
- In-depth initial assessment, conducted by a medical doctor, a mental health professional, or an addiction specialist.
- Collaborative treatment strategy, as agreed to by every member of the treatment team.
- A comprehensive approach that addresses the disease of opioid addiction on multiple levels – physical, mental, emotional, spiritual, medical, pharmaceutical, social, and nutritional.
- Evidence-based treatment protocols in compliance with the latest scientific data and research.
- A comprehensive program that offers all of the services that might be needed.
- An integrative approach where all service providers work cooperatively under the mantle of a shared mission statement and philosophy.
- The ability to treat both the addiction and any co-occurring mental/behavioral disorders – anxiety, depression, PTSD, etc.
- Full accreditation and staff licensing, in accordance with applicable state laws.
What Is the Bottom Line about Opioid-Class Drugs?
In the end, what you call the drug – opiate or opioid – is of less importance than what you do when you or someone you care about is struggling with drug dependence or addiction. With this class of drugs, the risk of diversion, misuse, tolerance, abuse, overdose, and death is so high that time is absolutely of the essence. A delay in seeking opioid misuse treatment can literally be the difference between life and death.