The terms “opiate” and “opioid” are frequently used interchangeably, however, there are differences between the two. The term opiate is used to classify substances that are naturally derived from the opium poppy plant.
The term opioid, on the other hand, is used to classify any substances that interact with opioid receptors in the brain. These substances include both opiates and the synthetic substances derived from them.
Put another way, all opiates are opioids, but not all opioids are opiates.
Opioids: A General Term For The Whole Opioid Family
At one point, the term opioid was used only to talk about the synthetic (man-made) medications made from opiates, however, its definition has been broadened to include the entire family of opioids, including natural, synthetic, and semi-synthetic opioid types.
Healthcare professionals use the word opioid to refer to most opioids and the term opiate for specific non-synthetic opioids. An opioid is any agent that binds to opioid receptors in the central nervous system and gastrointestinal tract, and interacts to produce a pain relief response.
The four broad classes of opioids include:
- endogenous opioids, naturally produced in the body, such as endorphins
- opium alkaloids (opiates), a substance derived from the opium poppy plant, including morphine and codeine
- semi-synthetic opioids, synthetically-modified opiates, including heroin, oxycodone, and buprenorphine
- fully synthetic opioids, entirely human-made substances, such as methadone
How Opiates And Opioids Work
All opioids are chemically related in some way, and interact with the same receptors (proteins in nerve cells) in the central nervous system (CNS) to change the way the brain perceives pain. At low to moderate doses, individuals typically do not feel “high,” instead they feel a mild sense of pleasure that feels more akin to a natural endorphin rush.
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It is relatively easy to develop a tolerance to the effects of opioid medications. Individuals using opioids for chronic pain relief will likely have to increase their dose at some point, to continue to feel the effects of the medication. Increasing the amount of opioid medication someone takes can be risky, though, as it can potentially lead to abuse and subsequent addiction.
Effects Of Opiates And Opioids
Although opiates and opioids have similar mechanisms of action, they may vary in potency. In order to reduce varying degrees of pain, these medications are available in varying degrees of strength. For example, the opiate morphine is three times stronger than the opiate codeine. However, the semi-synthetic opioid oxycodone is about 50 percent stronger than morphine, and the synthetic opioid methadone is three times stronger than morphine.
It can be a dangerous situation when someone who is abusing these types of medications does not realize that different opioid types may vary in strength. The introduction of fentanyl and carfentanil is a new development in the national opioid epidemic in the last decade that has taken many lives. Fentanyl is a synthetic opioid with a potency 50 to 100 times greater than morphine, and is considered lethal at the 2mg dose-range.
Carfentanil is a painkiller used for large mammals such as elephants and is not intended for human use, and is considered to be 10,000 times stronger than morphine. Similarly to fentanyl it is being mixed into heroin, to create an extremely lethal street drug.
These drugs were never intended to be used outside of a hospital setting but they have found their way from China to many different states in the U.S. Law enforcement officers have been warned that even touching a small amount of carfentanil powder with their bare skin can cause severe effects.
Opiate And Opioid Abuse And Addiction
At extremely high doses, opioids can make it very difficult to breathe, and sometimes stop breathing altogether. Difficulty breathing, or respiratory depression, is the most common cause of fatal opioid overdoses.
The risk of severe respiratory depression increases when someone takes other CNS depressants, such as alcohol or benzodiazepines, in addition to an opioid medication. A non-lethal dose of both substances, taken together can be fatal. With opioids, there is a tiny window between euphoria and death, and individuals who struggle with addiction usually like to push that window.
How Prescription Opioids Lead To Abuse And Addiction
Opioid addiction has become a significant epidemic across America. Many individuals in various states start out taking opioids for a legitimate medical purpose and end up abusing the medication until finally becoming addicted to it. Some people believe that this is may be due to the different expectations of doctors and their patients.
When doctors prescribe opioid medications, usually the goal is to help an individual manage their pain, not remove it entirely. While individuals may be thinking that opioids are a type of “painkiller” that will eliminate, not just reduce the amount of pain they are feeling. When these expectations are different, patients may take increasingly larger doses to get a higher level of pain relief and end up abusing or addicted to the medication instead.
From Prescription Opioids To Street Opioids
Once the prescription for opioid medications run out, it can be difficult to get another, which may be why so many people to turn to heroin as a substitute. Heroin is a derivative of morphine, and relieves pain the same way prescription opioids do, which makes it the drug of choice for people looking for an inexpensive and more obtainable opioid substitute.
However, heroin is produced illegally, making it impossible to know what it is made of or how pure it is. But people who are trying to avoid opioid withdrawal may be willing to take their chances on heroin.
Fentanyl is another potent opioid has recently increased in availability throughout the U.S. This illicit drug can be 50 to 80 percent more potent than morphine, which significantly increases the risk of fatal overdose.
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Over time, chronic abuse of opioids can alter the physical structure and chemical makeup of the brain. These changes to the brain may cause individuals to experience severely uncomfortable withdrawal symptoms from the lack of opioids in their system. More research is needed to fully understand all the effects of prolonged opioid exposure has on the human body.
Addiction Treatment For Opiates And Opioids
Addiction is a chronic brain disease. Once someone becomes addicted to opioids, it can be challenging to stop using opioids. Often, individuals who have struggled with opioid abuse and addiction will need to go through detoxification, a process of removing the drug from their body.
Once detox is complete, further addiction treatment is recommended to ensure that all aspects of the addiction were thoroughly addressed and that the individual can maintain an opioid-free life. Inpatient addiction treatment is usually best for individuals who have abused opioids for an extensive amount of time, abused more than one type of drug at once, who have an underlying mental health disorder, or who have relapsed before.
Any of these circumstances can make it more difficult to stop using opioids, and inpatient programs provide a new, well-structured environment for people to start to address these issues.