Opiates vs. Opioids: What's the Difference?

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August 12, 2022

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The terms opioids and opiates are often used interchangeably, but technically, they are not the same.

Opiates are drugs naturally derived from the poppy plant. Opioids are synthetic drugs that act like opiates, but chemists have adjusted them to make them stronger or more potent.

Both opioids and opiates are narcotics.[1] They both cause sedation and sleepiness. These days, the most accepted term to describe both opioids and opiates is opioids because most available opioid products are synthetic.

Don't let the terminology confuse you. Know that both opiates and opioids are dangerous. If you're misusing them, treatment can help. 

What Is an Opiate?

An opiate is any product produced directly from the Poppy plant, or “non-synthetic”. Don’t be fooled into thinking that just because opiates are “natural” or non-synthetic that this means they are “safer” than synthetic opioids. For example, heroin is a natural opiate, however it is one of the most potent and dangerous opioid-like drugs available.

These are a few common opiates: 

Codeine 

Codeine is a prescription painkiller that's often combined with other medications.[2] Some codeine products contain ingredients that block a hacking cough, and others are mixed with acetaminophen or aspirin to ease pain.

Misusing codeine products can be particularly dangerous, as codeine is often combined with acetaminophen and/or cough suppressants that can themselves be toxic when ingested in high doses.

Heroin

Heroin is an illegal drug often sold as a powder. Some dealers sell a sticky version known as "black tar heroin." Almost any heroin you buy from a dealer can be contaminated with something else, such as baby powder or laxative.[3]

Heroin is highly addictive, and people who use it often use bigger and bigger doses to get the high they crave. In time, they can take so much that they overwhelm the central nervous system and overdose. 

Morphine

Morphine is a prescription painkiller often used to treat severe acute pain or sometimes more chronic cancer related pain. 

Opium

Opium can be sold as a liquid, solid, or powder.[4] Pure opium can be tweaked and adjusted to make other drugs, including heroin.

But this pure drug can also be smoked or injected. It's just as powerful and addictive as other opiates, including heroin. 

What Is an Opioid?

Pharmaceutical companies have created more than 500 different types of opioids which are synthetic versions of opiates.[1]

These are a few of the common types you've likely heard about:

Fentanyl

This synthetic opioid is up to 100 times stronger than morphine and is responsible for thousands of overdose deaths each year.[5] Fentanyl is easy to produce, and dealers often swap out harder-to-make drugs (like heroin) for fentanyl. An unsuspecting buyer could take a regular-sized dose of what they believe is heroin and turns out to be fentanyl. This is one of the common causes of opioid overdoses these days as Fentanyl has risen in prevalence in recent years. 

Hydrocodone

Vicodin, Lortab, and Lorcet-HD all contain the generic drug hydrocodone. Like other opioid drugs, this medication can help to address pain. But it can also cause feelings of reward and euphoria. These pills are medically indicated for acute pain but are often misused in order to get high as well. They can be taken orally, crushed, snorted or injected. 

Hydromorphone

Hydromorphone is another pill and/or IV opioid medication used for acute pain. These pills or injections are usually given for acute pain but can also be diverted, taken orally, snorted or injected. 

Meperidine 

Demerol is the brand name for meperidine, and it's used to treat significant pain. Doctors typically deliver this drug via an IV in the hospital for severe pain.  This opioid is also considered highly addictive and can easily cause overdose when misused. 

Methadone 

People with long-lasting addictions to opiates and opioids often struggle with severe cravings, making them less successful in treatment. While methadone is technically an opioid, it is most commonly used these days as a treatment for opioid use disorder, for patients who receive it on a daily basis at a low dose at their methadone clinic to help relieve symptoms of withdrawal from or cravings for other more potent opioids. 

Oxycodone

OxyContin, Xtampza, and Oxaydo are a few brand-name medications containing oxycodone. This medication relieves moderate-to-severe pain, and it's often associated with opioid use disorders and misuse. Like other opioid pills, oxycodone pills can be crushed, snorted or injected. 

Oxymorphone

Opana is a brand-name drug that contains oxymorphone. This medication is sold in pill form, and it's designed to relieve moderate-to-severe pain. As an opioid, oxymorphone can deliver euphoria, and some people misuse the drug similar to other opioid pills. 

Why Are Opiates & Opioids Misused?

More than 564,000 people died from opioid and opiate overdoses between 1999 and 2020.[6] Many of these people overdosed because they misused their drugs.

Opiates and opioids attach to receptors in your brain and trigger the release of feel-good chemicals. While you're under the influence, you feel relaxed, happy, and content and otherwise euphoric.

As misuse continues, the brain modulates responses. Your doses don't trigger the same swell of good feelings, and you often must take larger doses to get the same euphoric high.

In time, the body becomes tolerant of the drug so that you feel bad or sick when you are not taking it. Most people who misuse opioids are not even trying to get “high”, but instead just using so that they can avoid unpleasant withdrawal symptoms and just feel “normal”. This is called “physical dependence”. 

What Can You Do If you are concerned about your opioid use?

First line treatment for opioid use disorder includes both medication assisted therapy (MAT) and behavioral therapy.

Three types of medications are the most common and efficacious medications for OUD:  

Opioid Agonists (Methadone)

Methadone is a full opioid agonist, and is used to help curb people’s cravings for more potent opioids. For this reason, it is one of the first line treatments for opioid use disorder. Methadone has a very long half life so it stays in the body for two to three days, helping prevent cravings and withdrawal symptoms. While it is a highly effective treatment for OUD, unfortunately it is only dispensed at Methadone clinics in the US at this time, meaning patients must be connected to a methadone clinic and arrive on a daily basis to receive their medication. 

Partial Opioid Agonists (Suboxone)

Suboxone is a partial opioid agonist. Partial opioid agonists only partially stimulate opioid receptors. They are safer to use with minimal risk of misuse. Because buprenorphine (Suboxone) is a partial opioid, it reduces opioid cravings and withdrawal, but it does not result in the euphoric symptoms that people experience with full opioids and it is very unlikely to cause overdose as compared to full opioids. As a result, it is very good at helping people avoid misuse of more potent full opioids. 

Opioid Antagonists (Naltrexone)

Opioid antagonists occupy opioid receptors in the brain and prevent drug binding and euphoria.  Naltrexone is the most common and well-known opioid antagonist used to treat opioid use disorder. Naltrexone binds to opioid receptors more strongly than opioid agonists, preventing patients from overdosing. While this medication does prevent overdose, it does not turn on opioid receptors and prevent cravings or withdrawal symptoms from opioids in the same way that Methadone and Suboxone do. Thus, while it is a good option for some patients, it is the least efficacious and least commonly prescribed treatment option for OUD. 

Take the Next Step

Fortunately, with modern advancements in treatments, in particular Medication for Addiction Treatment (MAT), opioid use disorder is very treatable.

To learn more about Bicycle Health's telemedicine addiction treatment and our success rates and safety compared to other common treatment options, call us at (844) 943-2514 or schedule an appointment here.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Opiates or Opioids: What's the Difference? Oregon Alcohol and Drug Policy Commission. https://www.oregon.gov/adpc/pages/opiate-opioid.aspx. Accessed June 2022.
  2. Codeine Information. U.S. Food and Drug Administration. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/codeine-information. January 2018. Accessed June 2022.
  3. Heroin DrugFacts. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugfacts/heroin. June 2021. Accessed June 2022.
  4. Opium Drug Fact Sheet. Department of Justice. https://www.dea.gov/sites/default/files/2020-06/Opium-2020.pdf. April 2020. Accessed June 2022.
  5. Fentanyl. United States Drug Enforcement Administration. https://www.dea.gov/factsheets/fentanyl. Accessed June 2022. 
  6. Opioid Data Analysis and Resources. Centers for Disease Control and Prevention. https://www.cdc.gov/opioids/data/analysis-resources.html. June 2022. Accessed June 2022.

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