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Opiates vs. Opioids: What's the Difference?

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By Elena Hill, MD, MPH
Aug 12, 2021

The terms “opioids” and “opiates” are often used interchangeably, but technically they are not the same. An “opioid” is a broad term that refers to any substance that acts on opioid receptors in the body. These may be natural or chemically produced. “Opiate,” on the other hand, refers to a subset of opioids derived from the poppy plant (also known as the opium plant). “Opioids” are either “endogenous” (Produced by the body naturally) or exogenous (administered or consumed).  

Endogenous opioids

Endogenous opioids are opioids produced inside the human body by various organs, particularly the brain and the pituitary gland. The main endogenous opioids are β-endorphin, enkephalins, and dynorphins. Endogenous opioids are responsible for regulating the brain's reward centers and its response to cortisol, the stress hormone. 

Exogenous opioids:

Exogenous opioids are opioids that are consumed or administered. These include “opiates,” “semi-synthetic” opioids, and “synthetic” opioids. 

1. Opiates

Opiates are opioids that are naturally derived from the poppy plant. Two commonly prescribed opiates are morphine and codeine.

2. Semi-Synthetic Opioids

Semi-synthetic opioids are processed/manufactured forms of natural opiates and can be several-fold stronger than natural opiates like morphine. Common semi-synthetic opioids include Hydrocodone (Lortab, Vicodin), Hydromorphone (Dilaudid), and Oxycodone (Percocet, OxyContin). 

3. Synthetic Opioids

Synthetic opioids are opioids that are entirely chemically manufactured. Man-made synthetic opioids function similarly to other classes of opioids, but because the production of synthetic opioids does not depend on the poppy plant, they can be manufactured quickly and sometimes at lower costs than opioids that must be derived from the natural poppy. Common examples include Methadone, Meperidine (Demerol), Tramadol (Ultram), Heroin and Fentanyl (Duragesic, Sublimaze)

In addition to natural opiates vs. semisynthetic vs. synthetic opioids, opioids can also be classified by the degree to which they “turn on” opioid receptors in the brain:

Full opioid agonists

Full opioid agonists, as their name implies, fully stimulate, or ”turn on” opioid receptors in the brain. They, therefore, tend to cause strong euphoric effects.  At the same time, they carry the risks that come with too much activation of opioid receptors, including the risk of overdose, respiratory suppression, and physical dependence. Examples of full opioid agonists include heroin, fentanyl, methadone, morphine, oxycodone, hydrocodone, hydromorphone, and codeine. 

Partial opioid agonists

Partial opioid agonists only partially stimulate opioid receptors. They can not stimulate opioid receptors fully even at high doses and thus are safer to use with minimal risk of abuse. Buprenorphine is the most common example of a partial agonist. Buprenorphine (Also called Suboxone) is a highly effective treatment for opioid use disorders. Because buprenorphine 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 has a much lower risk of overdose and dependency/addiction.

Opioid Antagonists

Opioid antagonists occupy opioid receptors in the brain and prevent opioid agonists from binding to them instead.  Naloxone (Narcan) is the most common and well-known opioid antagonist. Naloxone binds to opioid receptors more strongly than opioid agonists, preventing patients from overdosing. This is how Naloxone (aka “Narcan”) works as a reversal agent for patients that have overdosed on opioids. 

Struggling with opioid use disorder or know someone who is?

Fortunately, with modern advancements in treatments, in particular medication-assisted treatment, opioid use disorder is treatable.

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

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