Synthetic opioids are different from opiates in that synthetic opioids are synthesized in a lab while opiates are derived from nature and only moderately processed. Both types of drugs have similar effects and significant abuse potential.
A Brief History of Opioid Misuse
The United States has had a growing opioid epidemic since the 1990s.  In the early stages of this epidemic, natural and semisynthetic opioids, heroin, and methadone represented the bulk of opioid overdose deaths. However, 2013 saw the beginning of a spike in the use of and deaths connected to synthetic opioids such as fentanyl. An estimated 500,000 people have died as a result of overdoses that involved opioids from 1999 to 2019. In 2020 alone, over 56,516 deaths were attributable to synthetic opioids.  This represents more than 11% of the total opioid deaths that occurred between 1999 and 2019.
What is the Difference Between Opioids and Opiates?
While these terms are oftentimes used synonymously, there is technically a difference. Opiates are specifically opioids derived from a natural source. For example, opium and heroin, which come from the poppy plant, are “opiates”. Opioids are synthesized in a lab, either legally or illegally. They are also called “synthetic” opioids for this reason. 
While many sources use the words opiate and opioid interchangeably, this isn’t entirely correct. All opiates are opioids, but not all opioids are opiates. 
Are Synthetic Opioids “Stronger” than Opiates?
No, not necessarily. Synthetic opioids are opioids that are synthesized in a lab, either legally or illegally.  While for the most part, synthetic opioids are considered stronger or more potent than opiates, this is not always true:
For example, Heroin is actually an “opiate”, a natural derivative of the poppy plant, however it is much more potent than many synthetic opioids. In fact, Methadone, which is a synthetic opioid, is used to treat a more severe addiction to heroin, an opiate.
Therefore, a drug’s status as synthetic or “natural” does not necessarily correlate to its strength or potency.
Effects of Synthetic Opioids
Synthetic opioids like fentanyl have powerful effects on the brain, including: 
- Extreme euphoria
- Breathing changes
Over time, a person using synthetic opioids, like any other opioid, will develop a tolerance for the drug and need to use more to achieve the same effect.
Notable Dangers of Synthetic Opioids
Opioids can slow a person’s breathing, especially with concurrent use of other sedating drugs. If a person uses too much of an opioid or mixes an opioid with other drugs that have sedating effects, their breathing can slow to a point where their brain isn’t getting enough oxygen. This can cause a person to lose consciousness and overdose.
Opioids are also addictive. A person can develop a physical and psychological dependence on them even after a few doses, eventually developing an opioid use disorder (OUD). 
Signs & Symptoms of Synthetic Opioid Misuse
Opioid misuse, like any kind of drug misuse, can look different depending on the individual and their unique struggles. Some people may hide their misuse well, and others may not even know they have a serious drug problem until they try to quit using opioids or notice their drug use having a significant impact on their life.
Some common signs someone may be struggling with drug misuse include the following:
- Withdrawal from activities they used to engage with and enjoy
- A reduced ability to meet important life demands, such as going to work or school
- Changes in social habits, such as associating with different people who may also engage in drug use
- Financial problems and potentially criminal activity, such as stealing
- Struggling when trying not to use drugs and frequently thinking about drugs when not using
Signs of opioid withdrawal can include the following:
- Flu-like symptoms, such as sneezing and having a runny nose
- Severe opioid cravings
- Leg movements and shaking
- Cold flashes
- Diarrhea and vomiting
- Sleep issues
- Muscle and bone pain
Signs of an Opioid Overdose
The primary signs of an overdose on opioids include the following:
- Trouble breathing or respiratory depression
- Stupor or lack of responsiveness
- Significant changes in pupillary size
- Cold, clammy skin
- Inability to awaken or coma
Again, the risk of an overdose becomes much higher if other drugs that can cause respiratory depression are mixed with opioids. Common drugs that are often mixed with opioids and result in overdoses include benzodiazepines (benzos), alcohol, gabapentinoids and other opioids.
If it’s ever unclear if a person is overdosing on opioids or otherwise experiencing severe effects from opioid use, treat it as a medical emergency and call 911 immediately. If available, the drug naloxone can be used to counteract an opioid overdose, reversing the effects of opioids in a person’s system. Even if naloxone is administered, further medical care is still needed to ensure the person is stable and safe.
Treatment of Opioid Use Disorder
If a person has an OUD, medication assisted treatment (MAT) is considered the gold standard for treatment. MAT consists of three FDA approved medications: Methadone, Suboxone, and Naltrexone.
At Bicycle Health, we specialize in using Suboxone therapy for MAT. Suboxone (buprenorphine/naloxone) can prevent withdrawal symptoms and cravings for opioids, allowing the individual to focus on their recovery.
The buprenorphine component of Suboxone occupies opioid receptors, thereby preventing withdrawal. If the medication is misused, such as crushed and injected, the naloxone component is activated, preventing overdose and serving as an additional safety mechanism and misuse-deterrent. Suboxone is widely viewed as an effective and safe method of supporting recovery from opioid use disorder.[6,7]
Suboxone and other forms of MAT are available via prescription. As part of a MAT program, the individual will also receive counseling and other forms of support.
To start your treatment, it is often helpful to first talk with a licensed mental health professional who specializes in addiction treatment. If you don’t know where to begin, the SAMHSA National Helpline, available at 1-800-662-4357, can be a good place to start. It’s free and confidential, allowing people to get access to information about addiction and other mental health resources in either English or Spanish.
If you are concerned about your use of Synthetic opioids and interested in medication assisted treatments, reach out to your doctor or to someone at Bicycle Health to get started.