Opioids vs. Opiates – What's the Difference? at BrighterDay

Understanding Opiates and Opioids

In the discourse of addiction and mental health disorders, the terms 'opiates' and 'opioids' are often used interchangeably. However, these terms represent two different categories of drugs despite their similar effects on the human body. Here, we delve into the distinction between the two, providing a clear understanding of what constitutes opiates and opioids.

What Are Opiates?

Opiates are drugs derived naturally from the opium poppy plant, scientifically known as Papaver somniferum. The most common examples of opiates include opium, heroin, morphine, and codeine. These substances are typically used for pain relief, cough suppression, and treatment of diarrhea due to their strong impact on the central nervous system.

Common Opiates	Derived From
Opium	Poppy Plant
Heroin	Poppy Plant
Morphine	Poppy Plant
Codeine	Poppy Plant

What Are Opioids?

Opioids, on the other hand, is a broader term that encompasses both natural opiates and synthetic or semi-synthetic drugs. This means that opioids can be derived from the poppy plant, or they can be synthesized in a laboratory. Synthetic opioids are designed to mimic the effects of natural opiates but are often more potent and have a higher risk of addiction and overdose. Examples of opioids include the naturally derived morphine, and the synthetic or semi-synthetic oxycodone, Oxycontin®, hydrocodone, and fentanyl.

Common Opioids	Derived From
Morphine	Poppy Plant
Oxycodone	Synthetic
Oxycontin®	Synthetic
Hydrocodone	Semi-Synthetic
Fentanyl	Synthetic

In summary, while all opiates are opioids, not all opioids are opiates. The distinction lies in their origins: opiates are naturally derived from the poppy plant, while opioids include these natural substances as well as synthetic and semi-synthetic drugs. Understanding the difference between opioids and opiates is crucial in the broader context of addiction and mental health disorders.

The Chemical Structure of Opioids and Opiates

The distinction between opioids and opiates lies not only in their use and effects but also in their chemical structure and origin. Understanding these differences can provide valuable insight into the ongoing discussion on opioids vs opiates.

Natural vs Synthetic Drugs

Opiates refer to chemical compounds that are extracted or refined from natural plant matter, specifically the sap and fibers of the poppy plant. This category includes drugs like morphine and codeine, which have been used medicinally for centuries.

Opioids, on the other hand, are typically synthetic or semi-synthetic drugs. Most of these are "made in the lab" or "synthesized." This category includes drugs like fentanyl and methadone. However, a few opioid molecules like hydrocodone, hydromorphone, and oxycodone may be partially synthesized from chemical components of opium.

Drug Type	Origin	Examples
Opiates	Natural plant matter (poppy sap and fibers)	Morphine, Codeine
Opioids	Synthesized or semi-synthesized in the lab	Fentanyl, Methadone, Hydrocodone, Hydromorphone, Oxycodone

Opioid and Opiate Receptors

Both opioids and opiates function by binding to opioid receptors in the brain and body. These receptors are primarily involved in sensations of pain and pleasure. Upon attaching to these receptors, opioids and opiates can block pain signals and release large amounts of dopamine, which reinforces the desire to continue taking the drug [4].

Further, opioids and opiates are classified based on their interaction with opioid receptors. They can be:

Agonists: These fully activate opioid receptors.
Partial agonists: These partially activate opioid receptors.
Antagonists: These block opioid receptors.

Examples of each are opioids like morphine (agonist), buprenorphine (partial agonist), and naloxone (antagonist).

Understanding the chemical structure of opioids and opiates and how they interact with the body's receptors is key to understanding their effects, risks, and the potential for addiction. This knowledge also provides the foundation for developing strategies to combat the current opioid crisis.

Usage of Opiates and Opioids

By understanding the usage of these substances, one can discern why the 'opioids vs opiates' conversation is significant. These substances have multiple medical applications but also hold the potential for misuse, leading to severe side effects and possible addiction.

Medical Applications of Opiates and Opioids

Both opioids and opiates are commonly used to treat pain. Opioids are synthetic or semi-synthetic drugs that bind to opioid receptors in the brain and body, and are often prescribed for severe pain relief, postsurgical pain management, and chronic pain conditions. Opiates, including substances like morphine and codeine, have a longer history of medicinal use and are still important in managing pain, particularly in palliative care and end-of-life care.

Additionally, the U.S. Food and Drug Administration (FDA) has approved some opioids for treating intense coughing and chronic diarrhea. For example, opioids like loperamide are used to treat diarrhea and irritable bowel syndrome (IBS), while codeine and dextromethorphan are utilized as cough suppressants.

Risks and Side Effects of Opiate and Opioid Use

Despite their medical applications, both opioids and opiates carry significant risks and side effects. Opioids can lead to dependence and have a higher risk of abuse and overdose compared to opiates. Additionally, opioids are often more potent than opiates due to their synthetic nature, which can increase the risk of adverse effects and overdose if not used properly.

Opioids not only dull pain but can also create a sense of euphoria, leading to a risk of addiction. This, combined with tolerance build (needing to increase doses to produce the same effect), can result in opioid use disorder.

The use of both opioids and opiates is a complex issue in healthcare, requiring careful consideration of factors such as pain severity, duration of treatment, risk of dependency and abuse, and the overall benefit-risk profile for each patient in pain management.

In 2019, nearly 50,000 people in the United States died from opioid-involved overdoses, which highlights the seriousness of the opioid crisis that includes prescription opioids, heroin, and synthetic opioids such as fentanyl. Therefore, it's crucial to use these medications as directed by healthcare providers and to seek help if abuse or dependence on these substances is suspected.

The Impact of Opiates and Opioids on the Brain

When discussing the topic of 'opioids vs opiates', it's crucial to understand the profound impact these substances have on the brain. This section will explain the connection to dopamine and the long-term effects of opiate and opioid use.

The Connection to Dopamine

Opioids can bind to and activate receptors in various areas of the brain and body, particularly those involved in pain and pleasure sensations. By attaching to these receptors, opioids can block pain signals and release large amounts of dopamine, which reinforces the desire to continue taking the drug.

Furthermore, opioids affect brain processes to produce drug liking, tolerance, dependence, and addiction by stimulating mu opioid receptors in the brain that trigger biochemical brain processes, release dopamine in the nucleus accumbens, and create lasting memories or conditioned associations.

Long-term Effects of Opiate and Opioid Use

Opioid tolerance, dependence, and addiction are all manifestations of brain changes resulting from chronic opioid abuse. The abnormalities that produce dependence appear to resolve after detoxification, within days or weeks after opioid use stops. The abnormalities that produce addiction, however, are more wide-ranging, complex, and long-lasting. They may involve an interaction of environmental effects and a genetic predisposition in the form of brain pathways that were abnormal even before the first dose of opioid was taken.

The cognitive deficits model of drug addiction proposes that individuals with addictive disorders have abnormalities in the prefrontal cortex (PFC), which is responsible for regulation of judgment and executive functions. The compromised signaling between the PFC and the mesolimbic reward system leads to reduced ability to use judgment to restrain impulses and predisposition to compulsive drug-taking behaviors.

Moreover, opioid misuse can result in slowed breathing, which may lead to hypoxia, a condition where the brain does not receive enough oxygen. This can have short- and long-term effects, including coma, brain damage, or death. Additionally, opioid addiction can have lasting neurological impacts, with ongoing research on whether the damage can be reversed [4].

In conclusion, the impact of opiates and opioids on the brain is significant and multifaceted, affecting both the physical and cognitive functions. It's crucial to understand these effects when considering the issue of opioid and opiate misuse and addiction.

Opiate and Opioid Addiction

The misuse of both opiates and opioids is a major concern due to the risk of addiction. Understanding the nuances of dependence and tolerance, along with the current opioid crisis, is crucial in mitigating these issues.

Understanding Dependence and Tolerance

Chronic opioid abuse can result in dependencies and tolerance, both of which are manifestations of brain changes. Dependence tends to resolve after detoxification, within days or weeks after opioid use stops. However, addiction is more complex, wide-ranging, and long-lasting, potentially involving an interaction of environmental effects and a genetic predisposition.

Opioids stimulate mu opioid receptors in the brain that trigger biochemical processes, release dopamine, and create lasting memories or conditioned associations. Opioid tolerance occurs because the brain cells that have opioid receptors on them gradually become less responsive to the opioid stimulation. Consequently, more opioid is needed to produce pleasure comparable to that provided in previous drug-taking episodes.

Models of drug addiction suggest that opioids cause addiction by changing the set point of dopamine release and noradrenaline release. This altered set point leads to reductions in dopamine during resting states and increased glutamate activity that produces drug wanting or craving.

It's also proposed that individuals with addictive disorders have abnormalities in the prefrontal cortex, which is responsible for regulating judgment and executive functions. This compromised signaling leads to reduced ability to use judgment to restrain impulses and predisposition to compulsive drug-taking behaviors [6].

The Opioid Crisis in the United States

The misuse of opioids has escalated into a crisis in the United States. Over 100,000 Americans died from drug overdose in the last year, with the majority of those deaths attributed to opioids and synthetic opioids like fentanyl [7].

Opioids and opiates are both commonly used to treat pain, but opioids are often prescribed for severe pain relief, postsurgical pain management, and chronic pain conditions. However, opioids can lead to dependence and have a higher risk of abuse and overdose compared to opiates.

In 2019, approximately 50,000 people in the United States died from opioid-involved overdoses. This statistic underscores the severity of the crisis and the need for continued efforts in prevention, treatment, and recovery support.

The high potency and synthetic nature of opioids increase the risk of adverse effects and overdose if not used properly. Therefore, it is essential to carefully monitor the use of these substances and provide needed support to individuals dealing with addiction. Understanding the mechanisms of opioids vs opiates and the risks associated with their use is a crucial step in addressing the opioid crisis.

Opiate and Opioid Dosage and Overdose

When dealing with substances as potent and potentially hazardous as opiates and opioids, understanding dosage and the risks of overdose is crucial. The impacts of misuse can be severe and long-lasting, underlining the importance of careful administration and monitoring.

Measuring Opioid Dosages

Healthcare providers typically measure opioid dosages in morphine milligram equivalents (MME) or morphine equivalent doses (MED). This standardization allows for a comparison of the potency of an opioid dose relative to morphine, a well-understood and widely used opiate. Dosages above 50 MME per day are associated with at least a two times increased risk of overdose compared to dosages less than 20 MME per day.

Opioid Dosage	Relative Risk of Overdose
Less than 20 MME per day	Baseline
More than 50 MME per day	At least 2x higher

The Risk of Overdose and Overdose Prevention

The risk of opioid overdose is intrinsically linked to the phenomena of opioid tolerance, dependence, and addiction. These are all manifestations of brain changes resulting from chronic opioid abuse.

Opioids stimulate mu opioid receptors in the brain, triggering biochemical brain processes, releasing dopamine in the nucleus accumbens, and creating lasting memories or conditioned associations. This stimulation can lead to tolerance, where more of the substance is needed to produce the same level of pleasure. Changes in the locus ceruleus (LC), an area at the base of the brain, can lead to dependence and withdrawal symptoms when the opioid use stops. Over time, these conditions can set the stage for overdose.

Preventing overdose involves careful monitoring of dosages, regular check-ins with healthcare providers, and an awareness of the signs of overdose. Also important is ongoing research into the mechanisms of addiction, with models such as the "changed set point" model suggesting that drug abuse alters a biological or physiological setting or baseline, leading to craving and continued drug use.

In the battle of 'opioids vs opiates', understanding dosage and the risk of overdose is paramount. It underscores the need for careful usage, ongoing research, and the provision of supportive resources for those grappling with addiction.