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A poppy plant, the natural source of opium.

Opiate vs Opioid: Key Differences

Opioids and opiates are drugs used in the treatment of moderate to severe pain. The main difference between the two is that opiates are naturally-derived, while opioids are synthetic. However, they are both powerful analgesics with serious risks and side effects.

Because of this, they are often reserved for severe cases despite their widespread effectiveness in treating patients of all age groups. When used as intended, opioids and opiates can provide comfort to people suffering acute pain such as postoperative pain, and chronic pain as experienced by those undergoing cancer and end-of-life treatments.

Here are some important facts you should know.

What Are Opiates?

Opiates are naturally occurring narcotics derived from the poppy plant.

The poppy pod contains opium—a latex exudate that is naturally composed of opiate alkaloids—that can be obtained by consuming poppy seeds. Although rare, regular consumption of poppy seeds can result in opiate dependence, which is why it is not advised to take them as health supplements or as alternative medicine.

Ancient healers used opium as an anesthetic or relaxant, sometimes compounding it with poison hemlock to cause quick and painless death. It was also common for ancient people to take opium to induce sleep, relax the bowels, or treat dry cough.

However, results for these uses varied depending on the poppy variety and harvesting methods and were sometimes fatal. The isolation of opiates is a result of the need to have a more controllable and measurable way to access opium’s benefits.

A patient receiving an IV treatment.

Examples of Opiates

Morphine

Morphine was the first alkaloid isolated from opium. Morphine works by blocking the release of dopamine, a neurotransmitter that sends pain signals to the brain. This results in the inhibition of pain perception to provide comfort to the patient.

Codeine

Codeine is considered a prodrug: a compound the body can metabolize into a different form of drug. In this case, that different form is morphine.

Unlike morphine, codeine is absorbed well in the gastrointestinal tract and can be taken orally. However, codeine is only about one-tenth as strong as morphine.

Thebaine

Also called paramorphine, thebaine is a precursor to morphine and is used in the synthesis of other opioids. Thebaine in its raw form is toxic and is not used therapeutically.

Noscapine

Noscapine is used as an antitussive, but is also being explored for use as a treatment for different kinds of cancer as noscapine. It is also being tested as an anti-mitotic to inhibit the uncontrollable cell division that comes with cancer.

Papaverine

Papaverine acts as a relaxant. It inhibits smooth muscle contraction, which is useful in treating pain related to spasms and dilating constricted blood vessels that can block blood flow.

What Are Opioids?

Opioids are drugs that are either partially derived from opiates or fully derived from other compounds, then synthesized in the laboratory to mimic the effects of opiates.

As strong drugs with the potential to cause addiction, most opioids are often prescribed only for severe acute pain. They should only be used as a last resort for chronic pain.

 A doctor talking with a patient

Examples of Opioids

Heroin

Heroin—also known as diacetylmorphine—is a semisynthetic analgesic derived from morphine, but is two to five times more potent. When used as prescribed, heroin is effective in the treatment of severe pain associated with surgery, myocardial infarction, and terminal illnesses.

Hydrocodone

Used as both an analgesic and an antitussive, hydrocodone is typically combined with other non-opioid analgesics to provide relief. This semisynthetic opioid is a derivative of codeine. However, unlike codeine, it can relieve more intense acute musculoskeletal pain and has a stronger sedative effect.

Fentanyl

A synthetic opioid, Fentanil is a fast-acting anesthetic with 50 to 100 times greater potency than morphine. Unlike morphine, it has a shorter clearance rate and a high lipid solubility. This makes it usable for temporary local pain management, such as during childbirth.

Carfentanil

Carfentanil is a fentanyl analog that is about 10,000 times more potent than morphine and 100 times stronger than fentanyl. It is used in veterinary medicine as a tranquilizer for big mammals like elephants and is not for human use. Carfentanil is highly toxic and has also been examined and used as a chemical weapon.

Oxycodone

Oxycodone is a semisynthetic opioid typically prescribed as a second-line opioid treatment for patients with severe acute pain who can’t tolerate morphine. Oral oxycodone has >60% bioavailability, compared to just 20% for oral morphine.

Methadone

Methadone is a fully-synthetic opioid used in the treatment of opioid use disorder (OUD).

In medical detoxification therapy, it works by replacing and blocking shorter-acting opioids from attaching to the receptors in the brain. This helps eliminate their effects and the associated withdrawal symptoms. Methadone is also used in the treatment of severe pain that does not respond to other treatments.

Buprenorphine

A semisynthetic opioid, buprenorphine is an analog of thebaine used primarily in the treatment of OUD. It prevents other addictive opioids such as fentanyl from binding to the brain by displacing them and attaching them to opioid receptors.

Since buprenorphine has a ceiling effect on euphoria, respiratory depression, and sedation. This means it can provide relief to patients in recovery so they can safely withdraw without experiencing withdrawal symptoms.

a pharmacist putting the lid on a prescription bottle

Meperidine

Meperidine is a synthetic opioid used as an anesthetic during and after surgery. It is effective against postoperative shivering (POS) that can be due to postoperative pain or reduced thermoregulation from the use of anesthesia.

Tramadol

Tramadol is a synthetic opioid that is about as potent as codeine, with analgesic effects that can last up to six hours. Immediate-release formulations usually provide relief within an hour. Extended-release formulations are also available for the treatment of moderate to severe chronic pain. It is also used in veterinary medicine to treat postoperative, chronic, and injury-related pain in mammals.

Over-the-counter Opioids

Some milder forms of opioids are available for sale over the counter. Most people have already been unknowingly exposed to these compounds:

  • Dextromethorphan or DXM (cough suppressant)

Dextromethorphan binds to non-opioid receptors in the brain to suppress the activity that triggers the cough reflex. In large doses, it can give the user a “high,” making it a cheap recreational drug. When used recreationally, it can cause visual and auditory hallucinations and out-of-body sensations for up to six hours.

  • Loperamide (anti-diarrhea)

Loperamide is a synthetic opioid used in the treatment of diarrhea. It works on opioid receptors in the intestines to inhibit bowel movement and secretions. Loperamide has a low oral bioavailability and brain penetration ability, meaning it has minimal effect on the brain or the central nervous system. However, abusing loperamide can cause euphoria, cardiac arrhythmias, and addiction.

Opiate vs Opioid: The Bottom Line

Whether naturally derived or fully synthesized in the laboratory, both opiates and opioids come with specific benefits and risks that are best discussed with your prescribing physician.

Self-medicating with an opiate or opioid can cause serious complications such as addiction, but it can also happen to people with supervised use. Knowing the signs of opioid addiction and going to a doctor at the first sign of opioid dependence or tolerance can help you minimize or even reverse the damage to your health.

If you have concerns about your opioid or opiate use, suspect you are experiencing addiction symptoms, or simply want to learn more opiate vs opioid facts, reach out to us at Freedom From Addiction. We’ll help ensure you are on the right track to wellness.

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