The terms “opiates” and “opioids” are often used in discussions about pain-relieving drugs, sometimes causing confusion. While some people carefully distinguish between these terms, others use them interchangeably. In contemporary language, especially in journalism and by health organizations, the term “opioids” is increasingly used as an umbrella term to encompass both categories.
Both opiates and opioids have legitimate medical applications. They are prescribed to manage pain, induce anesthesia, suppress coughs, control diarrhea, and even to treat opioid use disorder. However, these substances are also misused illicitly, contributing to significant health and social issues.
The primary distinction between opiates and opioids lies in their origin and manufacturing process.
Opiates: Derived from Nature
Opiates are compounds that are naturally extracted and refined from the opium poppy plant (Papaver somniferum). These substances are directly derived from the plant’s sap and fibers. Key examples of opiates include:
- Opium
- Morphine
- Codeine
- Heroin
Alt text: Close-up of opium poppy capsules showing incisions where opium sap has been harvested, illustrating the natural source of opiates.
Opioids: Synthesized in the Lab
Opioids, in contrast, are generally synthetic or semi-synthetic compounds. This means they are largely “made in the lab” through chemical synthesis, rather than being directly extracted from plants.
While some opioid molecules, such as hydrocodone, hydromorphone, and oxycodone, are partially synthesized from chemical components of opium, many commonly used opioids are entirely designed and manufactured in laboratories. In fact, the term “synthetic opioid” is often considered redundant because nearly all opioids undergo synthesis.
The pharmaceutical industry has developed a vast array of opioid molecules, numbering over 500. While some have become essential medical tools, others are less widely used. Examples of well-known opioids prescribed medically in the United States include:
- Dextromethorphan (a common cough suppressant found in over-the-counter medications like NyQuil and Robitussin)
- Dextropropoxyphene (formerly available as Darvocet-N and Darvon)
- Loperamide (an anti-diarrheal medication, e.g., Imodium)
- Hydrocodone (often combined with acetaminophen in drugs like Vicodin)
- Oxycodone (found in medications such as Oxycontin and Percocet)
- Oxymorphone (e.g., Opana)
- Meperidine (e.g., Demerol)
- Methadone (e.g., Dolophine, used in opioid addiction treatment)
- Fentanyl (e.g., Ultiva, Sublimaze, Duragesic patches, a potent pain reliever)
- Carfentanil (e.g., Wildnil, primarily used in veterinary medicine for large animals)
Narcotics: A Broader Classification
Both opiates and opioids fall under the broader category of “narcotics.” The term “narcotic” itself is derived from the Medieval Latin “narcoticus,” originating from the Greek “narkoun,” meaning “to benumb.” Essentially, “narcotic” refers to substances that induce sleep, numbness, or stupor, and historically, it has been used to classify a wide range of psychoactive drugs.
Therefore, it is technically accurate to refer to both opiates and opioids as “narcotic drugs.” However, in contemporary usage, particularly when discussing the wider group of these drugs, “opioid” has become the more prevalent and encompassing term.
Understanding Dependency and Misuse
Whether an individual becomes dependent on an opiate or an opioid, whether through medical prescription or illicit acquisition, the potential for substance use disorder is significant. A crucial aspect of this dependency is cross-tolerance and cross-dependence. This means that switching from one opiate or opioid to another can often mitigate withdrawal symptoms and sustain the addiction.
Tragically, many individuals who initially become dependent on prescription pain relievers may transition to illicit opioids like heroin when their prescriptions are no longer available. This highlights the complex interplay between legal and illegal narcotics and the challenges of managing pain and addiction.
In summary, while opiates and opioids have distinct origins—natural versus synthetic—both are powerful narcotics with medical utility and a potential for misuse. The term “opioids” is now commonly used to refer to this entire class of drugs, emphasizing the importance of understanding their properties and risks.
