Many news outlets have written about the opioid epidemic, but a little digging reveals the term “opiates.” They sound the same, but what are the differences?
Clarifying what opioids and opiates are, and what they are not, sheds light on the nature and origins of the greatest public health crisis in a generation.
The Origins of Opioids and Opiates
To better understand the differences between opioids and opiates, it is necessary to look at where they come from. The History channel explains that the substances trace their origins back to the opium poppy. The poppy has been cultivated for millions of years, being used by the ancient Sumerians and Mesopotamians for its medicinal and euphoric effects, which played a big role in religious rituals. The poppy produces a milky sap, from which opium is made and over which international wars have been fought.
It is from the opium that the drugs we know as opioids and opiates are derived. Historically, the term “opioids” has been used to refer to synthesized products that intend to emulate the painkilling and euphoric effect of opium but have a different chemical structure than opium itself. Today, “opioids” refers to all drugs created from the opium product, whether those drugs are natural (such as morphine, which contains the base chemical compounds that occur in the poppy), synthetic (completely manufactured in a laboratory, like fentanyl), or semi-synthetic (created in a lab based on natural opiates, such as oxycodone and heroin, which is derived from morphine).
Among medical professionals, the term “opioid” is still used to refer to most opioids, and “opiates” is reserved specifically for non-synthetic opioids (that is, either fully natural or semi-synthetic in some cases). However, even within the various scientific communities, the terms tend to be used interchangeably, reflecting the modern uses of the terms “opioids” and “opiates.”
Broadly speaking, “opiates” will still be used when talking about substances that are formulated from the chemical compounds in the opium poppy and “opioids” for substances that are based on those compounds but are deliberately engineered to be much stronger and potent to better bring out the desirable effects of the opium. In most conversations, “opioids” is the catch-all term to describe everything from fentanyl to morphine even though the two substances have key differences.
As the Philadelphia Inquirer explains, all opiates are opioids; however, not all opioids are opiates. Furthermore, even though opiates have a natural base, they are still very addictive and cause deep psychological dependence if abused.
The American Council on Science and Health contends that the distinction is “unnecessary,” pointing out that while there are technical differences between opioids and opiates, the origin of a given drug – plant or laboratory – is unimportant, and that insisting on accurate nomenclature serves only to confuse.
As an example, even though heroin is derived from morphine (an opiate, isolated from the poppy), its placement in the opiate category because its precursor came from a flower is “scientifically nonsensical.” Bucking tradition, they argue that removing the word “opioid” from the English language would have no scientific impact whatsoever.
The choice of language suggests how the conversation about the opioid epidemic (versus the potential opiate epidemic) has formed. Oregon government’s Alcohol and Drug Policy Commission notes that journalists and politicians refer to all the drugs that trace their roots back to the opium poppy as “opioids,” the result of a response to a crisis that is so overwhelming, the technical details are lost.
One area where the difference between the two terms is important is in discussing the possible role of using cannabis to wean patients off their opioids and even to use cannabis as an alternative to opioid-based medications. Live Science explains that when a person consumes marijuana, the cannabinoids in the drug attach themselves to cannabinoid receptors throughout the body. The receptors are part of the endocannabinoid system, which naturally produces endocannabinoids (small molecules that activate those receptors) as a response to pain. Endocannabinoids have been described as the body’s own opiates due to the similarity of function; endocannabinoids modulate the sensation of pain, and opiates do much the same thing. This has led many researchers to theorize that opiate-like substances found in other plants – such as the Cannabaceae family, wherein the cannabis plant grows – could be the key to beating the opioid epidemic.
The Epidemic Debate
For now, however, the similarity in how opioids and opiates alike work on the human body renders some of the debate academic. While still acknowledging the differences between the two terms, the U.S. Centers for Disease Control (CDC), the White House, the Department of Health and Human Services, and the World Health Organization, all refer to the “opioid epidemic,” which reflects the direction the conversation has taken.
It also serves as a reminder that regardless of the origins and classifications of opioids and opiates, the terms equally refer to substances that are dangerous, addictive, and potentially lethal. There is medicinal value to some of them, and it is important to understand how they originate and what affects the various formulations have. This has implications for treatment, possibly bringing about an end to the epidemic in the future. Nonetheless, notwithstanding the technical distinction between the two terms, the practical reality of the scope and ultimate evolution of the crisis remains summed up in the ubiquitous use of the term “opioid epidemic.”