Opioids and Opiates Are More Similar Than Different

Opioids and opiates ease pain and have other medicinal purposes. The two classes of drugs aren’t exactly the same, but they share many similarities. Many experts use the terms interchangeably because the drugs’ uses and effects have a lot in common.

“It’s not a matter of opioids versus opiates,” says psychiatrist and substance use disorder specialist David Streem, MD. “From a patient perspective, opiates and opioids perform similar functions when used as prescribed. When misused, they can lead to a substance use disorder.”

In fact, opioids and opiates are more similar than different. Dr. Streem explains.

What’s the difference between an opiate and an opioid?

The key difference between the two groups of drugs is their chemical makeup:

• Opiates come from natural chemical compounds in the opium poppy plant (Papaver somniferum). Opiates, such as codeine and morphine, have approval from the U.S. Food and Drug Administration (FDA) for medicinal purposes. Opiates like heroin and opium aren’t legal because they don’t help (and often harm) your health.
• Opioids are made in labs. There are more than 500 different lab-made opioid chemical compounds. Common ones that have medicinal purposes include fentanyl, loperamide, methadone and tramadol.

Are opiates and opioids the same?

For the most part, yes. Opioids and opiates are both narcotics. The word “narcotics” comes from the Greek word “narkoun,” which means to numb. Narcotics dull your senses, including your perception of pain.

Some drugs like hydrocodone and oxycodone are a mix of natural and lab-made chemical compounds. They fall into the opioid category. Even though opiates are made from natural compounds, healthcare experts and others now lump them in with opioids.

“We view any drug that causes opioid-like effects to be an opioid,” states Dr. Streem.

So, all opiates are opioids. Other drugs that fall into the opioid category include kratom (an herbal supplement) and tianeptine (more commonly called gas station heroin).

Now that we’ve (sort of) cleared up this confusion, Dr. Streem explains the many similarities that opioids and opiates share.

4 similarities between opioids and opiates

Opioids and opiates share four key similarities:

1. Affect feelings of pleasure and pain

Chemicals in opioids and opiates bind to and activate opioid receptors in your brain, spinal cord and organs. This interaction slows or blocks signals that make you feel pain. It also causes your brain to release large amounts of dopamine.

“Dopamine carries nerve cell messages between your brain and body,” explains Dr. Streem.

You might know dopamine as the “feel-good hormone.” It plays a key part in your brain’s reward center, eliciting feelings of pleasure.

Opioid receptors in your body also help regulate:

• Breathing and digestion
• Growth and reproduction
• Sensory perceptions like vision, taste and smell

2. Treat the same conditions

Opioids and opiates ease pain from surgeries, traumatic accidents and cancer treatments. But the drugs are also effective for:

• Anesthesia
• Chronic coughs
• Chronic diarrhea
• Chronic pain

3. Cause the same side effects

Common side effects of opioids and opiates include:

• Confusion
• Constipation
• Drowsiness
• Feelings of extreme pleasure or euphoria
• Nausea
• Slowed breathing

4. Can be misused

Because opioids and opiates can make you feel euphoric (high), there’s an increased risk for misuse and opioid use disorder (OUD).

An estimated 2.5 million Americans have OUD. Signs of this substance use disorder include:

• Increased drug tolerance, which drives a need for higher doses or different opioids
• Overpowering urge to use opioids despite negative consequences, such as falling asleep on the job
• Withdrawal symptoms when you stop taking the drugs

OUD increases the risk of opioid overdose.

“Opioids can overly stimulate the part of the brain that controls breathing, causing you to stop breathing,” clarifies Dr. Streem.

A person who is overdosing requires immediate medical attention. After calling 911 or emergency services, you should administer Narcan®. This over-the-counter nasal spray reverses opioid effects, helping restore normal breathing.

Without question, the misuse of legal and illegal opioids continues to be a global crisis. But Dr. Streem stresses that it’s safe to take opioids — as prescribed by your healthcare provider — for acute or chronic conditions.

“Most people need prescription opioids for a short time and are unlikely to develop a substance use disorder,” he says. “But if you are concerned, there are other medications and treatments for easing pain.”