You may have heard the terms “opioid” and “opiate” used interchangeably, but they’re not quite the same. How are they different?
In the United States, opioid use is at an all-time high. If you’ve recently had surgery, chances are you were offered a prescription for opioids — or was it opiates? Now you can’t quite remember the difference.
Although related, opioids and opiates are not exactly the same thing. They are part of the same class of drugs, but there are some key differences in how they’re created and how they interact with your brain and body.
The main difference is that opiates are natural substances while opioids include opiates and also man-made drugs. But it doesn’t stop there.
We may need to do this step by step.
Let’s start with this categorization:
- endogenous opioids
Opiates are substances naturally derived from a poppy plant. Specifically, opiates come from opium, the white liquid extracted from the poppy plant, Papaver somniferum.
Opiates have been grown and processed for thousands of years for medicinal use. These naturally derived active molecules interact with opioid receptors in your brain, which results in pain relief and calming effects.
Endogenous opioids are substances — peptides — produced by your brain to fulfill many functions. One of these is natural pain control.
There are three main endogenous opioids:
If you’ve ever experienced a runner’s high at the end of a long jog, for example, that would be your endogenous opioids and their receptors working — specifically, endorphins.
“Opioid” is an umbrella term for substances that interact with opioid receptors in your brain, including opiates.
Opioid receptors are receptors in your nerve cells that work with substances to help regulate pain and pleasure.
As a class of drugs, opioids include:
- naturally derived opiates
- semi-synthetic varieties
- synthetic varieties
In short, all opiates are opioids, but not all opioids are opiates.
In the United States, more than 153 million opioid prescriptions are delivered each year, according to the
Not all opioids are used as medications. In fact, some of them are classified as illegal in the U.S., such as heroin.
Despite the difference between opioids and opiates, both are used to treat moderate to severe pain that’s either acute (recent) or chronic (long term).
For example, they may be used after back surgery or for ongoing pain management during cancer treatments.
Opioids can also be used for end-of-life pain management or difficulty breathing, according to the
Opioids may also be used to treat some cases of coughing and diarrhea, according to the National Institute of Health (NIH).
The differences between opioids and opiates come into play when looking at how they affect your brain.
When your body is in pain, it sends an alert to your brain through your spinal cord.
When you take opioids, the drug binds to the opioid receptors in your brain, spinal cord, and other major organs in the body to block that pain message.
At the same time, opioids send a flood of dopamine (a “feel-good” neurotransmitter) through your body, leading to a quick sense of relaxation on top of pain relief, according to the NIH. In some cases, particularly when not used according to directions, opioid use may lead to euphoria.
Since they are man-made, synthetic opioids have a different chemical composition than naturally derived opiates, yet can still effectively mimic the effects.
In other words, synthetic opioids may go farther and get there quicker. These findings are changing the way researchers think about addiction and treatment, though more research is needed.
As mentioned before, there are three categories of opioids: opiates (natural), semi-synthetic, and synthetic.
Nowadays, there are many brands and generic opioid medications. Here are a few of them.
These are derived from the poppy plant:
- codeine (Tuzistra SR)
- morphine (Duramorph, MS Contin)
These varieties are made in a lab and mixed with opiates:
- hydrocodone (Vicodin, Norco)
- hydromorphone (Exalgo ER)
- oxymorphone (Opana)
- oxycodone (OxyContin, Roxicodone)
These are completely man-made:
- fentanyl (Duragesic, Subsys)
- methadone (Dolophine, Methadose)
All opioids, including opiates, have the potential to lead to addiction when not used according to directions. However, studies have yet to confirm whether one may be more likely than the other to do so.
Research shows that the underlying causes of addiction are more complex than chemical dependence alone. This is the difference:
This is a physiological reliance on a substance. The neurons in your brain change to depend on this drug for homeostasis, or internal balance.
If you try to cut back, you will experience withdrawal symptoms, which in some cases can be severe. Chemical dependence can usually be resolved in a matter of weeks or months with a medically assisted detox program.
This is a somewhat controversial term. In fact, in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), it’s no longer a formal diagnosis. Instead, professionals now use substance use disorder.
Medically, addiction may refer to both a significant and severe physical and emotional dependence on a substance, often resulting from trauma, genetic predisposition, or family history.
Unlike chemical dependence, this may take months or years to resolve, depending on the approach to treatment and other factors like the environment. Because of the complex nature of addiction, relapses may be possible years after you’ve stopped using, unlike chemical dependence alone.
Some opioids are stronger than others
The stronger the substance, the more intense the withdrawal symptoms may be. Trying to take a lower amount of synthetic opioids may be so unpleasant that it drives you to keep taking them, paving the way for chemical dependence.
However, keep in mind that this may happen mostly when the drug is misused — in other words, when taken differently than originally directed, or in a larger quantity or for a longer period of time than originally prescribed for.
For example, fentanyl (a synthetic opioid) is 80 to 100 times more powerful than morphine (an opiate), according to the U.S. Drug Enforcement Administration (DEA). Prolonging its use or increasing its dosage without the supervision of a health professional can potentially lead to chemical dependence.
If a strong chemical dependence is combined with an emotional desire to continue using (and inability to discontinue use despite consequences), substance use disorder may occur.
If you think you may have an opioid use disorder, you are not alone and help is available.
There is no one-size-fits-all for treatment, and everyone’s recovery looks different.
Treatment may include some combination of:
- medically assisted treatment
- inpatient treatment
- support groups
Treatment may focus on different aspects that, although related, are separate processes. For example, you may receive help for chemical dependence, withdrawal symptoms, and psychological dependence. Each of these aspects may be treated in different ways.
Medically assisted treatment
Medically assisted treatment (MAT) is considered the gold standard in treating opioid use disorder. Withdrawal symptoms can be unpleasant and severe, so it’s important to undertake this process under the guidance of compassionate, trained professionals.
Because withdrawal can be so intense for some people, you may find it more comforting to detox under the 24-7 supervision of a team, while attending group and individual counseling.
If this is the case, inpatient treatment may be right for you. Contact your health insurance provider to see what options are available for you in your area. These resources may also provide support:
- SAMSHA’s Opioid Treatment Program Directory
- SAMHSA’s Buprenorphine Practitioner Locator
- SAMHSA’s Behavioral Health Treatment Services Locator
- FindTreatment.Gov’s Substance Use Treatment Locator
A therapist trained in substance use disorder can help you work through the underlying reasons that led you to develop a dependence on opioids. The APA’s Psychologist Locator is a great resource to assist you on your search for one.
It can be a relief to know that others are going through what you’re going through. Consider the Narcotics Anonymous (NA) Meeting Search tool to see what support groups are available near you.
Remember to take it one day at a time. With the right management and support, opioid use disorder can be overcome. You can do this.
The main difference between opioids and opiates is where they come from. In general, opioids are a class of drugs commonly used to treat moderate to severe pain. They can be naturally derived (opiates), man-made, or something in between.
Although moderately safe when used for shorter periods of time and according to medical directions, opioids and opiates may sometimes lead to chemical and psychological dependence when used incorrectly.
To avoid any complications, it’s highly advisable that you discuss your pain relief options with your healthcare team, and follow all prescription guidelines.