Key takeaways:

  • Heroin and opium are naturally derived from the poppy plant, typically grown in the Middle East. Increasingly, synthetic (manmade in a lab) opioids are becoming more popular because they are cheaper and easier to produce, and have even more potent effects
  • Opiates and opioids work by binding to specific receptors in the brain, mimicking the effects of pain-relieving chemicals that are produced naturally. These drugs bind to opiate receptors in the brain, spinal cord, and other locations in the body
  • There is currently an opioid epidemic occurring in the United States. In 2019, nearly 50,000 people in the United States died from opioid-involved overdoses

In 2019, 9.7 million people in the US reported misusing a prescription opioid drug, 745,000 Americans reported abusing heroin, and 1.6 million Americans reported being addicted to an opioid drug.

What are Opiates?

‘Opioids’ are any controlled substance that is derived from opium, a naturally occurring chemical found in poppy seeds, or synthetically made to replicate these effects. These substances can be medically prescribed for pain (prescription painkillers) or can be turned into the illegal substances opium or heroin. While they do have some medical uses, they are also widely abused for their calming, pleasurable, and euphoric effects. When used regularly or long term, these drugs are highly addictive in nature. [2]

When opioids are used for a long time or in a higher dosage than is prescribed, the person taking builds a tolerance to their effect, meaning they need to increase their dose to get the desired effect. When they increase the dose, the likelihood of adverse effects, addiction, and even fatal overdose dramatically rises. More people die each year from opioid overdoses than from any other legal or illegal substance. [3]

Where do opioids come from?

Heroin and opium are naturally derived from the poppy plant, typically grown in the Middle East. Increasingly, synthetic (manmade in a lab) opioids are becoming more popular because they are cheaper and easier to produce, and have even more potent effects. Synthetic opioids like fentanyl are increasingly available, and often sold to unsuspecting buyers. [2]

Because fentanyl is 50-100 times more potent than heroin or morphine, the risk of overdose is greatly increased. The majority of opioid overdoses are related to a synthetic opioid like fentanyl, which may have been accidentally consumed by a user who believed they were using heroin or another painkiller. [2]

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Get help during Covid-19

At Recovered, we recognize the impact COVID-19 has had and the continued challenges it poses to getting advice and treatment for substance use disorders. SAMHSA has a wealth of information and resources to assist providers, individuals, communities, and states during this difficult time and is ready to help in any way possible.

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Opioids vs Opiates

You may come across these two terms being used interchangeably. The reason for this is that these substances are often grouped into one category as they largely have the same effect on the user.

Opiates

Opiates, such as codeine, morphine, heroin, or opium are made from ingredients that are naturally derived from opium found in poppy plants. 

Opioids

Opioids are made synthetically to mimic the effects of opium. Some are fully synthetic while partially synthetic opioids contain trace amounts of opium. Examples include fentanyl and even the popular medication methadone which is used to help people who are trying to stop using other opioids.

Opiates and opioids work by binding to specific receptors in the brain, mimicking the effects of pain-relieving chemicals that are produced naturally. These drugs bind to opiate receptors in the brain, spinal cord, and other locations in the body. This blocks the perception of pain and releases endorphins, causing pleasure. Opiates can cause feelings of well-being, but they can also cause side effects such as nausea, confusion, and drowsiness. [3] The calming effects of opiates on the brain and body are what cause them to become highly addictive when abused continuously.

Types of Prescribed Opioids

Opioid pain relievers are used to treat a wide range of ailments and medical needs. There are two main classifications for this drug type; antagonists and agonists.

Antagonists are generally considered to be less addictive than agonists due to their lower potency, though abuse is still possible. Antagonist drugs such as Naltrexone are often used in the early stages of detox from stronger opiates to help with withdrawal symptoms. 

Agonists are far more potent and mimic the effects of endorphins in the brain by interacting with opiate receptors. Most frequently used in medical settings to help patients cope with extreme pain, with morphine for instance, agonists have a far stronger effect on the brain and if abused are far more addictive. Other drugs that fall into this category include fentanyl, heroin, oxycodone, and Demerol.

The most common opioids are:

Codeine

Codeine is less potent than other opioids and is often used to relieve mild to moderate pain. As well as being an over-the-counter opioid painkiller that can be obtained with a prescription, it is also combined with other substances to make weaker over-the-counter painkillers.

Darvocet/Darvon

During the period they were used, Darvon and Darvocet (propoxyphene-based painkillers) were responsible for thousands of hospitalizations and deaths. They have now been banned by the FDA but black market trade still exists.

Demerol

Demerol is the name brand for meperidine, an opioid that produces the same euphoric as morphine. Once used to treat moderate to severe pain, Demerol is not prescribed often today due to its highly addictive nature. 

Dilaudid

Dilaudid is a highly potent opioid painkiller that is often prescribed in extended-release tablets. Abusing Dilaudid can lead to breathing problems and death. 

Fentanyl

100 times more potent than morphine, Fentanyl is only prescribed in severe cases of pain. In recent years, fentanyl has been used by drug dealers to cut other drugs such as heroin, leading to increased cases of overdose. 

Hydrocodone

Often combined with other strong painkillers such as Vicodin, and less potent pain relief such as ibuprofen. The FDA has also approved some pure hydrocodone medications.

Methadone

Used to treat moderate to severe pain, methadone is also used for recovering heroin addicts (as well as other substance abuse) as a way of calming cravings. Though used to combat cravings and withdrawal symptoms, methadone is still highly addictive if misused. 

Morphine

Long used to treat severe pain, morphine is still a mainstay of modern medical pain relief. It is also incredibly addictive and if abused can lead to overdose and death. 

Oxycodone

Often sold under the more recognizable OxyContin and Percocet, oxycodone is a widely used and addictive painkiller.

Effects of Opioid abuse

Opioids relieve chronic pain and distress, and are often prescribed to people who are struggling with acute pain related to an injury, illness, or surgery. When taken for long periods or in larger doses than prescribed, people can easily become addicted to these drugs. It is even possible to become addicted to a prescribed opioid when taking it as prescribed, although it is more common for people to increase their dose to overcome tolerance. 

Some people who become addicted to prescription opioids go on to buy illicit opioids like heroin. As a person’s addiction worsens, they tend to prioritize the drug over other important tasks, responsibilities and relationships, and they often begin experiencing negative consequences as a result of their addiction.

Opiate overdose

There is currently an opioid epidemic occurring in the United States. In 2019, nearly 50,000 people in the United States died from opioid-involved overdoses. [3] The misuse of and addiction to opioids-including prescription pain relievers, heroin, and synthetic opioid such as fentanyl-is a serious national crisis that affects public health as well as social and economic welfare.

Opioid addiction

Like most forms of addiction, a person with opioid use disorder will be diagnosed by a licensed professional using these 11 criteria, outlined by the DSM-5: [4]

  1. Hazardous use: You have used the substance in ways that are dangerous to yourself and/or others, i.e., overdosed, driven while under the influence, or blacked out.

  2. Social or interpersonal problems related to use: Substance use has caused relationship problems or conflicts with others.

  3. Neglected major roles to use: You have failed to meet your responsibilities at work, school, or home because of substance use.

  4. Withdrawal: When you stop using the substance, you experience withdrawal symptoms.

  5. Tolerance: You have built up a tolerance to the substance so that you have to use more to get the same effect.

  6. Used larger amounts/longer: You have started to use larger amounts or use the substance for longer amounts of time.

  7. Repeated attempts to control use or quit: You've tried to cut back or quit entirely, but haven't been successful.

  8. Much time spent using: You spend a lot of your time using the substance.

  9. Physical or psychological problems related to use: Your substance use has led to physical health problems, such as liver damage or lung cancer, or psychological issues, such as depression or anxiety.

  10. Activities given up to use: You have skipped activities or stopped doing activities you once enjoyed in order to use the substance.

  11. Craving: You have experienced an intense craving for the substance.

These criteria are measured by the negative impact the substance has on a person's life; including physical, psychological, and behavioral measures, and are classified as mild, moderate, and severe. The criteria are measured against the previous 12 months of substance use and a score of 2-3 is considered mild, 3-5 moderate, and 6 or more severe. Even severe opioid addictions can be treated and overcome. [4]

Opioid withdrawal symptoms

Most people who develop opioid abuse disorder become physically addicted to the drug and will experience uncomfortable withdrawal symptoms when they try to cut back or stop using. Opioid withdrawal symptoms are normally not medically dangerous but do cause extreme discomfort and illness, and many will end up relapsing during the withdrawal phase because of this discomfort.

Withdrawal symptoms range from mild to severe, and the severity depends on a number of factors. Factors also play a part in determining the severity of opioid withdrawal symptoms, such as current level of health, any underlying mental or health disorder, the length of addiction, the dose they’ve been using, and how the substance was administered. 

Withdrawal symptoms normally set in within 24 hours of the last dose and someone experiencing them can expect a combination of the following: 

  • Agitation, anxiety, and mood swings

  • Muscle spasms, cramps, aches, and pains

  • Insomnia and restless legs

  • Runny nose and cold-like symptoms

  • Sweating, hot and cold chills, sometimes fever

  • Abdominal cramps, nausea, diarrhea, and GI upset

  • Tremors or shaking

  • Feeling generally ill and having flu-like symptom

Treatment for Opiate addiction

There are both inpatient and outpatient programs available to help with opioid abuse. For those suffering from opioid withdrawal, detoxing in an inpatient or outpatient rehab facility with medication-assisted treatment (MAT) can help to reduce discomfort and support the early phases of recovery. Being in a safe, structured setting can also increase the likelihood of success by removing triggers for relapse.

Most people who complete a rehab program for drug addiction will often need ongoing support to aid recovery, such as additional therapy, support groups, and 12-step programs. Long-term opioid addiction treatment can help to improve the likelihood of successful, lasting recovery. Many people also opt to take medications like Suboxone or Methadone to help ease withdrawals and reduce cravings.

If you or someone you know is suffering from opiate addiction, contact a treatment center today.