Opioid or opiate?
The terms “opioid” and “opiate” are often used interchangeably to describe drugs that have morphine-like effects in the brain. “Opiates” is used to describe only the naturally occurring substances derived from opium poppies. However, opioids include all types of substances that have these morphine-like effects in the brain and include semi-synthetic and synthetic drugs as well as the naturally occurring substances derived from the opium poppy. That is why most medical professionals prefer to use the term opioid when referencing the entire family of drugs, which include morphine, codeine and methadone. Endorphins are actually an opioid produced by the human body. Opioids attach to opiate receptors in the brain. Normally, these opioids are the endogenous variety created in the body. Once attached, they send signals to the brain of the “opioid effect,” which decreases pain, slows breathing, and has a sedating effect.
Prescription opioids can be used to treat moderate-to-severe pain and are often prescribed following surgery or injury or for health conditions such as cancer. In recent years, there has been a dramatic increase in the acceptance and use of prescription opioids for the treatment of chronic, non-cancer pain despite serious risks and the lack of evidence about their long-term effectiveness. According to the Centers for Disease Control and Prevention, providers in the United States wrote nearly a quarter of a billion opioid prescriptions in 2013. That’s enough for every American adult to have their own bottle of pills. Anyone who takes prescription opioids will become physically dependent and eventually can become addicted to them. In fact, as many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction. In addition to the risk of overdose, opioids can cause depression, constipation and low levels of testosterone.
Between 2000 and 2015, the rate of heroin-related overdose deaths in this country more than quadrupled, with more than 12,989 people dying in 2015. A highly addictive opioid, heroin is typically injected but it can also be smoked or snorted. Most heroin users live in large metropolitan areas and may also be addicted to marijuana or alcohol. Dr. Michael Mancino of UAMS’ Center for Addiction Services and Treatment says it’s important to recognize the symptoms of a heroin overdose and to act quickly if someone exhibits the symptoms, including shallow breathing, vomiting and excessive sleepiness. First and foremost, call 911. If the person has stopped breathing, CPR may be necessary but should be performed only by someone who has been trained in the procedure. Dr. Mancino says the drug naloxone, which can come in an auto-injection device, can be administered to treat a heroin overdose but should only be used by someone with the proper training.
Fentanyl is a synthetic opioid that’s 50 times more potent than heroin. Pharmaceutical fentanyl is primarily prescribed to manage pain associated with advanced cancer. It can be administered via injection, transdermal patch or in lozenges. The non-pharmaceutical version is often mixed with heroin or cocaine in order to increase the drug’s effect. Like heroin, fentanyl works by binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions. When it binds to these receptors, they can drive up dopamine levels in the brain’s reward areas, producing a state of euphoria and relaxation. The high potency of fentanyl greatly increases risk of overdose. Naloxone may be administered to treat a fentanyl overdose although multiple doses may be necessary. Depending on state and local laws, it can be administered by paramedics, law enforcement or family members who have obtained the medication.
Opioids are natural or synthetic chemicals that reduce feelings of pain. Some of the most commonly prescribed opioid pain relievers include hydrocodone, oxycodone and oxymorphone. Prescription opioids can help with some types of pain in the short term but they have serious risks. Even when taken as directed, they can cause nausea and feelings of confusion and dizziness. They should be used only as instructed and never taken in greater amounts than prescribed. Before taking any opioid medication, talk to your physician about all treatment options, including ones that do not involve prescription drugs. Be sure to tell your physician about past or current drug and alcohol use and discuss all of the risks and benefits of taking prescription opioids. Remember, your physician is a partner in your pain treatment plan. It’s important to talk about any and all side effects and concerns to make sure you’re getting the safest and most effective care.
Trusted by thousands of listeners every week, T. Glenn Pait, M.D., began offering expert advice as the host of UAMS’ “Here’s to Your Health” program in 1996. Dr. Pait began working at UAMS in 1994 and has been practicing medicine for over 20 years.