The Science of Recovery: Understanding Opiates & Opioids

Understanding opiates requires understanding their history. For more than 5,000 years, people have cultivated the poppy and prized it for its ability to numb pain. Addicts have been using the poppy and its derivatives since it was first cultivated.

Although all drugs derived from the poppy or designed to mimic its effects share certain common characteristics, they can differ greatly in terms of potency. In the first of our series on “The Science of Recovery,” we spoke to Dr. Deni Carise, Chief Clinical Officer of the Recovery Centers of America and Adjunct Clinical Professor at the University of Pennsylvania, about the distinction between opiates and opioids—a distinction that, for those whose lives have been touched by addiction, can mean the difference between life and death.

Opiates

“An opiate is derived directly from the poppy plant, like opium,” says Dr. Carise, while “an opioid is chemically manufactured.”

The most famous opiate, opium has been a fixture in western civilization for hundreds of years. More modern opiates include morphine and codeine, which have found use in the medical field for their ability to block the brain’s pain receptors. Besides killing pain, the drugs produce a feeling of euphoria that makes them addictive. As users require more and more of the drug to feel high, the drugs slow the body’s central nervous system, particularly the respiratory system, which can shut down entirely in case of overdose.

Opioids

As with opiates, heroin binds with the brain’s opioid receptors which control pain, pleasure and vital processes such as blood pressure and respiration.

Fentanyl, a Schedule II prescription drug, originally used for anesthesia and severe post-surgery pain. Though fentanyl is 50 to 100 times more potent than morphine, it is not the strongest opioid around. That distinction goes to carfentanil, which is 10,000 times more powerful than morphine.

“It’s used in veterinary science to sedate large, large animals, like an African elephant,” Dr. Carise says. “A dose the size of a couple grains of salt can kill a person.”

That may sound like something no human would want to mess with, but repeated opiate and opioid usage raises users’ tolerance and compels them to “chase the high” that they got when they first started using.

“We’ve seen that when there’s a batch that’s causing overdoses on the street, people actually want to buy it more because they think it will get them that initial high back, and somehow think they won’t die—they’ll be able to control it,” says Dr. Carise. “When someone has been doing the drug for so long, they don’t think they can overdose. But there’s really no way to know how it will affect them, or what’s in the drug they’re buying.”

Treatment

“Both opiates and opioids can kill you equally quickly,” says Dr. Carise. “The fact that an opiate is a natural substance does not make it any less dangerous.”

Dr. Carise says there is little difference in the overall treatment of addiction to opiates vs. opioids, but there is a difference in treatment when it comes to overdoses: Overdoses from traditional opiates, such as opium, morphine and codeine, and common opioids, such as heroine and OxyContin, can be counteracted by the drug Narcan. With adulterated, super-powerful opioids, Narcan isn’t as effective.

“A single dose of the drug Narcan might work for heroin, but not for fentanyl or carfentanil,” Dr. Carise says. “The carfentanil can outlive the Narcan and sometimes cause another overdose, sometimes even an hour later.”

“If you get Narcan and it works for you,” she says, “even if you feel fine, you should still go to the hospital, and you should still absolutely seek treatment.”