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Opiates and Opioids: New Understanding of an Old Problem


Opiates and Opioids are two words (and substances) that can often be intertwined and confused, but have some major differences. Opiates are derived from the opium poppy plant and are naturally occurring substances.  Opiate drug types include heroin, opium, morphine, and codeine. While similar to opiates, opioids are synthetic drugs (man-made) that produce opiate-like effects.  Opioids include oxycodone (Oxycontin), hydrocodone, and fentanyl.

Opiates have been used for centuries by various ancient cultures for recreational use and pain relief. They were so valued by individuals for their narcotic affects that two wars, in the 19th century, were fought over opium. Morphine was used as a pain killer during the Civil War, and Heroin was produced for commercial distribution in the 1890s, meaning individuals could simply purchase opiates for cough and pain from a drug store.

In 1914, the Harrison Act began regulating the marketing of opiates, limiting the distribution of opiates to doctors. Today, doctors can still prescribe opiates/opioids, however the regulations for prescribing have changed.  By the mid-1960s illicit heroin use began a comeback that lasted through the 1990s.  Heroin use declined in the early 2000s, but then began to trend upward again in 2010.  In 1995, Oxycontin was introduced and aggressively marketed as a safe pain pill by Purdue Pharma.   In 2007, the federal government filed criminal charges against Purdue Pharma for pushing OxyContin prescribing practices. The battle to regulate opiate/opioid use has raged in the United States for over a hundred years.

Opiate and Opioid use has a lengthy history, and misuse of them has waxed and waned over centuries.  In more recent years, the misuse of opiates/opioids has grown to epidemic proportions. Nationally, opioid-related ER visited increased 99% between 2005 and 2014. Opiates and opioids claim the lives of more than 120 Americans daily.  According to the Florida Medical Association, more than 14 people die from opiate/opioid use and nearly 30 non-fatal overdoses occur every day in the state. From 2017 to 2018, Volusia County opioid-involved non-fatal overdose emergency department visits increased by 20%.

The term “opioid epidemic” was officially coined in the 1990s, though it was declared a national public-health emergency in 2017.  Since that time, funding has increased and more light has been shed on understanding why this specific drug addiction has had such a major impact on the lives of so many Americans.  Understanding the epidemic means understanding addiction and how our brains react to opiates/opioids. The American Society Addiction Medicine (ASAM) defines addiction as a “treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.”

Our brains produce very small amounts of opiates naturally. Opiates and opioids work by binding to our opiate receptors in the brain.  Once attached, they mimic the effects of the pain-relieving chemicals that our brains produce naturally. These substances then produce their intended results by providing pain relief, but also trigger the body’s natural rewards system. They hijack these receptors, which control our motivation and drive for survival — such things as hunger, thirst, fight or flight reflexes, and our desire to procreate are all controlled here. Once this system is hijacked by the feelings that opiates and opioids produce, the brain starts to value the feeling over other essentials needed for survival.   This positive feeling associated with the drug’s use causes people to seek that feeling again by taking more of the medication. Over time, use of these substances change the brain’s chemistry. When these changes occur, a person may begin to depend on the drug just to feel normal.

Understanding how the brain is affected by opiate and opioid use helps us understand how to treat the addiction.  The use of medication in combination with other behavioral therapies is used in the treatment of Opioid Use Disorder (OUD). This is similar to the use of medication, in combination with behavioral therapies, for other chronic diseases like hypertension, diabetes, and asthma. 

Understanding addiction as a disease helps us treat addiction as a disease.  The medications used to treat OUD occupy the brain receptor sites affected by opiates and opioids.  With these medications, those same receptors that are hijacked by the substances are taken back. Some of the effects of that action are: normalized brain chemistry, relieved physiological cravings, prevented withdrawal, normalized bodily functions, non-impaired functioning, and no negative effects on intelligence, mental capability, physical functioning, or employability. 

Knowledge of how opiates/opioids affect the brain and how Medication Assisted Treatment can help individuals with OUD recover helps dispel the stigma surrounding the addiction. Treating the disease as we would any other medical condition normalizes the process for individuals seeking help.

If you or someone you know needs assistance with opiate/opioid use, please contact SMA’s Access Center at 1-800-539-4228.