Opiates are derived from alkaloid compounds in the opium poppy plant.
Some of the oldest known drugs in the world, opiates have a long and storied history that spans centuries and several continents. According to The Atlantic, the first known record of opiate use comes from 3400 BC in lower Mesopotamia, or modern-day Iraq. The opium plant was cultivated there for medicinal and recreational use, where it was known as the “Hul Gil,” or the “joy plant.”
Opiate use spread over the centuries to ancient Greece, India, China, and the Roman empire. Doctors used the drug as a treatment for pain or as an anesthetic before major surgery. In fact, opiates such as heroin were mixed into common pharmaceutical drugs from 1527 until 1924, when the U.S. Food and Drug Administration passed the Anti-Heroin Act in response to climbing addiction rates in the country.
These days, opiates are considered Schedule II drugs. This means that, while the drugs are considered acceptable for certain medical purposes, they are known to be highly addictive. In fact, the American Society of Addiction Medicine reported in 2016 that 23 percent of individuals who heroin, one of the most common forms of illicit opiate, will develop an addiction to the drug. If an individual struggles with opiate use, they will be at risk for both physical and psychological dependence on the drug.
A Distinction: Opiates vs. Opioids
Today, the term opioid is largely used to describe both opiates and opioids; however, there used to be a notable distinction between the two. Both opiates and opioids are highly addictive and can make an individual susceptible to dependence and addiction, but how and from whom an individual receives the drug can be drastically different.
The term opiates technically refers to any drug derived from the opium poppy plant. While some opiates are used in medical practices for pain relief, others are considered Schedule I drugs, or drugs with no acceptable safety use. Opiates include:
In contrast, the term opioids refers to any drug that produces a similar effect to an opiate. These drugs are often synthetic or partially synthetic. Sometimes, addiction treatment centers use synthetic opioids to treat opiate addiction. Much like opiates, opioid use runs the gamut from medically acceptable to illicit. Opioid drugs include:
Again, most professional organizations simply use the term opioids to describe both opiates and opioids; however, the distinction is still made between the two categories by some organizations.
Learn About Specific Opiates & Related Drugs
Prescription and Illicit Use
While Schedule I drugs like heroin or LSD are widely considered more dangerous or addictive, a damning case against Schedule II opiates has been slowly building in the 21st century. Per the Center for Disease Control and Prevention, nearly 2 million Americans were addicted to and abusing prescription opioids in 2014. Since 1999, over 183,000 people have died from overdoses of prescription opioids.
These harrowing statistics have led the medical community to rethink their treatment tactics. Doctors all over the country are taking active steps to ebb the rising tide of addiction by encouraging non-opioid treatments, providing their patients with education on responsible use, and implementing prescription-drug monitoring programs to watch for signs of dependence.
The medical community’s conscious efforts to end prescription opiate abuse is admirable, and this concerted effort will undoubtedly save many lives. Of course, their efforts only help a portion of people struggling with opiates. Illicit drug use still runs rampant throughout the globe, and opiates play no small part in this ongoing epidemic. The United Nations Office on Drugs and Crime reported in 2013 that 0.3-0.4 percent of the world population used some form of illicit opiate – an excess of 20 million people.
For some, use of prescription opioids and illicit opiates are implicitly connected. A 2008 study in the journal Drug and Alcohol Dependence found that individuals who were dependent on heroin were also 3.9 times more likely to report misuse of prescription opioids in the previous year than those who were not using the drug. Other people may find their way to opiates through other illicit drugs, such as cocaine. Regardless of how one begins abusing opiates, the ultimate risk is the same: physical and psychological dependence, ultimately leading to addiction.
Signs and Effects of Opioid Abuse
If you are concerned that a loved one may be misusing opiates or opioids, keep an eye on them and watch for some of the common signs of abuse. Because opiates affect both the body and mind, you may notice both physical and mental changes. Some of the most common physical effects are:
- Shallow breathing
- Small pupils
- Rashes or flushed skin
- Slurred speech
You may also notice changes in your loved one’s behavior. As one develops a psychological dependency on opiates or opioids, they may begin to withdraw from friends, family, or activities they once enjoyed. They may also display psychological symptoms, such as:
- Poor judgment
- Issues with concentration
- Memory problems
If an individual uses opiates for too long, they may also put their body and mind at risk for severe, irreparable damage. Prolonged use of opiates can cause inflammation of the heart, which leads to an increased risk for a heart attack or stroke. Individuals using illicit opiates may also find themselves at a greater risk of infection and even HIV or AIDS, as many illicit opiates are injected and often needles are shared among drug users. Psychologically, long-term opiate use has been linked with mood disorders, such as depression. The drugs can also lead to hormone imbalances, which can reduce sex drive or even cause infertility.
For many, the most harrowing consequence of any drug use is the risk of overdose. As mentioned, opiate overdose is very substantial threat. In 2015, the CDC reported 13,000 heroin-related deaths and 33,000 deaths due to prescription opioid overdoses. Due to statistics like this and the potential for sustained health effects, there is a legitimate sense of urgency for those struggling with opiate abuse to get into treatment as soon as possible.
Treatment for Opiate Addiction
Since opiates foster such strong addictions, professional treatment is always recommended. Admittedly, the first step for many people is often the most uncomfortable: withdrawal. Once a person is dependent on opiates or opioids, they will find their body struggling without the drug. As the opiates begin to be processed out of the body, withdrawal symptoms may begin to appear. Common physical withdrawal symptoms include:
- Muscle and joint pain
- Runny nose
- Rapid breathing
- Excessive yawning
- Abdominal cramps
- Enlarged pupils
- Increased salivation
- Goosebumps or chills
- Loss of appetite
Withdrawal can also cause psychological distress and include symptoms like:
- Intolerable cravings
- Confusion or disorientation
Though opiate withdrawal can be incredibly uncomfortable, it is not generally life-threatening. Even so, medical detox is recommended to reduce the likelihood of relapse and keep the individual safe throughout the entire process. In addition, medical professionals may prescribe medications to ease specific symptoms of withdrawal, making the process more comfortable.
In some instances, replacement medications may be used to manage opiate withdrawal. The National Institute on Drug Abuse suggests three medications for the treatment of opiate addiction: methadone, buprenorphine, and naltrexone. Not only can these drugs help to decrease withdrawal symptoms, studies have shown that they also act as opioid antagonists, meaning they can block the effects of illicit opiates. The medications blocks opioids from binding to their receptors in the brain, thus removing their euphoric effect and their appeal.
While drugs should not be used for treatment exclusively – methadone and buprenorphine are opioids themselves – they can be effective when combined with other treatment methods. Behavioral therapy, for example, is the backbone of most treatment plans. Here, individuals have an opportunity to work with therapists on an individual basis to identify the root causes of the addiction and work to change thoughts and related destructive behaviors. In group therapy, clients can work with therapists and peers who share their struggle, collaborating to overcome addiction together. A 2010 study in Psychiatric Clinics of North America found that Cognitive Behavioral Therapy, particularly methods that use motivational strategies, was effective for people in treating addiction and decreasing the potential for relapse.
Overcoming Opiate Addiction
There is no official standard for a “full recovery” from drug addiction. Treatment can be lengthy, and it is intimately personal. It’s important to find a treatment program that offers a customized approach to recovery – one that takes into account the individual’s unique needs and tweaks care according to progress.
Treatment does not end once an individual finishes a particular rehab program. Ongoing aftercare, such as attendance at 12-Step meetings and continued therapy, is needed to safeguard against relapse. While relapse is common with all addictions, there are studies that indicate the specific potential for relapse after treatment for opiate abuse.
In a study outlined in the Irish Medical Journal, a group of opioid-dependent individuals completed inpatient addiction treatment. Within one week of leaving treatment, 59 percent relapsed to opioid use. By contrast, a study in the British Medical Journal found that opiate replacement treatment, such as the use of medications like methadone and buprenorphine, has an 85 percent chance of preventing death from relapse-related overdose in the first year alone. Again, when replacement medications are used in conjunction with comprehensive therapy, the chances of a robust recovery are much higher.