What Are Opioids?

Discover the impact, types, effects, and prevention of opioids.

Dr. Deyhimy MD
May 1, 2024

Understanding Opioids

Opioids are a class of drugs that derive from, or mimic, natural substances found in the opium poppy plant. They work in the brain to produce a variety of effects, including pain relief. Opioids can be classified into two main categories: opiates and opioids.

Definition and Classification

Opiates refer to natural opioids such as heroin, morphine, and codeine, while opioids encompass a broader range of substances. According to the Centers for Disease Control and Prevention (CDC), opioids include all natural, semisynthetic, and synthetic substances that have similar effects to opiates.

Opioids can be derived from naturally occurring plant compounds found in the opium poppy plant, or they can be synthetic or a combination of naturally derived and synthetic ingredients. Some commonly prescribed opioids include OxyContin, Percocet, Palladone, and Vicodin, while heroin is an illegal and highly addictive form of opioid with no medical use [2].

Differences Between Opiates and Opioids

The main distinction between opiates and opioids lies in their origin and classification. Opiates specifically refer to naturally occurring opioids derived from the opium poppy plant. On the other hand, opioids encompass a broader range of substances, including natural, semisynthetic, and synthetic opioids.

While both opiates and opioids can produce similar effects in the brain, the term "opioids" is often used to refer to the entire class of substances that act on opioid receptors in the body. This classification allows for a more comprehensive understanding of the various substances and their impact on individuals.

Understanding the difference between opiates and opioids is essential when discussing the broader implications and effects of these substances. It helps to provide clarity in medical and scientific contexts, as well as in discussions surrounding the opioid epidemic and the development of appropriate strategies for prevention and treatment.

Impact of Opioids

The impact of opioids on individuals and communities has been significant, leading to what is commonly referred to as the opioid epidemic. Understanding the scope and trends associated with this epidemic is crucial in addressing the challenges it presents.

Opioid Epidemic Overview

The opioid epidemic refers to the widespread misuse and addiction to opioids, including prescription pain relievers, heroin, and synthetic opioids such as fentanyl. Over 75% of drug overdose deaths in 2021 in the United States involved opioids, making it a public health crisis [3]. The impact of the opioid epidemic is not limited to a single demographic or geographic area. It affects individuals of all ages, races, and backgrounds.

The epidemic has had a particularly devastating impact on small towns and rural areas, affecting the quality of life, economic opportunity, and rural prosperity. In fact, drug overdose death rates have risen in both rural and urban areas, with some rural counties experiencing higher rates than their urban counterparts. The crisis has also affected the agricultural community, with a survey revealing that as many as 74% of farmers have been directly impacted by the opioid crisis.

Statistics and Trends

The statistics surrounding the opioid epidemic paint a concerning picture. From 2020 to 2021, the number of drug overdose deaths increased by more than 16%, with over 75% of the nearly 107,000 drug overdose deaths in 2021 involving an opioid. The rise in opioid overdose deaths can be divided into three distinct waves, with each wave characterized by different factors and substances involved.

Age-adjusted rates of drug overdose deaths in the United States increased by 31% in 2020 compared to 2019. Adults aged 35-44 had the highest rates of drug overdose deaths, while young people aged 15-24 experienced the greatest percentage increase in deaths. These statistics highlight the need for comprehensive prevention, treatment, and recovery efforts across all age groups.

It is important to note that opioids are not only involved in overdose deaths but are also associated with a significant number of cases of opioid use disorder. More than 2 million Americans misuse opioids, and over 90 Americans die by opioid overdose each day. These numbers emphasize the urgency in addressing the root causes of opioid addiction, improving access to treatment, and implementing prevention strategies.

To combat the opioid epidemic, collaboration is essential. Medical personnel, emergency departments, first responders, public safety officials, mental health and substance use treatment providers, community-based organizations, public health, and community members all play a role in addressing the opioid overdose epidemic. By working together, implementing evidence-based interventions, and raising awareness, progress can be made in preventing opioid misuse, promoting treatment, and saving lives.

Types of Opioids

Opioids are a class of drugs that derive from, or mimic, natural substances found in the opium poppy plant. They work in the brain to produce a variety of effects, including pain relief. There are two main categories of opioids: prescription opioids and illegal opioids.

Prescription Opioids

Prescription opioids are medications that are legally prescribed by a doctor to treat persistent or severe pain. They are used by individuals with chronic headaches, backaches, recovering from surgery, experiencing severe pain associated with cancer, and by adults and children who have been injured playing sports or in various incidents. These medications may be given orally, via a skin patch, under the tongue, or by injection.

Prescription opioids come in various forms and are known by several names, including OxyContin, Percocet, Palladone, and Vicodin. These medications are intended to provide relief for individuals with legitimate medical needs. However, their long-term use for chronic noncancer pain is controversial due to concerns of psychological addiction, abuse, and diversion of these medications.

Illegal Opioids

Illegal opioids, such as heroin, are not prescribed by healthcare professionals and are obtained through illegal means. Heroin is a highly addictive and dangerous opioid. In 2021, 25 people died every day from a heroin overdose in the United States.

Another illegal opioid that has been on the rise is fentanyl. Fentanyl is a synthetic opioid pain reliever that is significantly more potent than other opioids. It is approved for treating severe pain, typically advanced cancer pain, when used under medical supervision. However, illegally made and distributed fentanyl has become a major concern in several states. Fentanyl is 50 times more potent than heroin and 100 times more potent than morphine. It is often available in counterfeit pills or mixed with heroin and/or cocaine [7].

It is important to note that while opioids can provide effective pain relief when used as prescribed by healthcare professionals, they also carry risks of addiction, dependence, and overdose. Understanding the different types of opioids and their potential dangers is essential for both healthcare professionals and the general public.

Effects and Risks

Opioids, while effective in reducing pain, carry various effects and risks that need to be understood. It is important to be aware of the physical effects of opioids and the potential risks associated with their use and misuse.

Physical Effects of Opioids

Opioids can have both desired and undesired physical effects. They are known to reduce the perception of pain, providing relief to individuals suffering from different conditions. However, they can also cause several side effects, including drowsiness, confusion, euphoria, nausea, and constipation. These effects can vary depending on the individual and the specific opioid being used.

At higher doses, opioids can slow down breathing, which can be potentially life-threatening. It is crucial to use opioids under the supervision and guidance of healthcare professionals to minimize the risk of respiratory depression and other severe complications.

Risks of Opioid Use and Misuse

The use and misuse of opioids carry significant risks. Prescription opioids, when not used as prescribed or taken for non-medical purposes, can lead to harmful effects. Slowed breathing, known as respiratory depression, is one such risk that can result in hypoxia and have short- and long-term neurological effects like coma, permanent brain damage, or death.

Opioids are associated with common side effects, such as sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, and respiratory depression. Less common side effects may include delayed gastric emptying, hyperalgesia, immunologic and hormonal dysfunction, muscle rigidity, and myoclonus.

One of the most prevalent side effects of opioid usage is constipation, which can have a high incidence and may not develop tolerance often. Severe constipation and nausea may lead to the discontinuation of opioids, resulting in under-dosing and inadequate pain management [6]. It is essential for healthcare providers to monitor and manage these side effects to ensure the optimal balance between pain relief and overall well-being.

It's important to note that opioids are considered broad-spectrum analgesic agents, affecting numerous organ systems and influencing various body functions. Therefore, it is crucial to use opioids responsibly, under medical supervision, and as part of a comprehensive pain management plan.

Understanding the physical effects and risks associated with opioids is vital for both healthcare professionals and individuals using these medications. By being informed, one can make educated decisions about opioid use and work towards minimizing risks while maximizing the potential benefits.

Treatment and Prevention

Opioid Use Disorder

Opioid use disorder (OUD) refers to a condition where individuals experience addiction to opioids. It occurs when attempts to cut down or control opioid use are unsuccessful, resulting in social problems and a failure to fulfill obligations at work, school, and home. Opioid addiction often follows the development of opioid tolerance and dependence, making it physically challenging to stop opioid use and increasing the risk of withdrawal [9].

Treatment for opioid use disorder typically involves a comprehensive approach that combines medication-assisted treatment (MAT) with counseling and behavioral therapies. MAT involves the use of medications, such as methadone, buprenorphine, and naltrexone, to reduce cravings and withdrawal symptoms, allowing individuals to focus on their recovery. Counseling and behavioral therapies help individuals address the underlying factors contributing to their opioid use disorder and develop coping strategies for long-term recovery.

Strategies for Prevention

Preventing opioid misuse and addiction is a critical component of addressing the opioid crisis. Collaborative efforts involving various stakeholders are essential for success in preventing opioid overdose deaths. Medical personnel, emergency departments, first responders, public safety officials, mental health and substance use treatment providers, community-based organizations, public health, and members of the community all play a role in addressing the opioid overdose epidemic [5].

Some strategies for preventing opioid misuse and addiction include:

  • Enhanced education and awareness: Educating healthcare professionals, patients, and the general public about the risks associated with opioids, proper pain management, and alternative treatment options can help reduce the unnecessary use of opioids.

  • Improved prescription practices: Implementing guidelines and regulations for prescribing opioids, such as limiting the duration and dosage of opioid prescriptions, utilizing prescription drug monitoring programs, and promoting the use of non-opioid pain management strategies, can help prevent inappropriate opioid use.

  • Expansion of access to treatment: Increasing access to evidence-based treatment options, including medication-assisted treatment (MAT) and counseling, can help individuals with opioid use disorder receive the care they need to recover and reduce the risk of relapse.

  • Community-based interventions: Implementing community-based programs that focus on early intervention, harm reduction, and overdose prevention, such as naloxone distribution and syringe exchange programs, can help save lives and connect individuals with necessary treatment resources.

  • Public health surveillance and response: Strengthening public health surveillance systems to track opioid-related overdoses, identifying emerging trends, and implementing targeted prevention efforts can help inform and guide public health responses to the opioid epidemic.

The Biden-Harris Administration has also taken action to expand access to evidence-based prevention, treatment, harm reduction, and recovery support services. Additionally, efforts are being made to reduce the supply of illicit drugs like fentanyl to address the opioid epidemic.

By implementing a multifaceted approach that combines prevention, education, access to treatment, and community-based interventions, it is possible to reduce the impact of opioid use disorder and work towards mitigating the opioid crisis.

Role of Healthcare Professionals

Healthcare professionals, including anesthesiologists, play a crucial role in managing pain effectively and safely. With their extensive training and experience in prescribing opioids and non-opioid pain medications, they can ensure pain relief while minimizing side effects and the risk of addiction associated with opioid use.

Anesthesiologists' Involvement

Anesthesiologists, in particular, have specialized knowledge and expertise in pain management. They are equipped to develop tailored treatment plans for individual patients, taking into account their specific needs and minimizing the risk of addiction and side effects.

Anesthesiologists are trained to balance the need for pain relief with the potential risks of opioid use. They employ various strategies to manage pain effectively, including the use of non-opioid medications, regional anesthesia techniques, and multimodal pain management approaches. By utilizing these alternative methods, they can reduce the reliance on opioids while still providing effective pain relief.

Managing Pain Effectively

Anesthesiologists are at the forefront of efforts to improve pain management and reduce opioid-related risks. They collaborate with other healthcare professionals to develop comprehensive pain management plans that prioritize patient safety and minimize the reliance on opioids.

By utilizing a combination of pharmacological and non-pharmacological interventions, anesthesiologists can help patients manage pain in a safe and effective manner. This may include the use of non-opioid pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, as well as techniques like nerve blocks or epidurals.

Anesthesiologists also provide education and support to patients regarding pain management and the potential risks associated with opioid use. They work closely with patients to ensure they understand their treatment options and are actively involved in decision-making regarding their pain management plan.

In summary, anesthesiologists play a vital role in managing pain effectively and safely for patients. Their expertise in prescribing opioids and non-opioid pain medications allows them to develop individualized treatment plans that prioritize patient safety, minimize the risk of addiction, and optimize pain relief. By utilizing a multimodal approach and collaborating with other healthcare professionals, anesthesiologists are dedicated to improving pain management practices and reducing opioid-related risks.


About the Author
Dr. Deyhimy MD

Dr. David Deyhimy, with over 20 years of experience, is a board-certified physician in addiction medicine and anesthesiology based in Orange County.

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