What Are Opioids?

Opioids are substances that act on opioid receptors in the body. Some are prescribed for pain or other medical purposes, and others are obtained through an unregulated drug supply. They can relieve pain, but they can also cause sedation, physical dependence, opioid use disorder, and fatal overdose.

For short-term mild body pain, over-the-counter (OTC) medications such as paracetamol and ibuprofen are usually enough to induce relief. However, a patient may experience more intense pain in circumstances that necessitate stronger treatment. These situations can include recovery from major surgical operations and injuries from sports, elevated falls, and other types of accidents. In these cases, doctors might prescribe stronger narcotic medications known as opioids to ease the pain. Opioids may be appropriate for selected pain conditions when the expected benefits and risks have been assessed.

While opioids can relieve moderate and severe pain, there are known risks associated with these treatments, most notably the potential for drug addiction. Opioids are among the most addictive drugs used worldwide, and opioid use disorder (OUD) can lead to recurring harmful physical and emotional repercussions. Below, we answer the question, "what are opioids?" We also shed light on possible treatment options for people who use opioids and are seeking help.

What Makes a Drug an Opioid, and What Are Opioids Used For?

Opioids are chemical drugs that operate by binding to opioid receptors in the spinal cord, brain, gut, and other areas of the body. Natural opioids are a class of drugs extracted from the opium poppy plant, while synthetic opioids are artificial compounds made in a laboratory that emulate the mechanisms of their natural counterparts.

Our current understanding of how opioids work is that they regulate the transmission of pain signals and produce significant amounts of the reward neurotransmitter known as dopamine. These processes are responsible for the familiar pain-relieving effect known to opioids, but they also induce a relaxing "high" or a heightened sense of euphoria. We can observe that this addictive outcome, combined with the tendency for patients to develop tolerance, runs the risk of causing OUD.

Physical dependence, tolerance and addiction are not the same thing. Physical dependence means the body has adapted and withdrawal may occur when the medicine is reduced or stopped. Tolerance means the response to a dose has changed. Opioid use disorder involves a problematic pattern of use causing impairment or distress. Tolerance and withdrawal alone do not count toward the diagnosis when they occur solely during appropriate medical treatment. CDC: Diagnosing opioid use disorder

List of Opioids

There are many types of opioids, both prescribed and illicit. In this section, we present a common opioid list accompanied by descriptions of each form of the drug. Buprenorphine and methadone are also opioids, with important roles in treating opioid use disorder.

Heroin

Heroin is an opioid with a chemical composition similar to that of morphine. This compound is extracted from the seed pod of various opium poppy flowers in Southwest Asia and Latin America, and it can appear in the form of a white or brown powder or a viscous black tar. Injecting, sniffing, and smoking are the common methods of intaking heroin. Some people even mix the substance with other drugs such as cocaine.

Heroin is highly addictive, and it can enter the brain very quickly and slow down the heart rate and breathing. Short-term effects of the drug include dry mouth, nausea, vomiting, and impaired cognitive function. Overdose involves dangerous suppression of breathing or consciousness and requires immediate action.

Oxycodone

Synthesized via the compound thebaine from the opium poppy, oxycodone is a semi-synthetic narcotic commonly used for relieving moderate to severe pain. Much like other opioids, oxycodone acts on the central nervous system (CNS). This medication generally comes in the form of capsules, tablets, or a solution, and it is also available in combination with other analgesics like ibuprofen and aspirin.

While oxycodone is sold on the market under brand names like OxyContin® and Percodan®, the drug is only legally available through a prescription. Common street names for oxycodone are OC and kicker, and it is often misused via either an oral or intravenous route. It is very possible to overdose on oxycodone, with its known effects including extreme drowsiness, fainting, coma, and even death.

Fentanyl

Fentanyl is a synthetic opioid first introduced in the 1960s for its use as an intravenous anesthetic. The manufacture and distribution of fentanyl is legal under supervision of a medical professional, but it is also made and sold illegally.

Pharmaceutical fentanyl prescribed by doctors often appears in oral lozenges, transdermal patches, and sprays. Meanwhile, illicitly manufactured fentanyl may appear in powders or counterfeit pills, sometimes without the person's knowledge. CDC: Fentanyl One can use fentanyl test strips to check for the presence of the compound in drugs.

Warning signs of an overdose include inability to wake, slow or abnormal breathing, and blue or gray lips or skin. Call 911, give naloxone if available, and follow dispatcher instructions. CDC: Responding to an overdose

Hydrocodone

A frequently prescribed opioid in the United States, hydrocodone is an orally active substance used as a pain reliever as well as a cough suppressant. It is chemically similar to codeine and morphine and produces similar physical effects. In medications, hydrocodone is usually present in combination with other compounds such as acetaminophen (Vicodin®, Norco®, Lorcet®, and Lortab®) and antihistamines (Hycomine®).

Also known by street names such as Hydro and Vikes, hydrocodone is prone to oral misuse in the form of tablets, capsules, and syrups. Dizziness, anxiety, and depression are observed to be prolonged effects of hydrocodone. Unmanaged physical and mental dependence may lead to an overdose, which can cause loss of consciousness and death. Products that combine an opioid with acetaminophen also raise considerations about liver injury.

What Are the Most Abused Opioids?

Opioids are involved in most drug overdose deaths in the United States. In 2020, 68,630 overdose deaths involved opioids according to the CDC, which was approximately 75% of the total overdose deaths for that year. Synthetic opioids made up the majority of those opioid-related deaths (the cause of 82% of deaths in 2020), specifically illicitly-produced fentanyl. This was attributed to the high potency of fentanyl and the increasing number of drug submissions testing positive for fentanyl, not a higher rate of official fentanyl prescriptions. For current figures, see CDC: Understanding the opioid overdose epidemic.

Aside from fentanyl, heroin, hydrocodone (Vicodin®), and oxycodone (OxyContin®) are among the commonly misused opioids. Drug deaths involving heroin in particular were seven times higher in 2020 compared to 1999. The combined sensation of euphoria and pain relief produced by these opioids plays a major part in these numbers.

Alcohol and other sedatives can increase overdose risk. Naloxone should be available when opioid exposure is possible.

Opioid Addiction Treatment Options for Long-Term Users

For long-time users of opioids, we strongly suggest considering several addiction treatment options available to reduce the risk of future health conditions associated with prolonged misuse of the drugs.

• Medications: Medications such as methadone and buprenorphine can ease opioid withdrawal and reduce cravings. Medications like Suboxone are available online through a video visit with a licensed provider. Buprenorphine, methadone, and naltrexone are evidence-based medications with different actions and initiation requirements. CDC: Treating opioid use disorder Buprenorphine and methadone can reduce overdose and mortality risk in treatment, but they still require appropriate prescribing and monitoring, and both still carry a risk of overdose. Naloxone is the emergency reversal medicine, not an ongoing craving treatment.
• Counseling and behavioral therapies: Aside from medications, long-term maintenance therapy that involves counseling and behavioral therapy can support recovery from opioid addiction. We recommend these programs, as they usually incorporate family therapy, support groups, and motivational interviews to address the roots of the addiction as well as optimize channels for further treatment.
• Residential treatment: Lastly, residential treatment programs allow patients to live alongside people experiencing similar situations for further support during recovery. These programs provide intensive help specifically attuned to the needs of each individual, with some hospitals offering the option of inpatient rehabilitation for those with medical conditions. We believe these residential programs can be more effective once appropriately supplemented by other treatments mentioned above, such as medications and behavioral therapies.

Contact a clinician if you are taking more than intended, repeatedly struggling to cut down, or continuing despite harm. You can ask for an assessment before a crisis. If you take a prescribed opioid regularly, do not change the dose or stop it without talking to the prescriber.

Start Suboxone treatment online. You can see one of our Suboxone doctors online, by video. The first visit is $89. Follow-up visits are $50 weekly, $75 every two weeks or $89 monthly. Visits are cash pay, and medication is priced separately.