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Tuesday, April 4, 2017

Dope 101: Opioids, opiates… six of one isn’t a half-dozen of the other




(Originally posted on AddictedMinds.com)

The terms opioids and opiates are frequently – and mistakenly – used as interchangeable words for the same drug when they really mean two related drug classes. The media doesn’t get that. Nor do they have to when they ring the ‘epidemic’ bell to get more viewers. For the record, we have a drug crisis, not just an opioid or opiate crisis.
An opiate is a natural narcotic analgesic (e.g. painkiller) derived from the opium poppy. Think opium, morphine, and heroin.
An opioid is a synthetic narcotic analgesic created in a lab to mimic or intensify or attempt to remove undesired inconsistencies of the natural product. Think Oxies.
Physicians used to prescribe the former. They now prescribe the latter when other pain meds like ibuprofen or acetaminophen aren’t strong enough. Street dope used to be only the former. Now street dope can be purely the former, impurely the former, or even mixed with the latter with usually disastrous outcomes.
From a dependency treatment standpoint, both classes are essentially equal in their abilities alter neurochemical processes in the body and change how the brain and body work over time. With the opioids, the carnage is often quicker. To explain the reason for that, I’m tossing out two words that will slay your opponent is Scrabble: Dolorimetry and pharmacopeia.

Big words, bigger problems

It all starts with pain. Dolorimetry (dolor is Latin for pain) is the measurement of pain in animals and, notably, humans are animals. If humans can measure it, they next want to fix it. There’s a long human history of not tolerating pain and seeking a remedy for it. And from that we get the ancient Greek word pharmacopeia, the science or study of drugs, their preparation, properties, uses, and effects.
For thousands of years, opium was used to treat the pain. In the 1500’s, laudanum (opium dissolved in alcohol) became the next generation. In the early 1800’s, the most active part of opium, morphine, was extracted. A less active part – codeine, about two percent of opium – was also extracted. Merck went commercial with morephine in 1827. Tens of thousands of Civil War soldiers became addicts. In 1874, heroin was first made by boiling down morphine in an attempt to find something twice as strong but less addictive. They got it half right… and by most accounts a century and a half later: ALL wrong.

Opioids speeding the way to ruin

Opium was banned in the U.S. in 1905 and set in the opioid lab race, which really took off later that decade when Bayer (yes, THAT Bayer) stopped mass production of heroin because of its dangers. Oxycodone was born in the lab in 1916. It was hoped that oxycodone would retain the analgesic effects of morphine and heroin with less dependence. Nope. But it still lives on today as OxyContin and Percocet. Hydrocodone was first synthesized in 1920, approved in the U.S. in 1943 and became Vicodin in 1984. Hydromorphone (Dilaudid) was first synthesized in 1924. Methadone was created in a lab in 1937 to find something, again, less addictive than morphine and heroin in surgery. Epic fail. Janssen Pharmaceuticals gave us fentanyl in 1959.
Which leads us to the latest trend is mixing into cheap street heroin even cheaper, illegal modifications of fentanyl (like carfentanyl) thousands of times more powerful than morphine or heroin.
By the way, that old opiate, morphine, is still among the World Health Organization’s List of Essential Medicines because of its relative safety in comparison to the misbegotten offspring. However, we can’t put the pharmacopeia toothpaste back in the tube and we have a drug crisis today.


Addicted Minds’ Editor-in-Chief, Scott Stevens, is the author of four alcohol books including the December 2016 release, I Can’t See The Forest With All These Damn Trees In The Way: The Health Consequences of Alcohol. Buy the new BookLocker title now on Amazon (viewbook.at/prehab), alcohologist.com, and everywhere books are sold. Stevens also heads up BlogTender LLC, a content marketing firm headquartered in Lake Geneva, Wis.