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Opioid VS Opiate VS Narcotics: What Are The Alternatives And Conversion Process?

Last Updated: January 14, 2022

Reviewed by Michael Espelin APRN

Opioids, opiates, and narcotics are all known as strong pain-relieving medicines and substances, and sometimes, these terms are often used interchangeably. Moreover, the differences between opiates vs opioids depend on their constitution and whether they are obtained naturally or synthetically, which, in its turn, affect the body in different ways. In 2019, it was reported that 62 million out of 275 million drug users used opioids, and 36.3 million of them acquired the fatal condition called opioid use disorder (OUD). So, the question is, are opiates good alternatives? What do opioids do to the body?

Opioid Vs Opiate: Are They The Same?

While both opioid vs opiate terms are frequently used interchangeably, the difference between opiate vs opioid exists. In opiate vs opioid, they are different from each other in that the former are naturally occurring compounds whereas the latter are synthetically produced. Both opioid vs opiate are classified as narcotics, although drug enforcement agencies around the world have adopted this term to mean any illegal drugs. Because of the high overdose, abuse, and addiction risk associated with them, they are available legally only through a doctor’s prescription. In this section information about opiate vs opioid differences will be provided.

What Are Opiates?

In opiate vs opioid, the former are substances that are obtained from naturally occurring opium from opium poppy plants, Papaver somniferum. Opium derived from poppy has long been known to possess medicinal properties and is believed to be responsible for creating a numbing sensation, pain relief, treating diarrhea, and inducing sleep. Opium alkaloids were later extracted from poppy plants and used in medicine for managing pain. These were called opiates and included alkaloids such as morphine, codeine, and thebaine. Examples of opiates include:

One similar thing about opiates vs opioids is that the use of these substances can cause tolerance and dependence. With regular use, the body can become tolerant to it, which would require higher doses taken at more frequent intervals. This leads to dependency and addiction. Since some people plant poppy seeds at their own home, using them for recreational purposes must be avoided.

A poppy field.

What Are Opioids?

What are opioids? It is a type of painkiller that is derived from non-natural sources of opium. They are categorized as semi-synthetic and synthetic opioids. Synthetics are completely created chemically, whereas semi-synthetics are derived from a hybrid combination of natural opiates and other chemicals. Patients with a prescription can buy these drugs like hydrocodone and use them at home for medical treatment.

Are opioids stimulants? No, they belong to the class of painkillers, whereas stimulants are those medicines that enhance the effects of nerve cells in the brain through the release of neurotransmitters. Stimulants enhance alertness, concentration, and energy in a person’s body, whereas these drugs are primarily used for treating pain and have a sedative effect on the person consuming it.

There Are Various Legal and Illegal Semi-synthetic and Synthetic Opioids Available. All of the Following Examples of Opioids Below Are Synthetic and Legal:

  • Methadone (Dolophine, Methadose)
  • Fentanyl (Actiq, Fentora, Duragesic, Subsys, Abstral, Lazanda)
  • Meperidine (Demerol)
  • Tramadol (Ultram, Ultracet, Ryzolt)
  • Carfentanil
  • Buprenorphine (Suboxone, Zubsolv, Bunavail)

Moving On, Some of the Semi-synthetic Examples of Opioids Are Listed Below. However, Take Note That Not All of These Examples of Opioids on This List Are Legal:

The opioid crisis in America has risen in recent years, with more and more people being addicted as they can be used at home. According to statistics about the crisis, more than 130 people die every day in the United States after overdosing on these drugs. When taken in high doses, effects of opioids can include dangerous symptoms, including breathing difficulties, which can even be fatal.

Narcotic Vs Opioid: What Is The Difference?

In narcotic vs opioid, the former are those drugs and chemicals that alter one’s state of mind and cause narcosis. According to the Centers for Disease Control and Prevention, initially, narcotics refer to substances that are used to relieve pain but the term narcotics was commonly mistaken as illegal drugs which cause dependency and addiction. Hence, the United States Drug Enforcement Agency (DEA) uses the term opioids instead of narcotics to avoid confusion. The only difference between narcotic vs opioid can be defined as being a subclass of narcotics. Thus, all opioids are narcotics, which can cause an overdose and dependence with regular and prolonged use.

Furthermore, take note that there are also drugs aside from opiate vs opioid that are considered narcotics. Some of these are the schedule I, and schedule II drugs. Examples of these are the stimulant drugs Focalin and Vyvanse.

Opioid Vs. Opiate Vs. Narcotics: Are They Safe?

Unfortunately, no. In opioid vs opiate vs narcotics, all of them are considered to be mind-altering medicines that offer pain relief and have a sedative effect. Addiction to these drugs can lead to serious and fatal repercussions.

According to a Study Of Doctors from Florida, Aside From Dangerous Overdoses, These Substances May Cause the Following Unwanted Events:

  • Dangerous behavioral responses
  • Substance use disorders
  • Possibility of diversion
  • Physical dependence
  • Increased risk of criminal activities
  • Increased risk of fatal withdrawal

Fortunately, there is a substance abuse treatment in case patients misuse or abuse these substances. This treatment requires professional help from experienced individuals who can guide patients in transitioning back to a sober and healthy lifestyle. In addition to this, there would be an incorporation of treatment stages for the patient to achieve a successful recovery.

Alternatives To Opioids: What Are The Best Non-Opioid Analgesics?

Opioids are effective in treating and managing pain. However, there are safer alternatives to opioids which can be used at home for pain relief that can be considered in cases of mild or moderate pain; situations where a patient is starting to show signs of opioid addiction or not responding appropriately to the current treatment. Different classes of drugs and substances can function as non-opioid pain meds.

These Examples of Opiates and Opioids Alternative Include (But Are Not Limited To):

  • Alpha-2-agonists
  • Anticonvulsants
  • Ketamine
  • Local anesthetics
  • Acetaminophen & NSAIDs

It is essential to note that some examples of opiates and opioid alternatives also have addictive properties and should be taken only after obtaining a medical prescription.

A doctor holds different pills in his hand.

Alpha-2-Agonists

Originally, alpha-2-agonists were best known for their role in treating hypertension and similar health disorders. However, since the turn of the century, they have increasingly been applied more widely – especially in anesthesia and pain management without opioids and opiates. Examples of alpha-2-agonists that are currently clinically certified to be effective for anesthesia and pain management in humans include:

It was discovered that alpha-2-agonists are effective in enhancing the analgesia provided by traditional analgesics, and this sole discovery unlocked the idea that these non-opioid analgesics could be applied effectively to treat cases of chronic, neuropathic, myofascial, and acute postoperative pain.

Anticonvulsants As Opioid Alternatives

Anticonvulsants are typically used for controlling seizures – especially in people who have epilepsy. Experts believe that the effectiveness of this non-opioid analgesic for severe pain may be down to the function of opioids in blocking the flow of signals from the central nervous system.

Some Anticonvulsant Drugs Include the Following:

Anticonvulsants have proven to be useful for nerve pain, and these drugs have also proved to be useful as heroin alternatives for reducing persistent back pain and chronic pelvic pain. In these instances, anticonvulsants can be used as non-opioid painkillers. However, take note that these painkillers must only be used when prescribed by medical doctors.

Ketamine

Ketamine has been proven to be used as an alternative to opioids and opiates for pain management, especially when dealing with postoperative rehabilitation. Additionally, Ketamine has also been widely used as a third-line drug for the management of cancer pain. It has been tested as a management for refractory cancer and chronic cancer pain, albeit with limited evidence.

Local Anesthetics As Opioid Alternatives

Here’s another good example of a non-opioid alternative for managing moderate to chronic pain. Local anesthetics, like opioids and opiates, are effective for postoperative relief and are also useful in the treatment of acute and chronic pain. Additionally, drug delivery systems (e.g., microparticles, nanoparticles, and liposomes) have been considered as local anesthetic delivery systems for prolonged anesthesia.

Non-opioid Local Anesthetics Are Classified Into Three Groups, These Include:

  • Amino amides (e.g., Etidocaine, Dibucaine)
  • Amino esters (e.g., Lidocaine, Tetracaine)
  • Naturally derived local anesthetics (e.g., Menthol, Cobratoxin)

If the patient is sensitive to amino amides or amino esters, considering Diphenhydramine and transdermal Fentanyl as alternatives is a great option. According to a study of medical doctors from Iowa, these two are suitable for patients who experience adverse reactions, such as constipation, from oral opioids.

Acetaminophen And NSAIDs

Acetaminophen, also known as Tylenol, and NSAIDs such as Ibuprofen, Aspirin, or Naproxen are effective for managing moderate pain and can be administered intravenously or orally. They do not exactly function the same way, but due to the fewer number of severe side effects that can be caused by them, physicians sometimes prescribe both drugs together for relief.

The prescriptions come in tiny doses of each, to reduce the risk of side effects. NSAIDs may also be used as heroin alternatives to decrease the frequency of intake. Acetaminophen is most effective for providing relief in mild and moderate cases, but NSAIDs take things a notch higher by reducing inflammation while also acting by providing relief.

Opioid Conversion: What Is It And How Does Conversion Process Look Like?

When a patient is going through an opioid treatment process where dosing on a particular drug is resulting in little to no effect, physicians may begin to consider the option of employing a rotation therapy with another one. What this means is that the patient begins to switch between opioids of different chemical classes to find the perfect dose for the condition of the patient. Opioid dose conversion in this manner can help increase the efficiency of treatment and improve overall outcomes with analgesic benefits, adverse event profile, and patient adherence. The opioid conversion table below is based on the Centers for Disease Control and Prevention.

DRUG Parental Dose (MG) Equivalent to 10 MG IV Morphine Oral Dose Equivalent to 30 MG Oral Morphine Bioavailability of Oral Dosage Form Dosing Interval (HRS)
Morphine 10 30 0.3 3
Anileridine (Leritine) 25 75 0.3 3
Codeine 100 300 0.3 3
Diamorphine 8 12.5 0.4 3
Fentanyl 0.1 1
Hydromorphone (Dilaudid) 2 3 0.6 3
Levorphanol 2 4 0.5 6-12
Meperidine (Demerol) 80 250 0.3 3
Methadone 2-10 2-10 1.0 8-12
Oxycodone (Percocet, Oxycontin) 10 12 0.8 3
Propoxyphene 50 100 0.5 4
Sustained Release Morphine (MS Contin) 30 0.5 8-12

Mismanagement of the process of conversion can lead to complications such as opioid toxicity or overdose. These situations will require admission to the rehab facility as soon as possible. Health professionals can always help in giving advice about the safest and the most effective ways to overcome this disorder, detox procedures to ease the withdrawals, and guide through the opioid addiction treatment process.

Take Opioids With Cautiousness

To sum up, both opioid vs opiate are classified as narcotics, roughly speaking with the difference that the last ones are illegal and not obtained by means of a doctor’s prescription. Although opiates vs opioids are used interchangeably, one must understand that these substances offer the same indication which is a pain reliever. Since opioid drugs such as hydrocodone are prone to be abused, non-opioid alternatives such as anticonvulsants and NSAIDs may be considered. Furthermore, as these drugs can cause addiction, it is important to learn how much of these opioids and opiates can be taken. Although there is an opioid conversion table available, remember that only a medical doctor can prescribe the most suitable dose for a patient.

In case a patient is experiencing opioid abuse or addiction, many rehabilitation centers offer opioid use disorder treatment. The main step in the treatment process is opioid detox, during which withdrawal symptoms of patients are managed. Various inpatient and outpatient services are offered in drug rehab during which patients go through different individual and group therapies which enable them to get rid of their abuse behavior and addiction and complete the recovery.

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Page Sources

  1. Commonly Used Terms | CDC’s Response to the Opioid Overdose Epidemic | CDC. (2021, January 26). CDC. https://www.cdc.gov/opioids/basics/terms.html
  2. Narcotics (Opioids) | DEA.gov. (2021, September 29). DEA. https://www.dea.gov/taxonomy/term/331
  3. Opioid Overdose Crisis. (2021, July 1). National Institute on Drug Abuse. https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis
  4. Opioid overdose. (2021, August 4). WHO. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose
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Published on: September 17th, 2019

Updated on: January 14th, 2022

About Author

Peter J. Grinspoon, MD

Dr. Peter Grinspoon is an experienced physician with long-term clinical practice experience. As a former analgesic addict, Dr. Grinspoon knows precisely how important it is to provide patients with effective treatment and support. Medical writing for him is the way to communicate with people and inform them about their health.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.