Opioid Basics

The terms “opiates” and “opioids” are often used interchangeably, but some people reserve the term opiates for only those compounds that are naturally present in the opium poppy, like morphine and codeine. The term “opioids” once referred only to synthetic substances that have chemical impacts on people that are similar to those of opiates. But today “opioids” has become a broader term, encompassing opiates; semi-synthetics (i.e., compounds derived from opiates, like oxycodone); and entirely synthetic compounds (like fentanyl and methadone).

The following may help in terms of understanding the statistics kept by the Centers for Disease Control and Prevention (CDC) on overdose deaths, which refer to some of these terms and categories.

The most important natural opiates used as medicine are morphine and codeine.

Branded forms of morphine have included MS Contin (made by Purdue Pharma) and Kadian (made by Watson Laboratories, later known as Actavis, now known as Allergan).

Semi-synthetics are compounds derived from morphine, codeine, or another naturally occurring compound in the poppy, thebaine. Most prescription opioids fall into this category. (Heroin is also technically a semi-synthetic, because it is derived from morphine, but it is a schedule I controlled substance, meaning that it can never be lawfully prescribed. The CDC breaks heroin out into its own category for statistical purposes in any event.)

The key semi-synthetic opioids most often used as painkillers are oxycodone, hydrocodone, hydromorphone, and oxymorphone.

Branded forms of oxycodone have included OxyContin (made by Purdue Pharma); Roxicodone (made by Xanodyne); Percocet (oxycodone plus acetaminophen [Tylenol], made by Endo Health Solutions); Roxicet (same, made by West-Ward); and Percodan (oxycodone plus aspirin, made by Endo).

Branded forms of hydrocodone have included Hysingla (Purdue); Zohydro (made by Zogenix); Vicodin (hydrocodone plus acetaminophen, first marketed by Knoll); Lortab (same, made by Akorn); and Norco (same, made by Watson, later known as Actavis, now Allergan).

Branded forms of hydromorphone have included Dilaudid (originally made by Knoll, now by Purdue).

Branded forms of oxymorphone have included Opana (made by Endo).

The most important synthetic opioids are methadone, used mainly as a non-euphoric maintenance drug in treatment regimens for recovering addicts, and fentanyl. But the CDC breaks out methadone separately in its overdose statistics, so fentanyl is the most important drug in its “synthetics” category.

Fentanyl is available as a prescription medicine, but is also now widely produced and trafficked illegally.

It is extremely powerful and, therefore, dangerous. According to the DEA, it is 50 times stronger than heroin and 100 times stronger than morphine. (Some chemical variations on fentanyl are more perilous still. Carfentanil, which has been used for tranquilizing elephants, can be 10,000 times more powerful than morphine.)

Lawful, branded forms of fentanyl have included Duragesic (a patch, made by Janssen, a Johnson & Johnson subsidiary); Actiq (a lollipop made by Cephalon (a Teva unit); Fentora (a tablet placed inside the cheek, also made by Cephalon); and Subsys (a mouth spray made by Insys).

Although some overdose deaths from fentanyl may involve diverted prescription medicines, the DEA believes that the vast majority of them come from fentanyl illicitly produced and trafficked, usually originating from unregulated labs in China, Mexico, or the U.S.

There are also some opioids that do not fall neatly into the categories I have outlined above, including tapentadol (marketed, for instance, as Nucynta, formerly by Janssen, and now by Depomed) and tramadol (marketed as Ultram by Janssen).

Caveat: I am a journalist, not a doctor, pharmacist, or chemist, so if you see errors in this post, please let me know at rhp@opioidinstitute.org.

For more information on this topic, try:

The Opiate Addiction Resource

The United Nations Office on Drugs and Crime