Opioids: What They Are, Why They’re a Problem and How to Fight the Epidemic

With so many stories about opioid abuse in the news, you may have questions. What are opioids? What’s normal opioid use and what’s addiction? What’s an overdose? Are opioids ever safe? This article is meant to explain the basics. You may also be wondering about changes in state laws about opioids. See Michigan’s New Opioid Laws: How They Impact Patients and Doctors for information about the new law and resources for dealing with opioid misuse.

What are opioids?
Opioids are a class of drugs derived from poppies, a flowering plant. They’ve been around for thousands of years. Today their most common forms are heroin, which is illegal, and several prescription drugs commonly used to relieve pain. These include oxycodone, hydrocodone, codeine, morphine, fentanyl and others. These can all be addictive.

Are opioids and opiates the same thing?
Opiates are the natural substances which include:

• Heroin
• Morphine
• Codeine 

Opioids are the synthetic, or man-made, drugs that interact with the brain’s opioid receptors. Receptors are the cells in the brain that react to opioids.

What are controlled substances?
You may also hear opioids and opiates called controlled substances. Controlled substances include all drugs regulated by the government. The Controlled Substances Act outlines U.S. policy about classifying certain drugs and regulating their manufacture, use, possession and sale.

Why do doctors prescribe opioids?
For many years, doctors believed drugs in the opiate or opioid class were more effective at treating pain than other methods. Many studies have shown this isn’t always the case. There are many methods for managing pain. Opiates and opioids treat acute pain from an injury or surgery more effectively than they treat chronic pain.

Can opioids be used safely?
Yes. Opiates and opioids are effective pain medications, particularly for acute pain from an injury, accident or surgery. Safe use is when they’re used as prescribed by your doctor for very short periods of time.

What’s the problem with opioids?
When opioids and opiates are taken in higher doses than what’s needed to treat pain, they can cause a relaxing and sleepy feeling some people find very pleasant. This sensation often leads to overuse and misuse.

Taking these drugs in a larger quantity than prescribed, longer than needed or without a prescription is considered misuse. It can lead to dependence, addiction, overdose and death. This is true even if they’re prescribed by a doctor.

What’s opioid dependence?
Dependence is when stopping their use results in physical withdrawal symptoms. Opioid withdrawal can be extremely unpleasant. Symptoms can include muscle pain, cramping abdominal pain, diarrhea, vomiting, nausea, restlessness, sweating, anxiety, fast heart rate, goosebumps, insomnia and tremors.

What’s opioid addiction?
Addiction is now referred to as substance use disorder. It’s when using the drug or trying to get the drug interferes with relationships, work, school and other responsibilities.

Does everyone who takes opioids become an addict?
No. Many people take opioids safely for pain and don’t misuse them. In addition to dependence and withdrawal, there are some other situations that can be confused with addiction:

• Intoxication: A state of impairment that may include slurred words, lack of good judgement, euphoria, sleepiness or falling asleep in the middle of talking, glazed eyes, a blank stare or complete unconsciousness.
• Tolerance: A condition where the same dose of opioids has less and less effect. It happens over a period of time. It means a higher dose or a more potent drug is needed to achieve the same effect. Everyone develops some degree of tolerance when using opioids for a while.
• Pseudo addiction: A condition resembling addiction but caused by under-prescribing of opioid pain medications for someone who has been taking them for a while. Because the patient’s pain is undertreated, they seek more opioids for relief. This is often confused with addiction or addictive behaviors.

What causes opioid addiction?

Pain medications work in the brain, not at the actual site of the pain. They reduce the experience of pain, but don’t treat the illness or injury causing it. When someone is taking opioid or opiate pain medication, it alleviates all kinds of pain, including emotional pain.

Opioids and opiates also cause dependence very quickly. This means a person’s brain gets used to the medication and they may not feel well when they stop taking it.

So, when a person takes the medication they feel physically and emotionally better. And when they stop they may feel physically and emotionally worse.

Some people are more predisposed than others to respond to this cycle of comfort and discomfort by taking more medication. And that can lead to addiction, now generally referred to as substance use disorder.

What is an overdose?
Opioids affect the part of the brain that controls breathing. In high doses, it can repress breathing enough that a person dies. It doesn’t happen immediately, so if someone is there, they can help. Symptoms of an overdose include:

• Very small pupils
• Shallow, erratic or stopped breathing
• Loss of consciousness
• Being unresponsive
• Vomiting
• Choking sounds

Illegal opiates and opioids aren’t regulated. They may contain any strength or combination of drugs. People who buy them don’t know exactly what they’re getting. Overdoses often happen because someone buys illegal opioids much stronger than they expect and they take too much.

What is Narcan and how does it keep people from dying from an overdose?
Narcan is a brand name for the drug Naloxone. It works by knocking the opioids off the opioid receptors in the brain and blocking their effects. This restores breathing and can save the life of a person who is overdosing.

Unfortunately, Naloxone only lasts for one hour and opioids can stay in the system for much longer. After an hour, the opioids will bind to the opioid receptors again. So, if a person overdoses and receives Naloxone, even if they seem fine, they should still go to the emergency room right away.

What can someone do if they’re addicted or would like to stop taking opioids?
Help is available. The best place to start is with your doctor. They may be able to refer you to specialists or facilities that can help with addiction. Medication-assisted therapy can ease temporary withdrawal symptoms. And a pain management specialist can help you manage your pain safely.


HAP has behavioral health specialists and others that can help you get off opiates if you have been relying on them for a long time. HAP members can reach our Coordinated Behavioral Health Management team Monday through Friday from 8 a.m. to 5 p.m. at (800) 444-5755. If you call outside our regular hours, leave a message and one of our specialists will call you.