The terms “opiates” and “opioids” are often used interchangeably, but they don’t refer to quite the same thing.

Both are narcotics, which means they induce sleepiness or numbness. Many opiates and opioids also cause feelings of euphoria.

The key difference between them is how they’re made: Opiates are naturally occurring compounds, while opioids are either fully or partially synthetic (made by humans).

That said, many people use the term “opioids” to refer to all opiates and opioids.

Here’s a closer look at how opiates and opioids compare.

Opiates are derived from opium poppies (Papaver somniferum).

Examples of opiates include:

  • Morphine. Morphine is a prescription pain reliever used to treat moderate to severe acute and chronic pain.
  • Codeine. Codeine is used to treat mild to moderate pain and also diarrhea. It’s sometimes mixed with other drugs in over-the-counter (OTC) pain relievers, like acetaminophen, or cough syrup and cold medication.
  • Opium. Opium is made from poppy latex, the milky substance in poppy pods. This sticky, smelly gum is sometimes eaten as is or manufactured into powder or syrup that’s smoked, made into pills, or added to drinks.

Opioids can be either semi-synthetic or synthetic.

Semi-synthetic opioids

Semi-synthetic opioids are produced in a laboratory using opiates.

Examples of semi-synthetic opioids include:

  • Oxycodone. Oxycodone is chemically similar to morphine and used to treat moderate to severe acute pain. It’s usually mixed with other pain-relieving drugs. Pure oxycodone is sold under the brand name OxyContin, but oxycodone is most often combined with other pain drugs and sold under the brand names Roxicodone, Percocet, and Percodan.
  • Heroin. Heroin is a substance made from morphine. People inject, snort, or smoke it.
  • Hydrocodone. Hydrocodone is a lot like oxycodone, but it’s mostly prescribed to treat moderate to severe pain that’s long lasting, like cancer pain.
  • Hydromorphone. Hydromorphone is chemically related to morphine, but it’s a lot more potent. It’s used for moderate to severe pain that doesn’t respond to less potent opioids. It’s sold under the brand name Dilaudid.
  • Oxymorphone. Oxymorphone is a powerful opioid similar to morphine and 12.5 to 14 times more potent than oxycodone. It’s used only for moderate to severe chronic pain. It’s sold under the brand name Oxana.

Synthetics

Synthetic opioids are lab-made substances that act on the body’s opioid receptors to produce the same effects as opiates.

Some examples of synthetic opioids include:

  • Methadone. Like other opioids, methadone is prescribed to treat pain, but it’s also used with counseling and other therapies in medically assisted treatment for opioid use disorder.
  • Fentanyl. Fentanyl is 50 to 100 times more potent than morphine and used to treat severe pain after surgery or to treat people with chronic pain who have a tolerance to other opioids. It comes in several forms, including lozenge, patch, or shot.
  • Tramadol. Sold under the brand name Ultram, tramadol is used for moderate to severe pain.

All opioids and opiates are controlled substances in the United States because of their high potential for misuse and risk of dependence, though some may carry more risk due to their potency.

That said, when used under medical supervision, opioids and opiates can be a safe and effective tool for pain management.

But with all opiates and opioids — including synthetic and semi-synthetic ones — dosage is everything. The higher the dose, the higher the likelihood of harmful side effects and overdose.

Mixing opioids with other substances or taking illegally obtained opioids also increases the risks, partly because it’s hard to know what you’re actually consuming.

Taking opioids and opiates exactly as directed by your prescribing clinician greatly minimizes the risks associated with them.

What about fentanyl?

Due to recent upticks in overdose deaths related to synthetic opioids like fentanyl, many people may assume that synthetic opioids are inherently dangerous. But most opioid-related deaths involve illegally manufactured fentanyl, which is a bit different from pharmaceutical fentanyl.

Pharmaceutical fentanyl is made in tightly regulated labs and comes accurately labeled with dosing information and instructions for use. When used correctly, it can be a powerful tool for managing severe pain.

Illegally manufactured fentanyl, on the other hand, comes from unregulated sources. It’s found in pill, liquid, and powder form, usually without any kind of information about its potency or dosing guidelines. In some cases, it’s added to other drugs, including other illegally manufactured opioids and cocaine, without consumers knowing.

Because fentanyl is so potent, consuming even a small amount without medical supervision can potentially lead to an overdose.

Opiates and opioids are very similar but come from different sources. Opiates come from poppy plants while opioids are either entirely or partially lab-made.

Still, most people use the term “opioids” to refer to both opioids and opiates.

Adrienne Santos-Longhurst is a Canada-based freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed-up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow or splashing about the lake trying to master the stand-up paddle board.