OpioidsWhat are the types, and why are they linked to the most drug deaths worldwide?

1What are opioids?

Opioids are any substances that act on the body’s opioid receptors, whether extracted directly from the poppy plant, made from it chemically, or manufactured entirely in laboratories.

The origin of the family is opium, the dried sap of the poppy seed pod, which contains active substances, chiefly morphine and codeine. Heroin was later made from morphine, and pharmaceutical companies then developed fully synthetic painkillers such as tramadol, fentanyl and methadone.

Some writers use the word “opiates” for natural substances only and “opioids” for everything that acts on the same receptors, but the common medical practice today is to use a single name for the whole family, because its members share the same mechanism of action and the most serious harms.

This family includes medicines that are indispensable in hospitals for severe pain, cancer pain and anesthesia, as well as substances that are illegal and have no medical use in Egypt. The real difference between treatment and addiction is not determined by the name of the substance alone; medical supervision and the purpose of use are what make the difference.

2How do opioids affect the brain and body?

The body naturally makes opioid-like substances, such as endorphins, that help it bear pain and stress. Opioids mimic these substances but with far greater strength. They bind to opioid receptors in the brain, spinal cord and gut, relieving pain and triggering a large release of dopamine in the reward circuit, so the person feels euphoria and relaxation.

The problem is that the body develops tolerance to the euphoria faster than to the respiratory depression. The person who uses them takes more to reach the same effect, while the risk of stopped breathing remains, and it rises sharply after a break in use during which the body loses its tolerance.

3What are the types of opioids by source?

Doctors usually classify opioids into three groups according to their source. This classification does not mean that natural ones are less dangerous; the risk depends on the strength of the substance, how it is used, and whether it is mixed with others.

One of the newest members of the family is tapentadol, an opioid painkiller dispensed by prescription for severe pain. Like other opioids, it carries a risk of tolerance, dependence and withdrawal if used without medical supervision.

There is another classification by use: medicines for pain relief such as morphine, tramadol, codeine and medical fentanyl; medicines used to treat addiction itself such as methadone; and substances with no medical use in Egypt such as heroin and raw opium.

4Types of opioids

Each substance in the opioid family has a complete guide and separate pages on its harms, symptoms and treatment. Here is a brief profile of each:

5Comparison of the best-known opioids

The table shows that the members of the family differ greatly in strength and duration of action: fentanyl is about 50 to 100 times stronger than morphine, while methadone stays in the body much longer than heroin. But all of them share the ability to depress breathing and cause dependence.

6Opioids by the numbers: why are they the deadliest?

The World Health Organization estimates that opioids account for the largest share of drug use-related deaths in the world:

The organization also notes that fewer than 10% of those who need treatment for opioid dependence receive it, and that mixing with alcohol or sedatives clearly raises the risk of death. In North America, illicitly manufactured fentanyl has become the leading cause of overdose deaths.

Source: the World Health Organization’s fact sheet on opioid overdose.

7Why does an opioid painkiller turn into addiction?

Many people with opioid addiction in Egypt did not start with heroin but with a painkiller such as tramadol or a cough medicine containing codeine. Sometimes it began for real pain, to boost work capacity, or on a friend’s advice. With repetition, tolerance develops, then stopping becomes painful, so the person continues to avoid withdrawal rather than to feel euphoria.

• Using the painkiller for longer than prescribed or without a doctor’s follow-up.
• Believing the medicine is “safe” simply because it is dispensed by a pharmacy.
• Using it to ease stress, sadness or exhaustion rather than pain.
• A personal or family history of addiction, or an untreated mental health condition.

8Common myths about opioids

9What dangers do all opioids share?

• Overdose and stopped breathing, with the risk multiplying when combined with sedatives, alcohol and pregabalin.
• Physical dependence and painful withdrawal when use stops.
• Chronic constipation, hormonal disruption, and reduced sexual desire.
• With injection: viral hepatitis, HIV, and heart and skin infections.
• Depression and anxiety, and decline in work, study and family relationships.
• Legal problems with prohibited substances or with possessing medicines without a prescription.

The details vary from one substance to another: tramadol adds the risk of seizures, compound codeine may harm the liver because of the paracetamol it contains, and methadone can disturb the heart rhythm. Read the details in harms of heroin, harms of tramadol and harms of fentanyl.

10Is opioid withdrawal dangerous?

Opioid withdrawal is very painful but rarely life-threatening in an otherwise healthy person, unlike alcohol and sedative withdrawal. Its symptoms include anxiety, insomnia, muscle and bone pain, sweating, runny nose, diarrhea, vomiting and cravings. It can become dangerous with severe dehydration, chronic illness or pregnancy.

The greater danger is relapse after stopping, because the body loses its tolerance, so the amount previously used can now stop breathing. The duration of withdrawal depends on how long the substance acts: it starts quickly with heroin, and starts later and lasts longer with methadone. Details are in heroin withdrawal symptoms, tramadol withdrawal and methadone withdrawal.

11How is opioid addiction treated?

Opioid addiction is among the types of addiction with scientifically proven treatments. Treatment combines safe withdrawal under medical supervision, medications chosen by the doctor, such as methadone and buprenorphine to reduce cravings and prevent relapse, or naltrexone after withdrawal is complete, and long-term psychological and family therapy.

1. Step 1
   Assessment

   A comprehensive medical and psychiatric evaluation, identifying the substances used and any co-occurring illnesses.

2. Step 2
   Safe withdrawal

   Easing withdrawal symptoms with medications chosen by the doctor, while monitoring fluids and sleep.

3. Step 3
   Rehabilitation

   Cognitive behavioral therapy, group and family sessions, and treatment of any accompanying depression or anxiety.

4. Step 4
   Relapse prevention

   A plan for triggers, regular follow-up, and educating the family about the signs of overdose.

Read more in heroin addiction treatment, tramadol addiction treatment and opium addiction treatment.

12Withdrawal and treatment for the whole opioid family

Two guides that bring together what all opioids share when use stops and in treatment:

13Do all opioids show up on a drug test?

Not all of them show up on the same test. The traditional rapid opioid test is designed mainly to detect morphine and its metabolites, so it picks up heroin, morphine, codeine and opium, while tramadol, fentanyl and methadone usually need their own specific tests. A positive rapid test needs laboratory confirmation, and detection times are approximate and vary by laboratory.

Details are in heroin testing and tramadol testing.

14How can the family deal with the risk of opioids?

1. Keep opioid painkillers locked away, and dispose of any leftovers after treatment ends, in coordination with the pharmacist.
2. Watch for signs: unexplained drowsiness, pinpoint pupils, constant constipation, and missing medicines or money.
3. Talk calmly and without accusation, focusing on your concern for their health rather than on punishment.
4. Learn the signs of overdose, and know that calling an ambulance immediately can save a life.
5. Seek specialist advice early; treatment works best the sooner it starts.

This is general educational material and not personal legal or medical advice.