Opioid vs. Opiate: What’s the Difference?

Dr. Robert Sherrick, Community Medical Services

By Dr. Robert Sherrick

Posted 12/03/2025

If you’ve ever found yourself confused by the terms opioid and opiate, you’re not alone. These words are often used interchangeably in the news, in medicine, and in everyday conversations. But there is a difference, —and understanding it can help make sense of everything from prescription painkillers to the ongoing opioid crisis.

Let’s break it down in plain language.

Opioids and Opiates in Simple Terms

Like a square is a rectangle but a rectangle isn’t a square, all opiates are opioids, but not all opioids are opiates. It’s a mouthful, but here’s the easiest way to think about the two:

Opiates are drugs naturally derived from the opium poppy plant (like morphine and codeine).
Opioids is a broader term that includes all opiates, including synthetic and semi-synthetic drugs that act like opiates in the body (like oxycodone, fentanyl, and heroin).

Why Does the Distinction Matter?

While the distinction may seem like splitting hairs, it can help individuals and medical providers alike understand how drugs affect the brain and body, and it can influence how it shows up on a toxicology screen.

Examples of Opiates (Naturally Occurring)

Although opiates and opioids act on the same receptors, opiates are limited to the handful of drugs that come directly from the opium poppy. These plant-derived compounds have been used for centuries to relieve pain, quiet coughs, and induce euphoria. Here’s a closer look at the major players:

Morphine is often called the gold-standard hospital pain reliever and is extracted directly from raw opium. It provides rapid, powerful relief for severe acute pain and palliative care. Because it fully activates opioid receptors, it also carries a high risk of tolerance, dependence, and respiratory depression if misused.
Codeine occurs in smaller amounts in the poppy plant and is far less potent than morphine. Once ingested, the liver converts part of it into morphine, providing mild-to-moderate pain control and cough suppression. It’s commonly formulated with acetaminophen or used in some cough syrups and mild pain meds, though new regulations have tightened access due to misuse.
Opium is the dried latex sap of the poppy, the crude substance from which morphine and codeine are isolated. While rarely used in modern medicine, it played a historic role in anesthesia and was once found in patent medicines like laudanum. Today it mainly serves as a reference point for understanding how natural opiates paved the way for modern opioids.

Examples of Opioids (Including Synthetic and Semi-Synthetic)

As scientists sought longer-lasting, more controllable pain relief, they began chemically modifying natural opiates (semi-synthetics) and eventually designing entirely new molecules in the lab (synthetics). All these compounds still latch onto opioid receptors and mimic the effects of opiates, but their potency, duration, and clinical roles vary.

Heroin is made from morphine but is altered chemically, crossing the blood-brain barrier exceptionally fast and producing an intense rush of euphoria. It has no approved medical use in the United States and is linked to a high risk of overdose but remains a potent example of how a small molecular change can drastically amplify addictive potential.
Oxycodone (Percocet, OxyContin) is a semi-synthetic opioid refined from thebaine (another poppy alkaloid) that is widely prescribed for moderate to severe pain. Immediate-release formulas treat acute pain, while controlled-release tablets can provide up to 12-hours or more of pain relief. However, oxycodone is often misused; tamper resistant formulations are available but often are more expensive than immediate-release tablets.
Hydrocodone (Vicodin) is another semi-synthetic opioid derived from thebaine. It is often combined with acetaminophen in tablet form. It was once the most-prescribed opioid in the U.S. for dental and injury-related pain. However, because acetaminophen carries its own toxicity risk, high-dose hydrocodone misuse can damage the liver and create opioid dependence.
Fentanyl is a fully synthetic opioid that is roughly 50-100 times more potent than morphine. While it is invaluable in anesthesia and treating cancer pain, illicitly manufactured fentanyl has fueled a dramatic surge in overdose deaths.
Methadone is a synthetic full opioid agonist with an exceptionally long half-life. Taken once daily, it prevents withdrawal and cravings without the highs and lows of shorter-acting opioids, making it a foundational medication in opioid use disorder (OUD) treatment and chronic pain cases.
Buprenorphine is a synthetic partial agonist used in addiction treatment, activating opioid receptors enough to curb cravings without overdose risk. Available in sublingual films, tablets, and long-acting injections, it can be prescribed in outpatient settings, expanding access to effective and safe OUD care.

How Do Opioids Work?

Natural opiates laid the groundwork for pain management, while synthetic and semi-synthetic opioids expanded medical possibilities (and, unfortunately, opportunities for misuse). However, while there are differences between the two, both come with the same risks and benefits.

Whether natural or synthetic, all opioids work by binding to receptors in the brain and body—especially the ones involved in pain, pleasure, and breathing. That’s why they’re effective for pain relief, but also why they carry serious risks of addiction, overdose, and respiratory depression (slowed or stopped breathing).

How Does This Distinction Affect Urine Drug Screens?

Because there are many different types of opioids, a single urine drug screen (UDS) cannot detect all of them at once. Most UDSs include a test for opiates, which commonly detects morphine, codeine, heroin, hydrocodone, and hydromorphone. In order to detect other opioids, additional tests are necessary. Many panels include specific tests for oxycodone and fentanyl. However, the results of any UDS can depend on the exact tests used in the panel.

I’ve Heard A Lot About Kratom and 7-OH Lately. Are They Opioids?

Yes, kratom and its concentrated form, 7-OH, are both opioids. While they are not derived from the opium poppy, and therefore not opiates, they work at the opioid receptors in the brain in the same way as morphine, heroin, or any other opioid. 7-OH is 10-20 times more potent than morphine, so it can be especially dangerous, leading to withdrawal, dependence, and severe opioid use disorder just like any other opioid.

Why is There Confusion Between Opioids and Opiates?

The lines between these terms have blurred over time. Even many medical professionals use “opioid” to describe the whole group because it’s more inclusive. In fact, “opioid” is now the standard term used in public health, policy, and medicine.

There are several reasons the line has blurred, ranging from historical and scientific to practical. In the early 1900s, clinicians only had a few naturally derived opiates, but by the mid-20^th century, chemists were creating dozens of semi-synthetic and fully synthetic pain relievers.

Instead of inventing a new label for every new molecule, researchers adopted “opioid” as the catch-all for any substance that activates opioid receptors, natural or not. This was also the case for public health messaging, as policymakers needed a term that covered everything from OxyContin® to illicit fentanyl to warn the public effectively.

So, if someone refers to “the opioid crisis,” they’re talking about all of it—from prescription painkillers to heroin and fentanyl. Understanding this linguistic shift can help patients, caregivers, and policymakers communicate more clearly about prevention, treatment, and recovery.

Need Help for Opioid Dependence? Contact Community Medical Services

Whether you’ve heard the term opioids or opiates, these drugs are as dangerous as they are beneficial. Here’s an easy way to remember it:

Opiates come from poppies.

Opioids include opiates and lab-made versions.

Both types can be useful medicines, but they can also be dangerous when misused. Understanding the difference helps us talk more clearly about addiction, treatment, and the role these drugs play in society.

If you or someone you love is struggling with opioid addiction, you’re not alone. Community Medical Services provides compassionate treatment for OUD, ensuring everyone has access to the support they need. Contact us today to get started or explore these additional resources for more information and support.