Daily MOS: Opiates, opioids, and whatever tramadol is.

Okay kids. Let’s do some drugs.

Today’s Moment of Science… opiates, opioids, and whatever the fuck tramadol is.

I did my masters degree in forensic science, completing a thesis on prescription opiate abuse trends and toxicology. Going to grad school in England, I miss the Cornish pasties, pub culture, and the universal healthcare (America, why can’t we have nice things?). Let’s dive into what I learned about drugs on my little trip to England.

(Um, in the classroom. We can leave out what happened with the stuff from Amsterdam and a French mime named Maxime).

Though we now know it’s a central nervous system depressant, opiates were originally thought to be a stimulant. Patients who were in severe pain suddenly got out of bed, seemingly energized. As it turns out, not feeling like hell is surging through every pore of your body gives you a smidge of life.

Though we often use the terms ‘opiate’ and ‘opioid’ interchangeably, they are technically different. An opiate is a naturally occurring compound that comes from the opium plant, including morphine, codeine, and thebaine. Opioids as a drug class include these along with semi-synthetic and fully synthetic opioids that behave similarly to opiates.

Semi-synthetic opioids tend to look chemically similar to opiates, while fully synthetic opioids can have completely dissimilar chemical structures from the naturally derived substances. It could be a molecular structure that spells out “Ben Shapiro’s wife’s pussy is still dry and it’s a problem,” if it acts like an opioid, it’s probably an opioid.

There are medications that reduce pain by attacking the inflammation that’s causing the pain, which can be helpful to healing in some cases. Opioids, on the other hand, do jack shit to heal the problem, but they make your brain think there isn’t a problem. Temporarily.

They reduce our sensitivity to pain by hitting what we refer to as opiate receptors, which are actually endorphin receptors. Your body releases endorphins for a lot of purposes, including managing pain. Opioids are a pharmaceutical way to manipulate our body’s factory installed pain control system.

To compare relative strength of the opioids, we generally use a measurement called morphine milligram equivalent (MME). It’s not a perfect measurement and though conversion factors aren’t dissimilar, they’re also not universal. Used by clinicians to try to manage pain care safely, it shows the limitations and usefulness of each of these medications. Though you can see theoretically how many milligrams of codeine converts to one of the stronger pain medications, an imperial assload of it is unlikely to be useful in a situation where a doctor thinks fentanyl is appropriate. Likewise, you probably shouldn’t prescribe a teensy dose of oxycodone when a normal dose of tramadol will do.

It might surprise you, but gram per gram, MME charts generally say there isn’t much difference in strength between Vicodin and morphine. Often they rank oxycodone, the opioid in Oxycontin and Percocet, as stronger than morphine. It’s not as strong as heroin (aka diacetylmorphine), but it came by the ‘hillbilly heroin’ nickname honestly.

However the fuck pharmaceutical companies got away with marketing it as non-addictive, I will never entirely understand.

Being synthetic, semi-synthetic, or natural is not an indicator of the strength of the drug. Tramadol and fentanyl are both fully synthetic. While tramadol is a tad weaker than codeine, fentanyl is dosed by the fucking microgram.

Regulations have come out in recent years in the US to try to combat the opioid crisis we’re dealing with. It was a good effort. Unfortunately, it’s unclear which it’s been more effective at: helping people struggling with addiction or hurting people dealing with chronic pain.

A question I hear sometimes is “why don’t we get rid of all opiates?” It’s kinda the same answer for why we can’t get rid of fossil fuels yet. Because we all know it’s a no good very bad option, but until something that can really replace it comes along we’re stuck with it for now. Yes, there are other medications and therapies that can manage some kinds of pain very well. But there are some patients and conditions for whom long term pain care with opiates is deemed appropriate, and for now, the best option.

This has been your daily Moment of Science, letting you know that cannabis cannot meet the needs of every pain patient.

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