It’s not the ‘opioid’ crisis. It’s the opiate crisis. The distinction matters.

October 4, 2019
If its synthesis starts with this—the pretty poppy, whence comes opium paste—that there drug's an opiate, not an opioid, friend.

EDITORS NOTE: We have published an update to this article.

The United States is in the midst of an opioid crisis. Except it’s not, technically—the drugs that we have declared a crisis around are opiates, not opioids. They ultimately derive from the poppy, uncredited star of Nirvana’s “Heart-Shaped Box” video, Papaver somniferum; in this way they differ from street heroin only insofar as they’re carefully (one would hope) titrated in a laboratory setting. 

To call Vicodin or Percocet or OxyContin “opioids” is flat-out wrong—they are not “like” opiates, as the -oid ending would have you believe (for -oid equals, and here I quote Webster’s, “resembling; having the form or appearance of”; cf. humanoid, =like or having the characteristics of, but not being, a human being); they literally are opiate painkillers.

Which presents a dilemma. To invoke the broad heading “opioids,” for the pharmaceuticals themselves, and to call our present epidemic “the opioid crisis” probably won’t strike any reader as wrong per se. In fact, so ingrained is this terminology that to buck this trend—to elect for the more precise usage, as you’ll no doubt have guessed that I, for one, would prefer—does run the risk of perhaps momentarily nonplussing your average reader, accustomed as he is to “opioid” and “opioid crisis.”

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But screw all that. For one thing, to call these drugs “opiates” and the crisis “the opiate crisis” will shock that complacent, and complaisant, reader out of his lexical stupor (which is not, when you think about it, all that much different from the narcotized haze these drugs famously produce). And what we’re awakening our reader to is nothing less than the category error perpetuated by every other rag that’s bought into this no-good, very-bad nomenclature. 

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Now, obviously there’s a political dimension to any style-guide prescription on this subject, and far be it from me to suggest that there was some sinister intent in the “opioid” coinage in the first place; it strikes me as just as likely that the word could’ve sort of slipped into the collective consciousness as a result of the fentanyl issue, which is both part of the crisis and in a way, paradoxically, wholly separate from it: many, many Americans became hooked on true pharmaceutical opiates like those mentioned above, only to find their way to cheaper street heroin (also a true opiate), which of late has been cut with fentanyl (which actually is an opioid; part of what makes it so relatively easy to mass-produce is that it doesn’t require the poppy>opium>morphine precursor). 

In any case, surely when we speak of “the opioid crisis” we are not limiting the discussion to full synthetics like fentanyl or methadone. We are speaking of the full spectrum, which includes the morphine-based pharmaceutical class, the morphine-based street-drug class, and, yes, these true opioids. 

To me, “opiate” ought to subsume this latter category, rather than the other way around. To refer to it as “the opioid crisis” is, in a very real way, to minimize the culpability of all the very bad actors who contributed to the crisis: just as they once pushed these drugs on doctors and clinics with the promise that they were somehow categorically different from street drugs like heroin, so we the journalist class have repeated that mistake linguistically. 

Let’s put a stop to that.

ICYMI: A reporter attended a school board meeting for 3 hours, longer than other journalists present. That ended up being a very good decision.

Mike Laws is a freelance copy editor and occasional writer who roves and trawls the greater New York City area. He is originally from Maryland’s Eastern Shore and still, for some reason, loves the Baltimore Orioles.