Opiates versus other opioids – are these relevant as diagnostic categorizations?

Background: For more than three decades, the international diagnostic systems have used the term ‘opioids’, including opiates, yet research publications continue to use an older terminology. In 2010, new Codes of Statutes for “opiate replacement therapy” (ORT) was brought into effect in Sweden, stating that only those “dependent on opiates” – explicitly described as heroin, morphine or opium – were eligible. Those addicted to other opioids were then denied access. This study examines the relevance of the distinction of opiates vs. other opioids. Are there differences in the severity of opioid dependence or concerning other substance-related diagnoses? Methods: Ninety-nine individuals participated: 1) the opiate group (n = 69), and 2) the other opioids group (n=30). Structured interviews covered the ICD-10 criteria of nine different types of addictive substances. For opioids, questions were asked separately in relation to opiates versus other opioids. Results: The two groups fulfilled the criteria for opioid dependence to the same extent, with most participants meeting all six criteria, so indicating a severe opioid dependence problem. Both opiates and other opioids had contributed to their development of opioid dependence, and both groups, to the same high degree, showed comorbidity affecting other dependence conditions. Conclusions: This study reveals that the two categories of opioids used contribute to the development of opioid dependence and that the term ‘opioids’ can be suitably used to convey a unitary concept in diagnostic terms. There was no support for treating the two groups differently. The study calls for more stringent use of terminology in accordance with the international diagnostic systems