[wpml_language_selector_widget]

Addiction Medicine

Avoiding stigmatizing language

It is useful to look at the terminology around substance use disorders (SUDs), which can be stigmatizing and punishing.1 The language used can affect how willing people are in seeking necessary treatment. Stigmatizing language can also influence the HCP’s perception and care of the patient, as well as society’s perception of the individual with a SUD.1

Since HCPs are often the first-point-of-contact for people with a SUD, it’s important that they consciously assess the words and tone used while communicating.2 Certain words can promote bias and judgment towards people who have a SUD, for example the terms “abuse” and “addict”. Other judgmental language can be found around test results such as “clean” or “dirty”, where testing “positive” or “negative” is preferred.2

Using person-first language, such as “person with a SUD” instead of “addict, “user” or “alcoholic” can maintain the integrity of the individual as a whole person separate from the disorder.1 The FDA REMS program chooses to replace “misuse” and “abuse” with “nonmedical use”, which describes using a drug in a way other than as directed by a health care provider.4 It also uses “substance use disorder” or “opioid use disorder” in place of “addiction”. Other agencies state that the terms “misuse” and “addiction” are okay to keep.1 It is up to individual HCPs to decide the exact language to be used, provided they “take all steps necessary to reduce the potential for stigma and negative bias”.5

Differentiating addiction from tolerance

In 2022, 6.1 million people had an opioid use disorder (OUD), a type of substance use disorder characterized by a problematic use of opioids with the knowledge that it can cause significant harm.6 While there are patients who are more susceptible to develop an OUD due to a past SUD, mental health illness, or family history of SUD/mental illness, any patient on prescription opioid therapy can potentially develop an OUD.6 This is especially true for long-term opioid use, where one can develop tolerance and require higher doses, increasing the risk of an overdose or addiction.6

Tolerance is an important concept when discussing any drug, and is especially true for opioids.8 People who have been taking opioids for a while develop tolerance, where mechanisms in the brain respond less to opioid receptor activation, and more of the drug or higher doses are needed to produce the effect of pain relief.9 People who have recovered from an OUD are at greater risk for an overdose because they are unsure of the dose they can safely tolerate. As previously mentioned, tolerance and withdrawal are normal responses to long-term opioid use. However, addiction also involves a psychological component of craving and inability to control drug use. A cycle can develop when a person with an OUD experiences withdrawal, and uses opioids again to relieve these symptoms. Withdrawal symptoms can further exacerbate existing pain since it often involves severe bone and muscle aches, diarrhea, abdominal cramps, sweating, agitation, and anxiety.10 It is also possible to have OUD without physical dependence, and therefore does not experience symptoms of withdrawal or tolerance.11 This can happen if a person does not use opioids daily, but binges on them to the point of overdose.11

Treating opioid use disorder

There are 3 FDA approved medications for opioid use disorder (MOUD): buprenorphine, methadone, and naltrexone.12 MOUDs are effective in eliminating withdrawal symptoms, blocking effects of opioids, and/or reduces cravings.12 They are either full or partial opioid agonists, which work by binding to opioid receptors, or opioid antagonists, such as naltrexone, which blocks the activation of opioid receptors.9 MOUDs are safe for prolonged use, but a doctor should be consulted before discontinuing them.9 Despite their safety and effectiveness, MOUDs remain underutilized in treating OUD.9 There may be several reasons for this, one of them being that methadone and buprenorphine, also called maintenance medications, are actually opioids themselves.13 Methadone is a schedule II controlled drug provided through opioid treatment programs.14 However, there are some misconceptions that these maintenance drugs can also be misused.15 Since people with OUD have a high tolerance, they are not able to feel euphoria from MOUDs.15
Treatment for OUDs can begin with primary care physicians through prescriptions of MOUDs, since a specialty treatment clinic is not always accessible or available for certain patients.17 Counseling and additional services can be offered; however they should not decide if MOUDs are prescribed or not.17 It’s also important not to place other preconditions for anyone seeking treatment for an OUD (eg, requiring treatment for a mental health disorder first).17 Furthermore, the MAT Act of 2022 expanded the ability to prescribe buprenorphine for OUD to all DEA-registered practitioners to help destigmatize as well as integrate care for OUD across heath care settings.18

References

  1. National Institutes of Health (NIH). Words matter – terms to use and avoid when talking about addiction. November 21, 2021. https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction
  2. Johns Hopkins Medicine. Reducing the stigma of addiction. https://www.hopkinsmedicine.org/stigma-of-addiction
  3. Fagan B, et al. A multidisciplinary approach to treating patients with opioid use disorder in the primary care setting. 2024. https://serotarcnetwork.org/2024-opioid-use-disorder-symposium/
  4. US Food and Drug Administration (FDA). FDA Education Blueprint for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain. October2023. https://www.fda.gov/media/173774/download?attachment
  5. Ashford RD, et al. Biased labels: An experimental study of language and stigma among individuals in recovery and health professionals. Subst Use Misuse. 2019;54:1376-1384.
  6. Centers for Disease Control and Prevention (CDC). Preventing Opioid Use Disorder. May 8, 2024. https://www.cdc.gov/overdose-prevention/prevention/preventing-opioid-use-disorder.html
  7. Rasor J, Harris G. Using opioids for patients with moderate to severe pain. J Am Osteopath Assoc. 2007;107(9 suppl 5):ES4-ES10.
  8. Martyn JAJ, Mao J, Bittner EA. Opioid Tolerance in Critical Illness. N Engl J Med. 2019;380:365-378.
  9. National Institute on Drug Abuse (NIDA). Medications to Treat Opioid Use Disorder. October 2018. https://irp.nida.nih.gov/wp-content/uploads/2019/12/NIDA-Medications-to-treat-opioid-use-disorder_2018.pdf
  10. Wang SC, et al. Opioid addiction, genetic susceptibility, and medical treatments: A Review. Int J Mol Sci. 2019;20:4294.
  11. Lembke A. Tapering long-term opioid therapy. Am Fam Physician. 2020;101:49-52.
  12. Substance Abuse and Mental Health Services Administration (SAMHSA). Medications, counseling, and related conditions. Last updated March 28,2024. https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions
  13. Bart G. Maintenance medication for opiate addiction: the foundation of recovery. J Addict Dis. 2012;31:207-225.
  14. Substance Abuse and Mental Health Services Administration (SAMHSA). Methadone. March 29, 2024. https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/methadone
  15. National Institute on Drug Abuse. What are misconceptions about maintenance treatment? May 2017. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/what-are-misconceptions-about-maintenance-treatment
  16. Steve Rummler HOPE Network (SHRN). How MAT medications work. May 29, 2024. https://steverummlerhopenetwork.org/recovery/how-medications-work/
  17. Primary Care Providers Can Prescribe with Confidence. May 20, 2024. https://www.fda.gov/drugs/prescribe-confidence/primary-care-providers-can-prescribe-confidence
  18. Dydyk AM, Jain NK, Gupta M. Opioid use disorder. StatPearls. Last updated January 17, 2024. https://www.ncbi.nlm.nih.gov/books/NBK553166/

All URLs accessed September 11, 2024.

Defining Pain

Pain Assessment

Analgesia Modalities

Guidelines

Individualizing Pain Plans

Safe Opioid Use

Addiction Medicine

Reading and Resources

Pin It on Pinterest

Scroll to Top

For optimized Clinical Trial Tracker use, please utilize Chrome or Firefox browsers