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
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
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