Terminology and Conceptualization of Opioid Use Disorder and Implications for Treatment

Abstract

Using accurate terminology has implications for clinical care, research, and public policy relevant to opioid use disorder. Some less accurate terms can also be stigmatizing and have negative effects on patients. For example, there is international agreement that the term “abuse” be avoided. Furthermore, opioid use is not the same as opioid use disorder. Opioid use disorder can be a chronic condition. As such, for many, acute care and care without follow-up is wholly inadequate. Terminology that ascribes undesirable characteristics, particularly terms that suggest the patient is responsible for causing his/her illness, is not only inaccurate but stigmatizing, leading to poor care and poor outcomes. The spectrum of unhealthy use ranges from use that risks health consequences to use with consequences that meet criteria for opioid use disorder. Dependence can be a confusing term as it can indicate disease in international systems but can also simply refer to a physiological state that happens with regular use. This chapter also discusses terminology for testing and treatment, such as “dirty urines” and “medication-assisted treatment,” both of which have implications for treatment.