Stigmatic Language: Pharmacotherapy

Examples include:

  • Still using an opioid / not “in recovery”
  • It’s a crutch
  • They’re still addicted / dependent
  • Mind altering substances
  • Use of narcotics
  • They’re not in recovery
  • They’re treading water; not going anywhere/not moving forward
  • It’s just social control
  • Liquid handcuffs
  • There is a difference between addiction and dependence. One is behavioral, and the other is physiological. A person can be dependent without being addicted, however that is not true in reverse.
  • Let’s address the next two together: Narcotic blockade is the mechanism through which cross tolerance occurs and helps to stabilize the opioid use disorder neurologically. Once therapeutic dose is achieved, a person does not experience any “effect” or euphoria.
  • People are in recovery when they say they are. Period.
  • If a person has stabilized on MAT, reports feeling better, has increased recovery capital, then by what metric are we assessing lack of progression?
  • These last two statements are problematic examples; however they are often derived from very real experiences of people who tried but terminated MAT. No, it is not for everyone. And yes, it is highly regulated because of the stigma, which spills over onto the patient. However, people who have had negative experiences with MAT are often those who terminated without a long taper, and endured an excruciating acute and protracted withdrawal. MAT is not mean to taper rapidly, because the medications used are long acting, and have a great affinity for the opiate receptors. They will not leave without a fight, which is, yes, complex, but also the reason why they are so effective.
  • Drug Seeking
  • Dope fiend
    • Dope whore
    • Dope sick
  • Chasing the high
  • Nodding off
  • Diversion
  • Illicit substances
  • Non-compliant
  • I cannot tell you how many charts I have read that use the term drug seeking. For many, they are thwarting withdrawals.
  • This term, and the related terms, may only be used in self-identification. Do not use this as a means to relate to someone; it reinforces self-stigma. We’ll talk more later about when self-identification language is helpful, but when working with others, it is absolutely not ok to use this in professional work.
  • Chasing the high and nodding off can both be associated with titrating during induction. For many, there is a significant correlation between chronic pain and OUD, therefore, the pain relief, or analgesia, may be equated with an effect of euphoria. They are not the same. Likewise, when we look at “nodding off”, the appearance of characteristics that people with lived experience observe as “being high” are often unavoidable physiological side-effects of dosing prior to achieving a therapeutic dose. These symptoms diminish when narcotic blockade or cross tolerance has been established.
  • Diversion is a criminal justice word, and highly connotated with the term “illicit substance”. Diversion also occurs the minute I hand my friend a prescription epi pen in response to anaphylaxis. While the selling and acquisition of substances outside of prescribed use does occur, it is common for a person with OUD, who is not on MAT, to find buprenorphine or methadone I lieu of not being able to find shorter acting substances that they primarily use. We also see this occur when MAT doses are sub-therapeutic.
  • Which brings me to “non-compliant” if a person is using alcohol, benzos, or cannabis while on MAT, it is often a sign of inadequate dosing. And use of the first two can be determinantal if not fatal with MAT. But there are many docs and clinics who continue to ”cap” dosing, and that is not appropriate, recommended, or sanctioned by the regs or accrediting bodies.