Opioid Addiction Treatment Definitions: So Many Terms, So Little Time

If you’re looking for help with opioid addiction, learning about recovery options can feel like a new language. We break down terms used in opioid addiction treatment.

Agonist: An agonist is a chemical that binds to a receptor in the brain, resulting in activation of the receptor to produce a biological response. Why is this relevant when talking about opioid addiction recovery? Because drugs taken that can lead to addiction, and medications used for opioid recovery, all affect the opioid receptors in the brain.

Antagonist: An antagonist blocks opioids from the brain by attaching to opioid receptors without activating them. Antagonists cause none of the mood-altering effects of opioids and can block full opioid agonists from opioid receptors. Examples of antagonists are naltrexone and naloxone.

Cognitive-behavioral therapy (CBT): This is a type of therapy which has been proven effective in treating addiction. It teaches people to challenge their own negative thinking patterns, improve their emotional regulation, and find healthy coping mechanisms.

Dependence: Dependence occurs when the body adapts to repeated drug use and only functions normally with the presence of a drug. When drug use is stopped, physical symptoms manifest as withdrawal. Dependence is not the same as addiction, although they are related. Non-addictive drugs like antidepressants can cause dependence.

Detoxification: Detoxification, commonly called detox, is the process through which withdrawal symptoms are managed, usually in a short-term, supervised setting. The understanding around cold turkey detox has changed, and detox without medication-assisted treatment increases chances of relapse. Learn more about detox and recovery.

Drug abuse: An older term that defined use that is unsafe or persists despite negative consequences. Due to its association with negative terms like child abuse, this term is increasingly avoided by professionals and seen as perpetuating stigma. More appropriate terms include drug misuse, addiction, or substance use disorder.

Full Opioid Agonist: A full opioid agonist binds to opioid receptors fully, producing the maximum response possible when attached to a cellular receptor. Examples of full opioid agonists are heroin, oxycodone, methadone, hydrocodone, morphine, opium.

Half-life: The half-life of a drug is the time it takes half of it to be processed by your body and eliminated. Some opioids have longer half-lives than others, meaning that the opioid you were taking may affect your induction treatment plan.

Illicit: Illegal or forbidden by law.

Induction: The medical term for the first week of medication-assisted treatment with buprenorphine, in which dosage is stabilized as the client transitions from illicit opioids to buprenorphine.

Maintenance: After the initial stabilization period of treatment, called the induction period, clients taking medication for recovery move to a maintenance phase, in which treatment and dosages are stabilized.

Medication-Assisted Treatment: Medication-assisted treatment, or MAT for short, is a commonly used term encompassing treatment with both medication and supportive therapy for addiction. MAT for opioid addiction includes treatment with methadone, buprenorphine, or naltrexone, but alcohol and smoking also offer medication-assisted treatments. Some advocates say the term medication-assisted treatment is stigmatizing (evidence shows the medication works to treat addiction without any additional assistance), and have begun to simply say medication or opioid agonist therapy.

Methadone Maintenance Treatment (MMT): Methadone maintenance treatment describes daily dosing of methadone, an opioid which reduces cravings, for recovery from addiction to illicit opioids like heroin. Taking methadone as prescribed at an opioid treatment program can stabilize clients and lead to long-term recovery.

Motivational Enhancement Therapy: Also called Motivational Interviewing, this is a therapy technique which encourages positive behavior change by helping people explore their own feelings.

Naloxone: Naloxone is an opioid antagonist, meaning its job is to kick opioids out of their receptors in the brain. Naloxone is an emergency medication that can be given intramuscularly or intranasally in case of opioid overdose, and keeping it around if you are still using opioids (or have a loved one who is) could save lives. Learn myths and facts about naloxone. Naloxone for overdose is often referred to by its brand name, Narcan. Buprenorphine products like Suboxone also include naloxone as it prevents misuse. Read more about the naloxone in Suboxone.

Narcotic: The term narcotic was originally derived from the Greek term narkotikos, which means benumbing, and included medications like opioids that relieve pain while also altering mood. However, there is now a negative association with this term, and it often implies that a drug is being sold or consumed for nonmedical purposes.

Neonatal abstinence syndrome (NAS): A condition of withdrawal that occurs when certain drugs pass from the mother to the fetus during pregnancy, causing the baby to become drug dependent and experience withdrawal after birth. This doesn’t mean a baby is born addicted to drugs, however. Neonatal abstinence syndrome is treatable and preventable. Learn about Elizabeth Brico’s experience in opioid addiction recovery during pregnancy.

Office-Based Opioid Treatment: Office-based opioid treatment (OBOT) is an outpatient addiction treatment done in a medical setting, rather than an inpatient behavioral health or Opioid Treatment Program (OTP) setting. Usually, this includes seeing a clinician in-office to receive a prescription for buprenorphine/naloxone which can be picked up at a local pharmacy, often times supplemented with counseling or support groups.

Office-Based Addiction Treatment: Just when you thought things couldn’t get trickier, sometimes OBOT (defined above) is referred to as OBAT. Office-based addiction treatment can refer to the treatment of all substance use disorders in a medical setting, instead of an inpatient behavioral health setting.

Opiates: What’s the difference between opioids and opiates? Traditionally, opiates were substances derived from the opium poppy, like morphine and codeine. Opioids are synthetically derived, rather than occurring naturally. Most people have stopped recognizing this distinction between synthetic opioids and naturally derived opiates, and have started using the term opioids to describe all substances that effect the opioid receptors in the brain.

Opioid Agonist Therapy (OAT): Opioid agonist therapy is treatment for opioid addiction that includes medication with opioid agonists such as methadone or buprenorphine. Although this is a more clinical term, it aptly describes this type of treatment.

Opioid Treatment Program (OTP): Opioid Treatment Programs are licensed methadone and buprenorphine providers that dispense medications, as well as offer supplementary services like counseling and support groups, on-site. In contrast to an OBOT program where clients receive a prescription, OTP clients usually begin receiving daily doses of medication at their clinic and then gradually receive take-home doses directly from the clinic.

Partial Agonist: An agonist that produces a lower response than a full agonist when binding to receptors in the brain. Partial agonists can reduce the effects of full agonists. Buprenorphine is a partial opioid agonist

PDMP: Prescription drug monitoring programs, PDMP’s for short, are state-level prescription monitoring systems checked by clinicians and pharmacists involved in the prescribing of controlled substances. PDMP’s help both providers and states identify patients filling a questionable amount of prescriptions, or prescriptions that shouldn’t be mixed together. There is some debate over the best way for these programs to be executed, as well as their privacy concerns.

Prior Authorization (PA): When a PA is required, this indicates that your clinician will need to request and receive pre-approval from your health insurance provider before covering the cost of a certain treatment, medication, or procedure. Prior authorizations are unfortunately common for recovery medications like Suboxone.

Self-medication: The use of a mood-altering substance to reduce effects of stress, anxiety, or other mental health issues without the supervision of a clinician. Many people struggling with addiction are self-medicating to make themselves feel better.

Sublingual: A fancy way to say “under your tongue.” If you don’t let medications like Suboxone or Zubsolv dissolve under your tongue (let’s say you swallow it), the medication will not be absorbed right and you won’t feel the full effects.

Suboxone: What’s all this talk about Suboxone? Suboxone is a common brand-name for prescription medication buprenorphine/naloxone. Buprenorphine/naloxone is the gold-standard treatment for opioid addiction. Learn more about the science of buprenorphine.

Substance use disorder: Substance use disorder, or SUD for short, is the medical terminology used to define substance use that persists despite negative consequences in a person’s life. Substance use disorder can range in severity. More specifically, someone struggling with opioids can be defined as having Opioid Use Disorder.

Taper: A taper involves a gradual decrease of medication, rather than stopping it entirely. For medications that cause dependence, a slow reduction in dosage over a period of time can decrease symptoms of withdrawal.

Titration: Titration is finding the adequate dose of medication for your body, and may involve gradual adjustments to the medication by your medical provider. For opioid addiction treatment with medication like buprenorphine/naloxone, titration is usually completed during the induction phase of treatment, and once a stable dose of medication has been found, the client moves to the maintenance phase of treatment.

Tolerance: An increase in the dosage of a drug required to achieve the same effects. A person may find they no longer respond to the drug the way they initially did. Individuals who become tolerant to opioids like heroin or morphine require greater doses of these drugs to achieve the same effects originally produced by lower doses.

Withdrawal: Uncomfortable physical and psychological effects of stopping a drug upon which a person has become dependent.

Don’t let the evolving terminology of addiction get you down — for many years, addiction and its treatment was largely stigmatized. The changing language of opioid addiction treatment indicates the ongoing evolution (and improvement) in care.

Have another term you think is important to know? Let us know in the comments.

kali-lux-b&w-outside.jpeg

As Workit Health's Head of Marketing, Kali Lux leans in to the culture gap between addiction, recovery, and medicine. She's interested in finding solutions that work for substance users better than drinking or drugging does, and believes Workit is one of them. She's written extensively on her own experience through addiction into long-term recovery. You can connect with her on Twitter @kalireadsbooks.