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.
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Agonist: An agonist is the term for a chemical that binds to a receptor in the brain, resulting in the activation of that receptor to produce a biological response. Why is this relevant when talking about opioid addiction recovery? Because the opioids that can lead to addiction and some of the medications used for opioid recovery are agonists that affect the opioid receptors in the brain. (See also Full opioid agonist and Partial agonist.)
Antagonist: An antagonist blocks opioids from attaching to opioid receptors in the brain and does not activate them. Antagonists cause none of the mood-altering effects of opioids and can block full opioid agonists from opioid receptors. Because they block the opioid receptors, they can cause precipitated withdrawal if taken while opioids are already in the body. Examples of antagonists are naltrexone and naloxone.
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Behavioral health support: Behavioral health support refers to the non-clinical prevention, diagnosis, and treatment of mental health conditions and substance use disorders. Some kinds of behavioral health support include therapy, coaching, recovery groups, and therapeutic exercises or courses.
Buprenorphine: Buprenorphine is one of three medications approved by the FDA to treat opioid use disorder. It is a partial opioid agonist that binds to and partially activates the opioid receptors in the brain, relieving cravings and reducing withdrawal symptoms. Buprenorphine is primarily prescribed as films or tablets that are dissolved sublingually or buccally in formulations that also include naloxone. It may also be prescribed as an extended-release injection. Because it is a partial agonist (therefore not producing the same sense of euphoria as a full opioid agonist) and is often combined with naloxone, buprenorphine is considered to be at lower risk of misuse than full opioid agonists like methadone.
Buccal: A fancy way to say “against the inside of your cheek.” Some medications need to be dissolved either against the side of the cheek or under your tongue to be absorbed properly. (See also Sublingual.)
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Cognitive-behavioral therapy (CBT): This is a type of therapy that has been proven effective in treating addiction. CBT teaches people to challenge their own negative thinking patterns, improve their emotional regulation, and find healthy coping mechanisms.
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Dependence: Dependence occurs when the body adapts to repeated drug use and only functions normally in the presence of that 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 detoxing from opioids without medication-assisted treatment is now understood to increase the risk of relapse. Learn more about detox and recovery.
Drug abuse: An older term that refers to substance 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.
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Full opioid agonist: A full opioid agonist binds to opioid receptors in the brain and fully activates them. This produces the maximum response possible. Examples of full opioid agonists are heroin, oxycodone, methadone, hydrocodone, morphine, and opium.
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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 which opioid you were taking may affect your timeline for starting treatment or inducing on buprenorphine.
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Illicit: Illegal or forbidden by law.
Induction: The medical term for the first week of medication-assisted treatment with buprenorphine. During this time, the dosage is adjusted and eventually stabilized as the member transitions from illicit opioids to buprenorphine. (See also Titration.)
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Maintenance: After the initial induction period of treatment, individuals taking medication for recovery move to a maintenance phase, in which treatment and dosages are stable. The maintenance phase can be relatively brief or last for years, depending on the needs of the individual.
Medication-assisted treatment: Medication-assisted treatment, or MAT for short, is a commonly used term encompassing treatment with both medication and behavioral health support for addiction. MAT for opioid use disorder 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 dismissive because the evidence shows the medication works to treat addiction without any additional assistance. These people have begun to simply say medication or opioid agonist therapy.
Methadone maintenance treatment (MMT): Methadone is one of the medications approved by the FDA to treat opioid use disorder. It is a full opioid agonist. Methadone maintenance treatment describes daily dosing of methadone to reduce craving, for recovery from addiction to illicit opioids like heroin. Taking methadone as prescribed at an opioid treatment program can stabilize individuals and lead to long-term recovery. It is well-supported by scientific research.
Motivational enhancement therapy: Also called Motivational Interviewing, this is a therapy technique that encourages positive behavior change by helping people explore their own feelings.
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Naloxone: Naloxone is an opioid antagonist, meaning it blocks opioids from the receptors in the brain. It binds very efficiently to the opioid receptors in the brain and can displace opioids from those receptors. Naloxone is an emergency rescue medication that can be given intramuscularly or intranasally in case of opioid overdose to reverse the overdose within the brain. The most commonly used version is often referred to by its brand name, Narcan, and is administered as a nasal spray. Keeping it on hand can and does save lives. Learn myths and facts about naloxone. Buprenorphine products like Suboxone also include naloxone to prevent misuse. Read more about the naloxone in Suboxone.
Naltrexone: Naltrexone is an opioid antagonist approved by the FDA to treat opioid use disorder. It binds to and blocks opioid receptors in the brain, which can reduce cravings and reduce the euphoric effects of opioids. It is also approved to treat alcohol use disorder. It is prescribed as oral tablets under the brand name ReVia and Depade or as an extended-release injection under the brand name Vivitrol. Read more about naltrexone.
Narcotic: The term narcotic was originally derived from the Greek term narkotikos, which means benumbing, and included medications like opioids that relieve pain and cause drowsiness while also altering mood. This term now carries a negative connotation, and 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. The baby becomes 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.
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Office-based opioid treatment: Office-based opioid treatment (OBOT) is an outpatient addiction treatment done in a medical setting, like a doctor’s office. This contrasts with inpatient behavioral health or opioid treatment program (OTP) settings. Usually, OBOT includes seeing a clinician in-office to receive a prescription for buprenorphine/naloxone which can be picked up at a local pharmacy. This may be supplemented with behavioral health support like counseling or recovery groups.
Office-based addiction treatment: Just when you thought things couldn’t get trickier, sometimes OBOT (defined above) is referred to as OBAT. Where OBOT refers just to treatment for opioid use disorder, OBAT can refer to the treatment of any substance use disorder in a medical office setting.
Opiates: What’s the difference between opioids and opiates? Traditionally, opiates were substances naturally derived from the opium poppy, like morphine and codeine. Opioids are synthetically derived in a lab. Most people have stopped recognizing this distinction between synthetic opioids and naturally derived opiates, and the term opioids has come to describe all substances that affect the opioid receptors in the brain.
Opioid agonist therapy (OAT): Opioid agonist therapy is the 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 that they can take on their own at home, OTP clients usually begin by receiving daily doses of medication at their clinic and then gradually receive take-home doses directly from the clinic.
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Partial agonist: An agonist that binds to receptors in the brain and activates them partially, producing a less intense response than a full agonist. Buprenorphine is a partial opioid agonist.
PDMP: Prescription drug monitoring programs, PDMPs for short, are state-level prescription monitoring systems checked by clinicians and pharmacists involved in the prescribing of controlled substances. PDMPs help both providers and states track which patients are receiving which prescriptions. They can flag when an individual fills a questionable amount of prescriptions, when a provider prescribes a questionable amount of prescriptions, or when prescriptions 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 the provider will need to request and receive pre-approval from a health insurance plan before the plan will cover the cost of a certain treatment, medication, or procedure. Prior authorizations are unfortunately common for Suboxone, although it has become common for insurance plans to cover generic buprenorphine/naloxone without a PA.
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Self-medication: The use of a mood-altering substance to reduce the 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 (for example, if you swallow it), the medication will not be absorbed right and you won’t receive the full effects.
Suboxone: What’s all this talk about Suboxone? Suboxone is a common brand name for prescription medication buprenorphine/naloxone. Another brand of this formulation is Zubsolv. Buprenorphine/naloxone is an effective, FDA-approved treatment for opioid use disorder. 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.
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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 the risk of dangerous or uncomfortable withdrawal. Learn more about tapering off buprenorphine.
Titration: Titration is finding the adequate dose of medication for a person’s body, and may involve gradual adjustments to the medication by a 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: When a larger dose of a substance is 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 and greater amounts of these drugs to achieve the same effects previously produced by lower doses.
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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 were largely stigmatized. The changing language of opioid addiction treatment indicates the ongoing evolution (and improvement) in care.