By Stephen Wood
Medication Replacement Therapy (MRT), Medication Assisted Therapy (MAT). Opioid Substitution Treatment (OST). Opioid Replacement Therapy (ORT). Opioid Agonist Therapy (OAT). This confusing array of acronyms are all terms that have made their way into the dictum of patients, healthcare providers, policy leaders, politicians and journalists —and new ones pop up every day.
Buprenorphine Enabled Recovery Pathway (BERP) is one I just came up with but could just as easily make its way into the menagerie of acceptable buzzwords for using an agonist-antagonist (or other drug) for the treatment of substance use disorder.
It doesn’t stop there.
Safe Consumption Facilities (SCF), Safer Injection Facilities (SIF), another SIF in Supervised Injection Facilities, Supervised Injection Sites (SIS), Medically Supervised Injection Sites (MSIS), and Drug Consumption Sites (DCS) only begin to round out the list of areas that people who use intravenous drugs can go to use in a safe, clean and supported environment.
We see these terms bantered about in the media, among healthcare providers, legislators and policy makers. We hear them from patients with SUD, their families as well as advocate organizations. These terms are in published research reports and clinical studies. To even the savviest person though, it is a confusing alphabet soup of acronyms that are all trying to describe an array of programs, possibly something similar or maybe even the same.
But can we be quite sure? Should I support MAT but not OST? What is the difference between a SIF and a SIS? What about BERP?
There is a need for everyone to get on the same page. As a nurse, I worked previously in clinical research studying sepsis. “Sepsis” was being defined in a myriad of ways and this made it difficult to interpret when the disease was present and what interventions would have the most value. It was a difficult entity to study as well, as without a concrete definition, the results from one study might not be applicable to another that used different criteria for what we thought was the same disease. Similar to substance use disorder, sepsis can be difficult to define and can be from significantly different pathology; pneumonia, a urinary tract source or from a central nervous system infection. The heterogeneous nature of sepsis made defining it a challenge.
We are at a similar crossroads with substance use disorder. Not that these interventions are really all that different. When you compare MAT to ORT or to OAT, they are basically the same. The same can be said for SIS, SIF and MSIS. In essence, the principle and practice is the same. But definitions are important in many aspects. A definition helps to clarify principle and practice, provide a standard for research and most importantly, helps to engage public support when used appropriately.
Too many acronyms can be confusing and, especially to the lay public, can create some unease as to just what exactly is and isn’t being proposed in their communities.
NIMBY, the acronym for Not in My Back Yard becomes particularly relevant when it comes to nomenclature. A community might say “sure” to the development of medically supervised injection site, but “no way, not in my neighborhood” if the same building is proposed as a drug consumption site. They may very well be the same site, with the same intentions, interventions, purpose and outcome. But let’s face it, image matters. Quite possibly, just the use of the word “drug” could deter many to allow such a program to exist.
A common language is important. It allows professionals to identify a specific issue, to have clarity with regard to defining that issue and to provide consistency when evaluating a program or intervention.
Chosen wisely, these definitions and acronyms also help “sell” these concepts to the public, softening the blow, so to speak. Public support is critically important when dealing with mental health and substance abuse issues, and something as simple as substituting “Intravenous Substance Injection Site” (ISIS) with “Centers for Addiction Recovery” (CARe) can make quite a difference.
This sounds simple, and it is. There is a real need to start using a common language.
For sepsis, this came after an international meeting that defined and characterized the disease. The same can be done for substance use disorder, and we must call for an international consensus for a shared terminology.
Substance Use Disorder (SUD) seems like a good start for those who struggle with using substances to manage the symptoms of trauma and mental health issues. What should come next is a common term for the treatment of SUD with medications that help control the symptoms and enhance recovery. This terminology should avoid stigma and judgment.
My own suggestion is that patients, healthcare providers, and other stakeholders refer to providing medication to treat a chronic and relapsing disease as “medication.”
Describing medical interventions as anything else, makes the process sound more complicated than it really is. This has already been realized by the regulations around buprenorphine. It also stigmatizes the treatment.
The same can be said for sites that allow for substance use while also providing medical care, teaching patients about prevention of infection, and offering recovery. These places sound a lot like hospitals. There is no need to create fearful connotations around drug consumption and supervised injection at what are sites for people to embark on recovery.
Applying terminology that helps people to understand substance use and the treatment for it is no different than describing the treatment of any other chronic, relapsing disease — and will help to demystify the entire process for the public.
It will help to make prescribing buprenorphine no more complicated than prescribing an antihypertensive. It will make sites that offer steps towards recovery for substance use on par with cardiac rehab.
Words are powerful, and carefully chosen words and acronyms can help to reframe and destigmatize, which will improve access and enhance recovery. Substance use disorder, like hypertension, gout, and arthritis, is a disease. We treat it with medication as well as supportive care, and we provide both inpatient and outpatient support for those who need it. Treatment is often lifelong, relapse is common, but help towards recovery is always there.