Definitions
Abuse
A term not recommended for use in clinical or research contexts. Harmful use of a specific psychoactive substance. When used to mean substance abuse, this term previously applied to one category of psychoactive substance-related disorders in the D.S.M. ASAM recommends an alternative term because of the negative connotations of the word abuse. Substance misuse. Or use people who inject drugs (PWID): An acronym used to refer to people who inject drugs and generally preferred as “person-first” non-stigmatizing language. https://ssc.jsi.com/resources
Addiction
Treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in compulsive behaviors and often continue despite harmful consequences. Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases. (ASAM)
Adverse childhood experiences (ACEs)
All types of abuse and neglect, such as parental substance use, incarceration, and domestic violence. ACEs can also include situations that may cause trauma for a child, such as having a parent with a mental illness or being part of a family going through a divorce.
Source: Adverse Childhood Experiences, Child Welfare Information Gateway. (n.d.). https://www.childwelfare.gov/topics/prevention/adverse-childhood-experiences-aces/
Buprenorphine
Pronounced ‘bew-pre-nor-feen’) is a prescription drug approved by the FDA to treat opioid use disorder (OUD) as a medication for addiction treatment (MAT). It suppresses and reduces cravings for opioids. It can be prescribed or dispensed in physician offices, significantly increasing access to treatment. It is a replacement in the treatment of heroin and methadone dependence. Replacing a prescribed drug to treat a drug of dependence in this way is known as pharmacotherapy. See also Opioid use disorder (OUD), Medication for addiction treatment (MAT).
Sources:
Alcohol and Drug Foundation (2023, November 23), Buprenorphine. https://bit.ly/410GAzi.
SAMHSA (2021, July). Tip 63: Medications for Opioid Use Disorder, PEP 21 – 02-01 – 002-002. https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Full-Document/PEP21-02 – 01-002
Carfentanil
Drug used as a tranquilizing agent for elephants and other large mammals is 10,000 times more potent than morphine and 100 times more potent than fentanyl. It is often mixed in with other drugs, such as heroin, cocaine, or crystal meth. Often drug users have no idea their drugs have been tainted.
Comprehensive Addiction and Recovery Act (CARA)
Law signed by President Obama in 2016, now PL 114 – 198. It addresses many components of the opioid epidemic, including prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. It authorizes over $181 million annually in new federal funding to overcome the opioid epidemic. It expands prevention and educational efforts — particularly aimed at teens, parents and other caretakers, and aging populations — to prevent the use of methamphetamines, opioids, and heroin and to promote treatment and recovery.
Source: NIH
Dopamine
A neurotransmitter involved in motivation, learning, pleasure, the control of body movement, and other brain functions.
Diagnostic and Statistical Manual of Mental Disorders (D.S.M.)
The American Psychiatric Association book used by insurance providers and health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders, including substance-abuse disorders. The current manual is DSM‑5 TR.
Drug misuse
The use of illegal drugs and/or prescription drugs in a manner other than as directed by a doctor, such as use in greater amounts, more often, or longer than told to take a drug or using someone else’s prescription.
Fentanyl
A strong synthetic narcotic primarily used to ease the suffering of patients with chronic pain or terminal illnesses. It is a potent synthetic opioid drug approved by the Food and Drug Administration for use as an analgesic (pain relief) and anesthetic. It is approximately 100 times more potent than morphine and 50 times more potent than heroin as an analgesic. Since the 1990s, the drug has been available in a patch or lozenge for easy and effective delivery of time-released medicines. Fentanyl is so potent that residual chemicals in used patches have been suspected of contaminating water supplies when flushed down the toilet. Used patches also stick to children or animals, causing unintentional overdoses.
Good Samaritan Law of North Carolina
After calling 911, individuals who experience a drug overdose or witness an overdose and seek help for the victim cannot be prosecuted for possessing small amounts of drugs, paraphernalia, or underage drinking.
Source: Craven County, NC. 911 Good Samaritan Law. https://cravencountync.gov/2074/NC-911-Good-Samaritan-Law
Harm reduction
A set of treatment practical strategies and ideas to reduce negative consequences associated with drug use for individual and public health needs, to decrease the health and socio-economic costs and consequences of substance use and addiction-related problems, especially medical complications, and transmission of infectious diseases, without necessarily requiring abstinence. A range of treatment and recovery support activities may be included in a harm-reduction strategy. (ASAM). Harm reduction incorporates a spectrum of strategies that include the respectful, non-judgmental, non-coercive provision of services focused on safer use, managed use, abstinence, meeting people who use drugs “where they are,” and addressing conditions of use with the use itself. Interventions and policies designed to serve people who use drugs should reflect specific individual and community needs, so there is no universal definition or formula for implementing harm reduction.
Medication for opioid use disorder (MOUD)
A term sometimes used instead of MAT, MOUD refers primarily to the medications used to treat opioid use disorders, not to the complementary counseling and behavioral therapies included in medication-assisted treatment.
Methadone
A prescription opioid drug approved by the FDA that replaces heroin and other opioids as part of treatment for dependence on these drugs (OUD). It can only be prescribed at an opioid treatment program (OTP). Methadone is a long-acting opioid agonist that, when taken daily, reduces opioid cravings and withdrawal and blunts or blocks the effects of opioids. (See OUD, Source: SAMHSA, Methadone 2023).
Source: Substance Abuse and Mental Health Services Administration (SAMHSA) (2023, September 18). https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/methadone
Methamphetamine
(Commonly called meth, ice, speed, and crystal, and other terms.) A highly addictive central nervous system stimulant also categorized as a psychostimulant. Methamphetamine use has been linked to mental disorders, problems with physical health, violent behavior, and overdose deaths.
Motivational interviewing (MI)
A collaborative conversation for strengthening a person’s motivation and commitment to change. MI is a person-centered counseling style for addressing the common problem of ambivalence about change. (ASAM).
Naloxone (Narcan)
A medication approved by the FDA to reverse opioid overdose rapidly. It is an opioid antagonist that binds to opioid receptors and can reverse and block the effects of other opioids, such as heroin, morphine, and oxycodone. Administered when a patient is showing signs of opioid overdose, naloxone is a temporary treatment, and its effects do not last long. Therefore, it is critical to obtain medical intervention as soon as possible after administering/receiving naloxone. The medication can be given by intranasal spray (into the nose), intramuscular (into the muscle), subcutaneous (under the skin), or intravenous injection. By blocking opioid receptor sites, naloxone helps to counteract life-threatening depression of the central nervous and respiratory systems, allowing a person experiencing an overdose to breathe normally. Naloxone can be injected into a muscle or sprayed into the nose, depending on the drug’s packaging. It is non-addictive, safe, and can be administered with minimal training. For overdose of fentanyl and other highly toxic drugs, more than one dose of naloxone may be necessary.
Naltrexone (brand Reviva)
A prescription medication approved by the FDA to treat alcohol use disorder and OUD. Naltrexone blocks the euphoric and sedative effects of opioids by binding and blocking opioid receptors and reduces and suppresses opioid cravings. For OUD treatment, naltrexone is given as an extended-release intramuscular injectable (often referred to by the brand name Vivitrol). SSC (n.d.); Mayo Clinic, 2023
Sources:
Strengthening Systems of Care for People with Opioid Use Disorder (SSC) n.d. https://ssc.jsi.com/resources
Mayo Clinic. (2023, March 1). Naltrexone. https://mayocl.in/46y8SSQ
Narcan
Brand name for Naloxone (see): a medication used to treat opioid addiction to discourage misuse and as a rescue medicine for opioid overdose.
Narcotic drugs (also known as Opioids)
(See: Legally defined by the U.S. Controlled Substances Act enacted in 1970.) Narcotic refers to opium, opium derivatives, and their semi-synthetic substitutes. Examples include the illicit drug heroin and pharmaceutical drugs like OxyContin®, Vicodin®, codeine, morphine, methadone, and fentanyl.
Neonatal Abstinence Syndrome (NAS)
Conditions are caused when a baby withdraws from certain drugs, including opioids, the baby is exposed to in the womb before birth. States with laws requiring reporting “neonatal abstinence syndrome” include Arizona, Florida, Georgia, Kentucky, Tennessee, and Virginia.
Source: https://bit.ly/3v7Bk0N
Neonatal Opioid Withdrawal (NOWS) Syndrome
Symptoms that infants may experience as a result of exposure to opioids specifically. Symptoms of NAS and NOWS may include severe irritability, difficulty feeding, respiratory problems, and seizures.
Neuroadaptation
See Tolerance for the definition.
North Carolina Drug User Health Resource Guide
A comprehensive list of resources for people in North Carolina, broken down by region and county. Includes places to get medical care, housing, food, syringe access, MAT, and behavioral health treatment.
North Carolina Opioid and Substance Abuse Plan. May 2021.
Source: https://bit.ly/3Ty0n7h
North Carolina Opioid Settlements
Part of a historic $26 billion agreement to help bring desperately needed relief to communities impacted by opioids. These funds will be used to support treatment, recovery, harm reduction, and other life-saving programs and services in communities throughout the state. North Carolina’s Opioid and Substance Use Action Plan lays out concrete strategies to advance prevention, reduce harm, and connect people to the care that they need.
Source: https://ncopioidsettlement.org
Opioid addiction
Opioid use disorder (OUD) is the preferred term. OUD occurs when attempts to cut down or control use are unsuccessful or when use results in social problems and a failure to fulfill obligations at work, school, and home. Opioid addiction often comes after the person has developed opioid tolerance and dependence, making it physically challenging to stop opioid use and increasing the risk of withdrawal.
Opioid dependence
Occurs when the body adjusts to regular opioid use. Unpleasant physical symptoms occur when the medication is stopped.
Opioid misuse
The use of prescription opioids in any way other than as directed by a prescriber. The use of any opioid (prescription or non-prescription) in a manner, situation, amount, or frequency that can cause harm to self or others.
Opioid tolerance
Occurs when a person using opioids begins to experience a reduced response to medication, requiring more opioids to experience the same effect.
Opioid Overdose Prevention
Improve opioid prescribing, reduce exposure to opioids, prevent misuse, and treat the opioid use disorder.
Opioid Rapid Response Program (ORRP)
Program to mitigate drug overdose risks among patients experiencing disrupted access to prescribers. This interagency coordinated a federal effort to help mitigate overdose risks among patients who lose access to a prescriber of opioids, medications for opioid use disorder, or other controlled substances, such as benzodiazepines. Disrupted access could be due to law enforcement actions or other events, such as retirement, death, or voluntary closure by a clinician prescribing controlled substances. ORRP helps address care continuity and risk reduction for patients by alerting state health agencies about law enforcement events that might disrupt patients’ access to care and supporting state and local capacity building to prepare for and respond to disruptions in care.
Opioid Risk Tool
Assessment device for measuring withdrawal.
Clinical Opiate Withdrawal Scale — eleven-item scale to assess common opiate withdrawal symptoms. (PDF, 606KB)
Opioid treatment program (OTP)
An accredited treatment program with SAMHSA certification and DEA registration to administer and dispense opioid agonist medications approved by the FDA to treat opioid addiction (e.g., methadone, buprenorphine). OTPs must provide adequate medical, counseling, vocational, educational, and other on-site assessment and treatment services or by referral to an outside agency or practitioner through a formal agreement. (See Opioid agonist medication, Methadone, Buprenorphine.)
Opioid treatment program (OTP)
A program certified by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) to treat patients with opioid use disorder using methadone. These programs may also offer treatment with buprenorphine and/or naltrexone. An OTP can exist in several settings, including, but not limited to, intensive outpatient, residential, and hospital settings. Services may include medically supervised withdrawal and/or maintenance treatment, along with various levels of medical, psychiatric, psychosocial, and other types of supportive care. (ASAM).
Opioid use disorder (OUD)
A substance use disorder involving opioids causing significant impairment and distress. See Substance Use Disorder. A diagnosis of OUD is based on specific criteria such as unsuccessful efforts to cut down or control the use or use and failure to fulfill obligations at work, school, or home, among other criteria. OUD consists of an overpowering desire to use opioids, increased opioid tolerance, and withdrawal syndrome when discontinued.
Overdose
The accidental or deliberate consumption of a dose much larger than that either habitually used by the individual or ordinarily used to treat an illness that results in a serious toxic reaction or death. (ASAM). Injury to the body (poisoning) occurs when a drug is taken excessively (the amount will vary due to individual factors, including tolerance). An overdose can be fatal or nonfatal. Opioid overdose can cause respiratory failure, leading to coma, brain damage, and death.
Peer recovery specialist
An individual who has lived experience with a mental health condition and/or addiction to alcohol or other drugs; has completed formal training and provides one-to-one strength-based support to peers in recovery. Also called “peer support specialist” or “peer recovery coach.”
Peer-support specialist (PSS)
See also peer recovery specialist). People living in recovery with substance/opioid use disorder. A P.S.S. provides support to individuals with substance and opioid use disorder. Peer recovery specialists/coaches work one-to-one with clients and in groups. Peer Support Specialists are certified through the North Carolina Certified Peer Support Specialist Program.
People who inject drugs (PWID)
An acronym used to refer to people who inject drugs and generally preferred as “person-first” non-stigmatizing language.
People who use drugs (PWUD)
An acronym refers to people who use drugs and is generally preferred as “person-first” non-stigmatizing language.
Polysubstance use
Concurrent (or co-occurring) use of opioid and non-opioid drugs, such as alcohol, marijuana, methamphetamine, cocaine, and hallucinogens.
Post-overdose Response Team. (PORT)
This overdose follow-up program allows agencies to visit a recently overdosed person (e.g., within 24 – 72 hours). The North Carolina Harm Reduction Coalition (NCHRC) explains that “a follow-up visit conducted within days of a naloxone reversal provides multiple opportunities such as an:
- Opportunity to direct people to harm reduction services for active drug users and treatment services for drug users looking to reduce or stop their substance use;
- Opportunity to provide naloxone, overdose prevention training and overdose prevention materials; and
- Opportunity for stakeholders in the opioid response to work together to reduce overdose mortality.”
Source: North Carolina Department of Human Services. https://files.nc.gov/ncdhhs/Post-Overdose-Response-Toolkit.pdf
Pre-exposure prophylaxis (PrEP)
A method for people who do not have HIV to prevent transmission through sex or injection drug use is by taking a daily pill consistently. PrEP does not prevent other sexually transmitted infections (STIs), so it should be combined with condoms.
Precipitated withdrawal
A condition that occurs when an opioid agonist is displaced from the opioid receptors by an antagonist in an opioid-dependent individual. It is also possible for a partial agonist to precipitate withdrawal. (ASAM).
Prescription drug monitoring programs (PDMPs)
Safe, healthy, family-like substance-free living environments that support individuals in recovery from addiction.
Recovery houses
Safe, healthy, family-like substance-free living environments that support individuals in recovery from addiction.
Recovery position
If an opioid user remains unresponsive, and you must leave them alone to make the call, put them in the recovery position — on their side with legs bent and head resting on the arm on the floor. This position avoids aspiration if they vomit.
Recovery support services
Individual, program, and system-level approaches that foster health and resilience. They help individuals with behavioral health needs to be well, manage symptoms and achieve and maintain abstinence; reduce barriers to employment, education, and other life goals; help individuals secure necessary social support in their chosen community and may provide housing to support recovery. (See also Peer support.)
Relapse
A process in which an individual who has established disease remission experiences a recurrence of signs and symptoms of active addiction, often including the resumption of the pathological pursuit of reward and/or relief using substances and other behaviors. When in relapse, there is often disengagement from recovery activities. Relapse can be triggered by exposure to rewarding substances and behaviors, environmental cues to use, and emotional stressors that trigger heightened activity in brain stress circuits. Using substances or re-engaging in addictive behaviors is the latter part of the process, which can be prevented by early intervention (ASAM).
Screening, Brief Intervention, and Referral to Treatment (SBIRT)
SBIRT is an approach to quickly assess the severity of alcohol and drug use, facilitate a discussion to increase insight and awareness about substance use and motivation toward behavioral change, and refer those who need further care to treatment.
Stigma
Irrational or negative attitudes, beliefs, and judgments toward people with a particular characteristic, circumstance, or condition (e.g., socio-economic status, gender, race, sexual orientation, age, medical condition, or health status). HIV stigma can diminish the health and well-being of people with HIV by discouraging them from learning their HIV status, accessing treatment, or remaining in care. Stigma occurs on many levels, including individual, interpersonal, organizational, and structural/systemic. Stigma at the individual level pertains to personal beliefs, attitudes, and internalization of stigma, including through shame. Interpersonal stigma is manifested in the interaction between individuals, such as health service staff/providers and clients. Stigma at the organizational level encompasses harmful norms and inequitable policies, procedures, and practices. Structural/systemic stigma includes societal-level conditions, cultural norms, and institutional policies that may result in discrimination against particular groups.
Stimulants
Class of drugs, including the illegal drugs methamphetamine, cocaine, MDMA, and prescription drugs generally used to treat attention deficit hyperactivity (ADHD) disorder.
Suboxone
An opioid prescription drug to treat opioid dependence. It can be used as an induction agent to stabilize someone in withdrawal during medical detoxification and for maintenance treatment to promote recovery from opioid use disorder. It consists of two drugs: buprenorphine (a partial opioid agonist) and naloxone (an opioid antagonist). It is administered as a dissolvable film placed under the tongue or cheek. The FDA approved a generic buprenorphine and naloxone sublingual (applied under the tongue) in 2018.
Substance use disorder (SUD)
A cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues to use alcohol, nicotine, and/or other drugs despite major related problems such as significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home. Diagnostic criteria are given in the DSM‑5.5. Substance use disorder is the new nomenclature for (ASAM). What was considered substance dependence and substance abuse in the DSM‑4.6 (ASAM)? “Substances” include illicit or illegal drugs and legal drugs such as alcohol, nicotine, and prescription medications.
Syringe services programs (SSPs)
community-based prevention programs can provide a range of services, including linkage to substance use disorder treatment; access to and disposal of sterile syringes and injection equipment; and vaccination, testing, and linkage to care and treatment for infectious diseases and referrals to substance use disorder (SUD) treatment. (See also harm reduction, PrEP, naloxone, substance use disorder).
Sources:
https://www.cdc.gov/ssp/index.html#:~:text=Syringe%20services%20programs%20(SSPs)%20are
Team Development for Overdose Follow-up Programs
Team creation and operating the overdose follow-up program based on harm reduction is a key component. Involving harm reduction advocates, peer support specialists, or a case manager in your program development and actual response will make all the difference in helping a person decide on whether they are ready to engage in treatment services. In addition, an individual who has been directly impacted and personally experienced drug use or an overdose should be included and consulted with during program development. Programs that are created based on real experiences can be very effective. We recommend you connect with your local harm reduction agency and ask them for their expertise on drug use and overdose.
Source: https://www.nchrc.org/
Telemedicine/Telehealth
Allows you to visit your health care provider care for you without an in-person office visit. Telehealth is done primarily online with internet access on your computer, tablet, or smartphone.
Trauma-informed therapy or addiction treatment
Treatment to help you understand and recover from trauma and not retraumatize you by reliving the traumatic experiences associated with your addiction. Trauma can directly impact your ability or motivation to connect with others and use support services.
U.S. Food and Drug Administration (FDA)approved opioid list
Government agency that approves drugs. Three drugs are approved for treating opioid dependence: buprenorphine, methadone, and naltrexone. All three treatments are safe and effective in combination with counseling and psychosocial support.
Veterans Treatment Court
Alternative to the criminal justice system. According to NOLO, more than 100 veterans’ treatment courts exist in 25 states. The model requires regular court appearances, mandatory attendance at treatment sessions, and frequent and random testing for drug and alcohol use. Source: https://justiceforvets.org/what-is-a-veterans-treatment-court/Veterans respond favorably to this structured environment, given their past experiences in the Armed Forces. However, a few will struggle, and those veterans need a veterans treatment court program the most. Without this structure, these veterans will re-offend and remain in the criminal justice system.
Withdrawal management
Services to assist a patient’s withdrawal. The liver detoxifies, but clinicians manage withdrawal. (ASAM)
