Dear _________________,
We are writing in response to your recent piece,
“____________________________”. We are very grateful to you for helping bring
attention to the issue of substance use.
Our organization, ______________________,
is devoted to working with and for people who use drugs, with the goals of
meeting people where they are, and promoting “Any Positive Change”. We provide
________________ in the greater __________________ area.
We
wish to provide you with some guidance regarding accurate language and evidence
based clinical concepts that may aid you in any further work on this topic.
Despite a rich literature of evidence based best
practices, and myriad guidelines and reviews, public opinion is slow to change. Intractable stigma against people who use drugs is
influencing bad policy, discouraging people from seeking health care and other
services, and causing people to die alone of preventable overdoses.
Organizations like ours simply do not have the public’s ear, try as we might.
You do. Please partner with us to advance our mutual goal of healthy communities.
It is in this spirit that we offer you the following guidance.
Many of the
problems attributed to illicit substances are actually caused by social
determinants of health, or issues around acquisition and administration of
substances, not the substances themselves. Experience of trauma, abuse, or
other violence has been shown to be strongly associated with problem substance
use. These are the true culprits, in addition to stigma, social and economic
oppression, lack of access to treatment and other healthcare, and a prison
industrial complex that ensures its profitability by continuing to classify a
public health problem as a criminal problem.
Words like
“addict” and “junkie” are hateful and have no place in civil society. We
firmly support people with substance use disorders (SUD) in using whatever
language they feel comfortable with when describing themselves. We are in no
way advocating for the censorship or rebuke of subjects of this or future
pieces. We seek to create change only in
the way others describe people with substance use disorders.
We applaud
the progressive practices of the Associated Press as the update their AP
Stylebook:
Around the beginning of the year, in
January, we noticed that there was a hole in our guidance on addiction,” says
Jeff McMillan, an AP enterprise editor who was the lead author of the new
section. He adds, “As we began talking to experts, we learned that the language
that was traditionally used is changing, and we thought it would be good to
give people a vocabulary.
-
From The AP
Learns to Talk About Addiction. Will Other Media Follow? By Maia Szalavitz
Because We Believe that Language
Matters these are some of the things we’d like
journalists to know about discussing substance use:
Addiction
“Addiction”
and “addict” are not medical terms and have not been so for decades. Addiction formerly
referred to a set of behaviors, such as drug seeking and continuing to use
despite negative consequences. It is a poorly defined term that is not used as
a medical diagnosis. Instead, please use the medically correct terms from the
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V),
such as “person with methylphenidate (Ritalin)® use disorder” or “Ava is
physiologically dependent on opioids”.
If a person has not been formally diagnosed but
feels that their use is a problem, you could describe them as a “person with
problematic substance use”. Otherwise, use neutral, descriptive language such
as “Jacob is a 27-year-old computer programmer who smokes cocaine 2-3 times a
week.”
Opioid
Agonist Treatment (OAT)
OAT is preferable to the terms “Medication
Replacement Treatment (MRT)”, “Medication Maintenance Treatment (MMT)” or “Medication
Assisted Treatment”. The words “maintenance” and “replacement”
suggest that patients are not resolving their substance use disorder, but
merely substituting one substance for another. The term MAT stigmatizes Opioid Use Disorder
by suggesting that medication used in the treatment of OUD is not as important
as medication used in the treatment of other chronic health conditions with a
lifestyle component, for example, as insulin is used in the treatment of
diabetes. Placing substance use disorders in a
special category reinforces existing negative stereotypes. OAT is value-neutral
and precise in that it excludes naltrexone, for which there is insufficient efficacy
data.
OAT is the
gold standard treatment for everyone with an opioid use disorder, but
especially for pregnant people. It has been shown to increase patient’s
access to health care, including prenatal care, while reducing risk of relapse,
and therefore, fatal overdose. Parents on OAT medications should be represented
as making the very best choice for themselves and their child.
Detoxification
from Opiates
Recommending permanent detox for all patients is
often endorsed by those who are not fully informed on the medical complexities
of substance use disorder. One serious issue which is often overlooked is that
detox greatly increases the risk of relapse when compared to OAT, and declining
tolerance experienced during detox greatly increases risk of fatal overdose.
Because of these concerns, we advocate for extreme caution when offering detox
as an option to patients, and maintain that OAT is the safest treatment plan
for most. All detoxing patients and their loved ones should be given naloxone
(Narcan) and written instructions for administration. Under no circumstances should a person be pressured or coerced into
detox, especially by law enforcement or a drug court judge. Medical
decisions should be made by patients, with the counsel of healthcare providers.
Again, thank you for helping to bring attention to
this issue. Please contact us at: ______________________ for any questions, or
if you require information, more diverse views of substance use, or assistance
with future pieces. If this is a topic of particular interest to you, please
consider joining us in our work, to which your journalistic expertise would be
a welcome addition!
Joelle
Puccio, BSN RN
