Balance, Pain

The use of terms in substance control legislation and policies

The use of terms is an important issue in legislation and policies. Correct use of terms in a text body contributes to the realization of its objectives. Like body language is important for a speaker and can send messages contrary to what the speaker is saying, the choice of inappropriate terms can be counter-productive for the enforcement of legislation or the implementation of policies. Initially, it requires some discipline not to use the terminology that one “always” has used, but in the end, laziness backfires by the extra efforts needed to convince the target audience.

The World Health Organization recommends: “Terminology in national drug control legislation and policies should be clear and unambiguous in order not to confuse the use of controlled medicines for medical and scientific purposes with misuse.” (World Health Organization, Ensuring balance in national policies on controlled substances. Geneva, 2010)

Below is a list of terminology that does not contribute to access to controlled medicines for the treatment of pain and suffering (an objective of the international substance control conventions), including pain management and the treatment of opioid dependence. Alternatives are provided.

WillemWillem Scholten PharmD MPA

Consultant – Medicines and Controlled Substances

Lopik, The Netherlands, October 2014

Addict See addiction. Person with dependence
Addiction Considered stigmatizing by the Expert Committee on Drug Dependence since the 1980s; considered pejorative and stigmatizing by the 35th ECDD (2012). Dependence, dependence syndrome
Addictive substance See addiction. Dependence-producing substance
Criminal law (if referring to substance control legislation) International law on substance control is about the “health and welfare of mankind” and as national law is in most cases based on the conventions, it is too. Health law See preambles of the Single Convention on Narcotic Drugs and the UN Convention on Psychotropic Substances.
Dependent person See WHO Style Guide: this reduces the person to one characteristic only. Person with dependence (syndrome)
Drug Ambiguous language; in particular when a controlled medicine is meant, the word interferes with the promotion of its availability. Depending on the context: either medicine or substance of misuse
Narcotic Archaic terminology to refer to a class of substances by an unimportant side-effect of only some members of the class.Narcotic suggest the side-effect “sleep inducing”, but this is since decades called “hypnotic”. Furthermore, it is hardly a side-effect of any substance in the Single Convention, and certainly not the main side effect for opioids, which is constipation. Moreover, some substances in this convention are stimulants. Psychoactive substance (or for specific cases: opioid medicines, opioid analgesics etcetera) Use of “narcotic” is only justified if it refers to the list of substances regulated by the Single Convention on Narcotic Drugs.
Opiate Not in line with chemical nomenclature rules.Suffix “-ate” is reserved for salts and esters. Opioid See Glossary of WHO Guidelines Ensuring Balance in Controlled Substance Policies for the various different meanings of the word “opioid”.
Psychotropic substance Not really problematic, but just not usual. Psychoactive substance Use of “psychotropic” is justified if it refers to the list of substances regulated by the UN Convention of Psychotropic Substances
Physical dependence Usually refers to the symptoms of withdrawal and tolerance, which do not constitute dependence however. Who says “physical dependence” tells his audience that this is dependence, but at the same time, intends to say that this is not a problem. Contradictory as this is, it is not very likely that the audience will accept or even understand such a message,. It is much easier to use “tolerance” and “withdrawal” and to explain that for dependence at least one of four other symptoms is necessary. Withdrawal and/or tolerance 28th ECDD (1992) decided that physical and psychological dependence cannot be defined properly and abolished the terminology, replacing it by “dependence” and concluded that its definition of dependence is in line with the definition in ICD-10.The four other symptoms required for dependence are: 1. a strong desire to take the drug, 2. difficulties in controlling its use, 3. persisting in its use despite harmful consequences, 4. a higher priority given to drug use than to other activities and obligations (ICD-10).
Statistical-DDD or S-DDD Linguistically incorrect terminology introduced by International Narcotic Control Board (INCB). DDD WHO definition includes that “DDD” is intended for statistical purposes, therefore the addition “Statistical” is a duplication. (A “tautology” in philological terms).
Substitution therapy Gives the impression to politicians, civil servants and other lay people that this therapy is replacing “street drugs” with “state drugs” and therefore this language counteracts availability of therapy. Opioid agonist therapy, opioid agonist therapy for the treatment of dependence, OAT

About Pain policy & palliative care

Improving global pain relief by achieving balanced access to opioids worldwide


One thought on “The use of terms in substance control legislation and policies

  1. I have been encouraging “medicine” rather than drug. Very hard in US….. The “drug” store for a pharmacy. Adverse “drug” reactions. Will continue to chip away!

    Posted by Pain policy & palliative care | October 30, 2014, 7:18 AM

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