The official journal of
EUROPAD - European Opiate Addiction Treatment Association
WFTOD - World Federation for the Treatment of Opioid Dependence
Editor: Icro Maremmani, MD - Pisa, Italy, EU
Associate Editors:
Thomas Clausen, MD - Oslo, Norway
Pier Paolo Pani, MD - Cagliari, Italy, EU
Marta Torrens, MD - Barcelona, Spain, EU
Statistical Editor:
Mario Miccoli, PhD - Pisa, Italy, EU

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Heroin Addiction and Related Clinical Problems: 2021, 23, N3 (pages: 81 - 85)

Despite Repeated Criticism, Medications (Methadone, Suboxone) For Opioid Use Disorder Continue Being Called "Substitution" Treatments

Appel P.

Summary: Even though its use has declined, “Opioid Substitution Treatment or Therapy” (OST) is still used to describe agonist therapies, viz. methadone, suboxone, despite its stigmatizing effects and fundamental inaccuracy. ‘Medication Assisted Treatment (MAT) was an earlier, ca. 2000, response to the need to improve terminology, which, in turn, has been superseded by ‘medications for opioid use disorder' (MOUD). Yet agonist therapies continue being called ‘substitution' treatment at a significant rate: a 2019-2020 online ‘verbatim' search yielded 289 ‘hits' for OST vs 330 ‘hits', for MOUD respectively, showing the disturbing persistence of a discredited term. This essay explores how the term ‘substitution' fails to describe MMT on linguistic and psychopharmacological grounds, its sometimes intentional stigmatizing effects, indirect fatal consequences, underscoring the need to abandon the term. Federal and state government agencies, non-MOUD treatment systems and support groups, treatment accrediting agencies, academics, journals, health services training institutions, international health agencies, and the media, should screen for the term “substitution”, eliminate it if found, and use MOUD instead. The goal is to increase the willingness to welcome and implement programs employing agonist medications for OUD as essential to public health and individual recovery, and to view MOUD programs as a key support for the communities where patients are treated.


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