Elsevier

Public Health

Volume 153, December 2017, Pages 147-153
Public Health

Review Paper
Access to treatment with controlled medicines rationale and recommendations for neutral, precise, and respectful language

https://doi.org/10.1016/j.puhe.2017.08.021Get rights and content

Highlights

  • Wording about substance use disorder and psychoactive substances should be appropriate.

  • Medical journals should request authors to eliminate terms that do not meet this standard.

  • Inappropriate terms can induce biases negatively influencing social and public-health policies.

  • Use of appropriate language increases chances that patients will receive the best treatment.

  • Use of appropriate language increases chances for rational policies on psychoactive substances.

Abstract

The European Pain Federation EFIC, the International Association for Hospice and Palliative Care, International Doctors for Healthier Drug Policies, the Swiss Romandy College for Addiction Medicine, the Swiss Society of Addiction Medicine, and the World Federation for the Treatment of Opioid Dependence called on medical journals to ensure that authors always use terminology that is neutral, precise, and respectful in relation to the use of psychoactive substances. It has been shown that language can propagate stigma, and that stigma can prevent people from seeking help and influence the effectiveness of social and public-health policies. The focus of using appropriate terminology should extend to all patients who need controlled medicines, avoiding negative wording. A narrow focus on a few terms and medical communication only should be avoided. The appropriateness of terms is not absolute and indeed varies between cultures and regions and over time. For this reason, it is important that communities establish their own consensus of what is ‘neutral’, ‘precise’, and ‘respectful’. We identified twenty-three problematic terms (most of them we suggest avoiding) and their possible alternatives. The use of appropriate language improves scientific quality of articles and increases chances that patients will receive the best treatment and that government policies on psychoactive substance policies will be rational.

Introduction

Recently, on behalf of their organizations, five authors from our author group, representing the European Pain Federation EFIC, the International Association for Hospice and Palliative Care, International Doctors for Healthier Drug Policies, the Swiss Romandy College for Addiction Medicine, the Swiss Society of Addiction Medicine, and the World Federation for the Treatment of Opioid Dependence called on medical journals world-wide (editors-in-chief, editors, and reviewers) to ensure that authors use neutral, precise, and respectful wording.1

The call, an opinion piece, was perforce brief, and we could not in detail describe the language that we consider appropriate. With this article, we provide additional inappropriate terms, explanation, and alternatives. We do so on a personal title.

Section snippets

Similar calls in the past

This call was not the first for neutral, precise, and respectful wording regarding the use of psychoactive substances. In 2014, the Editorial Team of the journal Substance Abuse called on its authors, reviewers, and readers to use language that makes an appeal for respecting people (‘people-first language’), focusing on the medical nature of substance use disorders and treatment, to promote the recovery process and to avoid perpetuating negative stereotypes and biases.2 Ironically, they found

More change is needed than you think

The sources we cited here focus almost entirely on people who use psychoactive substances and treatment of substance use disorders. However, we would argue that more treatments and more people are affected:

  • 1.

    Terminology related to psychoactive substances affects treatment of all disorders and diseases that require availability and accessibility of controlled medicines, including opioids (for treatment of moderate and severe pain, dyspnea, and for opioid agonist treatment of opioid dependence),

Cultural, temporal, and geographical variation

The appropriateness of terms is not absolute. It is dependent on the perception of a word by the emitters and receptors of messages. This means that it can (and will) change over time; it can be perceived in different ways by different subpopulations. Subpopulations may be different groups within one local community but also speakers of the same language in different regions. For English, being spoken in so many parts of the world, the connotation of a word will not necessarily need to be the

Undesirable terminology

We identified a number of terms which are problematic when used in the medical domain with explanation on problems and alternatives (Table 1). We also suggest some alternative terms that may be appropriate under certain circumstances only.

Using undefined or ill-defined terms is imprecise and affects the quality of science. We found that some people use definitions deviating from what has been agreed internationally, sometimes even opposite to these official definitions (e.g. defining

Acknowledgements

The table in this article was drafted as part of a campaign promoting terminology that enhances a respectful approach of people who use controlled substances and to promote access to controlled substances, e.g. for the treatment of opioid dependence and the treatment of pain. The campaign is conducted by International Doctors for Healthier Drug Policies, the Swiss Romandy College for Addiction Medicine, the International Association for Hospice and Palliative Care, the European Pain Federation

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