PPSG Glossary

Glossary of Terms

Addiction
"Addiction" is a sociologic term which refers to compulsive drug use, psychological dependence, and continuing use despite harm. Neither physical dependence nor tolerance are sufficient to define "addiction." In the past as well as in present day language "addiction" is frequently and incorrectly equated with physical dependence and withdrawal. "Addiction" and related terms such as "addict" are used in narcotic control laws and are sometimes inappropriately defined to include physical dependence, thereby confusing pain patients with addicts.

Guideline
We use the term "guideline" to mean an official policy statement, which does not have the force of law. Guidelines may be issued by a professional association or a government agency to express the group's attitude about a particular matter. While guidelines themselves do not have binding legal force, they define the parameters of conduct for professionals which are consistent with accepted standards of practice.

State medical boards have issued guidelines regarding the medical use of opioids which define the conduct which the board considers to be within the legitimate practice of medicine. Guidelines may also be called a position statement or policy statement; and these may appear in a position paper, report, article, letter or news letter.

Law
"Law" is a broad term that refers to rules of conduct with binding legal force, adopted by governments at the international, federal, state or local levels. Law can be found in treaties, constitutional provisions, decisions of the court, statutes and regulations. A number of laws have been adopted by the states concerning pain management.

"Statute" is a law created by a legislative body, whether federal, state, county or city. "Statute" may
mean a single act or a collection of acts. Statutes are commonly referred to as laws or acts.

"Regulation" is an official rule or order issued by agencies of the executive branch of government.
Regulations have the force of law, and are intended to implement a specific statute, often to direct
the conduct of those regulated by the agency.

Narcotic
"Narcotic" is a legal, not a scientific term which denotes some of the drugs that are controlled under the Single Convention on Narcotic Drugs, 1961, and the U.S. Controlled Substances Act (CSA). Under the Single Convention and CSA, substances such as the opioids are classified as narcotics. Marijuana and cocaine are also legally classified as "narcotics." When discussing pain relief, we avoid use of "narcotic", preferring "opiate" or "opioid".

Opiate
"Opiate" refers to drugs whose origin is the opium poppy, including codeine and morphine.

Opioid
"Opioid" is a scientific term denoting both natural (codeine, morphine) and synthetic (methadone, fentanyl) drugs, and whose pharmacological effects are mediated by specific receptors in the nervous system. "Opioid" also applies to agonists and antagonists with morphine - like activity.

Schedules of Controlled Substances
Controlled substances are drugs which have a potential for abuse. They are classified by the U.S. Controlled Substances Act of 1970 and the individual state laws into five schedules according to three basic considerations: (1) the degree of potential for abuse; (2) whether the substance has currently accepted medical use; and (3) whether the use under medical circumstances is considered safe⁽¹⁾. The schedules are known as schedule I, II, III, IV, V, schedule I being the most restrictive and V the least restrictive. Schedule I substances have no accepted medical uses and are illegal (heroin, LSD, marijuana); schedules II, III, IV, and V have accepted medical uses and generally have Food and Drug Administration (FDA) approval for medical use. Schedule II substances can be narcotic or non-narcotic. Schedule II narcotics include morphine, methadone, hydromorphone, and oxycodone.⁽²⁾

1. Controlled Substances Act, 812, Schedules of controlled substances.

2. District Court of Appeal of Florida, Third District.676 So.2d 1380, June 26, 1996

Tolerance
"Tolerance" refers to the physical adaptation of the body to an opioid, resulting in the need to increase the dose to achieve the same effect, as in "analgesic tolerance", or as in the reduction in a response (such as sedation) with repeated administration of drug.

Physical dependence
"Physical dependence" also describes the physical adaptation of the body to the presence of an opioid; it is characterized by signs of withdrawal when use of an opioid is stopped abruptly, or when an opioid antagonist is administered to an individual who has been on chronic opioid therapy.

Psychological dependence
"Psychological dependence" is a behavioral pattern characterized by a compulsion to obtain a drug for mood altering effects.

Sources:
Cancer Pain Relief, Second Edition, With a guide to opioid availability, World Health Organization, 1996. [Ordering information]

Supplement 1: Availability of Opiates for Medical and Scientific Needs, United Nations: International Narcotics Control Board, 1995.

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