Words matter. For 25 years before I joined CHCF last fall, I was a health care journalist. Journalists care a lot about words. And the media organizations that employ them care that their reporters use words in a similar way, which makes adherence to a "style guide" critical. The Associated Press, which reaches more than half the global population with its content every day, maintains one of the most influential style guides in the business and updates it regularly. Not only must AP journalists around the world adhere to this style, vast numbers of other news organizations adopt it too.
That's why it's a big deal that the AP Stylebook included an entry on "addiction" in its recently released 2017 update. People who work in addiction treatment long ago dropped the words "addict" and "substance abuser" because those terms are so stigmatizing. The AP has correctly dropped these words in favor of language that recognizes that addiction is not a moral failing but a disease.
"Addiction to alcohol and other drugs is considered a disease that affects a person's brain and behavior," the AP Stylebook now says. "Addiction" is the preferred term for the disease, although "substance-use disorder is preferred by some clinicians." The AP also directs reporters to avoid words like "alcoholic, addict, user, or abuser" and instead to use phrasing such as "person with addiction."
Careful Use of Words Reduces Stigma
Clinicians and counselors have advocated for this type of "person-first" language for years. Stigmatizing language can be a barrier to seeking treatment, and it contributes to bias even among doctors and therapists. With its tremendous reach, the AP can help to reduce stigma not only in the medical field, but also among members of the public, to correctly place addiction in the realm of physical diseases like diabetes and hypertension.
As the country continues to fight the epidemic, which claimed more than 33,000 lives from prescription opioids and heroin in 2015, now is the time for the media to revisit the words they use to talk about this crisis and those who are affected by it.
While the revisions to the AP Stylebook are helpful, some misleading information remains. Under its entry on heroin, the AP writes, "Authorities attribute recent increases in heroin use largely to crackdowns on prescription opioids." The data do not support this statement. First, yes, some people who use prescription opioids will progress to heroin. But the best estimates indicate that only around 4% of people using prescription opioids for nonmedical purposes will go on to heroin. Second, opioid prescribing has quadrupled since 1998. Four percent of a larger population using opioids will sadly lead to more numbers of people using heroin. In addition, drug cartels took advantage of the increased demand for illicit opioids by dramatically increasing the available supply.
CHCF has pushed forward on three fronts to address the impact of growing opioid use. We're working to promote safer prescribing so clinicians either don't start patients on opioids or reduce their dosage, increase availability of and access to medication-assisted treatment to help people who suffer from opioid addiction obtain the best evidence-based treatment, and increase availability and co-prescribing of naloxone, which can reverse overdoses.
California Focuses on Opioid Safety
Eighteen months ago, we also began supporting 16 local opioid safety coalitions in 24 counties across the state. These coalitions bring stakeholders from diverse backgrounds to the table and are achieving reductions in opioid prescribing as well as increasing access to naloxone in their counties. Work on expanded increase to treatment is progressing.
One word we have recently dropped from our opioid work is "painkiller," and we note that AP continues to include it in its style guide entry "opiate, opioid." The AP instructs its journalists to use the term "powerful prescription painkillers" to distinguish prescription opioids from heroin.
The term "painkiller" when discussing prescription opioids is a false promise. While these can be excellent medications for patients who are recovering from surgery or severe injury, or suffering from pain due to serious illness, these medications are generally ineffective as chronic pain treatments. Risks outweigh benefits in most cases, and high opioid doses can paradoxically make pain worse. In addition, the most recent evidence suggests that even a few days of use can double the likelihood of long-term use. Doctors and other health care providers are starting to rethink how they approach pain, recognizing that a goal of zero pain is often not possible. The goal should instead be to reduce pain enough that patients can resume the activities they were avoiding due to pain.
Compared to AP's decision to avoid stigmatizing language, these two quibbles are small. It's worth celebrating AP for taking the lead, and it's clear that other media should follow.