21 C.F.R. Part 291

Code of Federal Regulations (C.F.R.) that, among other things, sets standards for narcotic treatment and use of methadone.

42 C.F.R. Part 2

Federal Regulation concerning confidentiality of alcohol and drug abuse patient treatment records.

42 C.F.R. Part 8

Federal Regulation concerning dispensing of drugs through opioid treatment programs.

Addiction

A behavioral syndrome characterized by the repeated, compulsive seeking or use of a substance despite adverse social, psychological, and/or physical consequences. Addiction is often (but not always) accompanied by physical dependence, a withdrawal syndrome, and tolerance.

Alcoholism

A pattern of compulsive use of alcohol in which individuals devote substantial periods of time to obtaining and consuming alcoholic beverages despite adverse psychological or physical consequences, e.g., depression, blackouts, liver disease, or other consequences. (Adapted from Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision [DSM‐IV‐TR].)

Antagonist

Substance that tends to nullify the effect of another (e.g., a drug that binds to a receptor without eliciting a response).

AUDIT

Alcohol Use Disorders Identification Test. A screening tool for identification of alcohol use disorders.

Biopsychosocial

Combining biological, psychological, and social concerns or effects.

Buprenex® (Generic: buprenorphine)

Injectable formulation of the Schedule III narcotic (opioid) partial agonist buprenorphine. Approved for use as an analgesic. Not approved for use in the treatment of opioid addiction.

Buprenorphine

An opioid partial agonist that is a synthetic derivative of thebaine. Two sublingual formulations of buprenorphine, the Schedule III pharmaceuticals Subutex® (buprenorphine) and Suboxone® (buprenorphine/naloxone), received Food and Drug Administration (FDA) approval in October 2000 for use in the treatment of opioid addiction. Buprenex®, an injectable formulation of buprenorphine, has previously been available in the United States and is approved for use as a parenteral analgesic.

Buprenorphine/naloxone

Drug combination; see separate definitions and brand name Suboxone®.

CAGE‐AID

CAGE Questionnaire Adapted to Include Drugs.

CAGE Questionnaire

A screening tool for identification of alcohol use disorders (questions use words beginning with letters C, A, G, and E consecutively).

Children’s Health Act of 2000 (P.L. 106‐310)

Legislation (Public Law) that authorizes expanded research and services for a variety of childhood health problems, reauthorizes programs of the Substance Abuse and Mental Health Services Administration (SAMHSA), addresses the problem of youth substance abuse and the violence associated with it, and works to improve the health and safety of children in child care. Title XXXV of the Children’s Health Act is the Drug Addiction Treatment Act of 2000 (DATA 2000), which authorizes qualifying physicians to treat opioid addiction in clinical settings other than the Opioid Treatment Program (OTP) setting.

CINA

Clinical Institute Narcotic Assessment Scale for Withdrawal. An interview and observation tool for assessing opioid withdrawal signs and symptoms.

COWS

Clinical Opiate Withdrawal Scale. An interview and observation tool for assessing opioid withdrawal signs and symptoms.

DAST 10

Drug Abuse Screening Test. A questionnaire tool for identification of drug and alcohol use disorders.

DATA 2000

See Drug Addiction Treatment Act of 2000.

Dependence

A condition manifested as a characteristic set of withdrawal signs and symptoms upon reduction, cessation, or loss of the active compound at cell receptors (a withdrawal syndrome).

Drug Addiction Treatment Act of 2000

Title XXXV of the Children’s Health Act of 2000. The Drug Addiction Treatment Act of 2000 (DATA 2000) establishes a waiver authority for qualifying physicians to prescribe or dispense specially approved Schedule III, IV, and V narcotic medications for the treatment of opioid addiction in clinical settings other than the Opioid Treatment Program setting.

HIPAA

Health Insurance Portability and Accountability Act.

LAAM

Closely related to methadone, the synthetic compound levo‐alpha‐acetyl‐methadol or LAAM (Brand name: ORLAMM®), has an even longer duration of action (from 48 to 72 hours) than methadone, permitting a reduction in frequency of use. In 1994, it was approved as a Schedule II treatment drug for narcotic addiction. Both methadone and LAAM have high abuse potential. Their acceptability as narcotic treatment drugs is predicated on their ability to substitute for heroin, the long duration of action, and their mode of oral administration.

MAST

Michigan Alcohol Screening Test. A questionnaire tool for identification of alcohol use disorders.

MCV

Mean corpuscular volume.

Methadone

A Schedule II synthetic opioid with pharmacologic actions similar to morphine and heroin; almost equally addictive. Approved for use in the treatment of opioid addiction in federally regulated Opioid Treatment Programs. May be administered orally, intramuscularly, and subcutaneously.

Monotherapy

Therapy using one drug or approach.

Morphine

Most active narcotic alkaloid of opium. Has powerful analgesic action; abuse leads to dependence.

Mu agonist

A drug that has affinity for and stimulates physiologic activity at mu opioid cell receptors. See also opioid full agonist.

Mu opioid receptor

A receptor on the surface of brain cells that mediates opioid analgesia, tolerance, and addiction through drug‐induced activation. When an opioid agonist, or partial agonist (e.g., buprenorphine), binds to a mu opioid receptor, a series of other proteins associated with the mu receptor‐signalling pathway becomes activated. Other opioid receptors are the delta and kappa receptors.

Naloxone

Brand name: Narcan®. An opioid antagonist, similar to naltrexone, that works by blocking opioid receptors in the brain, thereby blocking the effects of opioid full agonists (e.g., heroin, morphine) and partial agonists (e.g., buprenorphine).

Naltrexone

Naltrexone, a narcotic antagonist, works by blocking opioid receptors in the brain and therefore blocking the effects of opioid full agonists (e.g., heroin, morphine) and partial agonists (e.g., buprenorphine).

NATA

Narcotic Addict Treatment Act.

Needle embolization

Blood clot caused by use of a needle. If dislodged, the clot may cause death.

Nonopioid

Drug or compound not related to natural or synthetic opium and related alkaloids.

OAT

Opioid Agonist Treatment.

Opioids

Drugs that are derived naturally from the flower of the opium poppy plant (e.g., morphine and heroin) and those that are synthetically produced in the lab (e.g., methadone and oxycodone).

Used therapeutically to treat pain, but also produce a sensation of euphoria—the narcotic “high.” Repeated misuse and abuse of opioids often leads to dependence and addiction.

Opioid full agonist

Drugs that have affinity for and stimulate physiologic activity at opioid cell receptors (mu, kappa, and delta) that are normally stimulated by naturally occurring opioids. Repeated administration often leads to dependence and addiction.

Opioid partial agonist

Drugs that can both activate and block opioid receptors, depending on the clinical situation. Partial agonists have properties of both agonists and antagonists. The mu agonist properties of partial agonists reach a maximum at a certain dose and do not continue to increase with increasing doses of the partial agonist. This is termed the ceiling effect. The ceiling effect limits the abuse potential and untoward side effects of opioid partial agonists. The Schedule III medication buprenorphine is an opioid partial agonist.

Parenteral

Not through the gastrointestinal route; for instance, given via intramuscular or intravenous injection.

Pharmacodynamics

Study of the biochemical and physiological effects of drugs and the mechanisms of their actions, including correlation of these actions and effects with the drugs’ chemical structure.

Pharmacokinetics

Study of the action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion.

Pharmacotherapy

Treatment of disease by using medicines.

Polysubstance abuse

Concurrent use or abuse of multiple substances (e.g., drinking alcohol as well as smoking tobacco, snorting cocaine, inhaling glue fumes).

Psychosocial

Combining psychological and social aspects.

SMAST

Short Michigan Alcohol Screening Test. Shortened, self‐administered version of the MAST alcohol use disorder screening tool.

SOWS

Subjective Opioid Withdrawal Scale. Self‐administered scale for grading opioid withdrawal symptoms.

Sublingual

Under the tongue.

Suboxone®

Brand name for the Schedule III sublingual formulation of buprenorphine combined with naloxone. Received FDA approval in October 2000 for use in the treatment of opioid addiction. Naloxone is added to the formulation to decrease the likelihood of abuse of the combination via the parenteral route.

Subutex®

Brand name for the Schedule III sublingual formulation of buprenorphine. Received FDA approval in October 2000 for use in the treatment of opioid addiction.

Talc granulomatosis

Formation of granulomas (small nodules) as a chronic inflammatory response, in the lungs or other organs, in this case to talc or other fine powder. Talc granulomatosis may occur in drug users because many injected drugs have been adulterated with an inert substance (such as talcum powder) to cut or dilute the amount of drug.