Guidance

Glossary

Published 21 July 2021

Applies to England

A

Agonist

A drug chemical that stimulates a nervous system receptor creating an effect in the body or brain.

Antagonist

A drug chemical that blocks a nervous system receptor preventing an effect in the body or brain.

B

Blockade effect

The effect of a drug fully occupying nervous system receptors and preventing a second drug from having any effect. The blockade might be by an antagonist preventing an agonist from having an effect, or by an agonist preventing a second agonist from having an effect. The blockade can sometimes be overcome with high doses of a second agonist but this is dangerous as it can lead to overdose.

Buprenorphine

In drug treatment, buprenorphine is an opioid used to treat opioid use disorder. It is both agonist and antagonist, unlike methadone. Subutex and Espranor are branded oral buprenorphine products. Other buprenorphine formulations are available, including long-acting or depot injections, but these are beyond the scope of this guidance. Buprenorphine-naloxone is buprenorphine combined with the opioid antagonist naloxone to prevent its misuse by being crushed and snorted or injected. Suboxone is branded buprenorphine-naloxone.

C

Contingency management (CM)

An intervention that encourages behaviour change by providing a reward when the behaviour is achieved. Rewards are typically in the form of vouchers, privileges, prizes or cash. The behaviour should be clearly specified, observable and the reward provided in a timely fashion. CM is used to modify a person’s drug misuse or to increase health-promoting behaviours.

D

Detoxification

A clearly defined process, agreed with the service user, that supports them to safely and effectively stop using all opioids while minimising withdrawals.

Diversion (of opioid substitution treatment (OST) medication)

OST medication given or sold to someone to whom it is not prescribed, which can be lethal.

Dose optimisation

The dose of opioid substitute that stops withdrawals and cravings and helps the service user completely stop using illicit opioids.

H

Harm reduction

Policies and practices that aim to reduce the harm that people do to themselves or others from their drug use. It focuses on safer drug use rather than just not using drugs, which may be unlikely or unrealistic for some people.

I

Induction

The start of a service user’s OST including the initial adjustment of dose, also called ‘titration’.

M

Maintenance

Longer-term prescribing of OST on a stable dose, regularly reviewed and with other support continuing.

Methadone

In drug treatment, methadone is an opioid agonist used to treat opioid use disorder. Physeptone is a branded methadone.

Motivational interviewing (MI) (and other motivational enhancement techniques)

A set of therapeutic principles, an interactional style and specific techniques in which the therapist takes the position of a collaborative partner in discussions with the service user about their drug use. This includes feedback on assessments or test results, asking open questions, listening, summarising things the service user has said that support behaviour change, reflecting these back and providing affirmations. The underlying principle is that service users persuade themselves that change is desirable, achievable and will benefit them.

N

Naloxone

An opioid antagonist used as the emergency antidote for overdoses caused by heroin and other opioids. The main life-threatening effect of opioid overdose is to slow down and stop breathing. Naloxone blocks this effect and reverses the breathing difficulties. Naloxone is most commonly administered by intramuscular injection. Nasal preparations are also available.

Naltrexone

An opioid antagonist recommended by the National Institute for Health and Care Excellence for preventing relapse to deter opioid use as it blocks the effects if someone ‘slips’ and uses an opioid after otherwise stopping. Only usually works if backed up by psychosocial and other support.

O

Opioids

A group of drugs including heroin, methadone and buprenorphine that act on opioid receptors, which are nerve endings in the brain that affect the pain and reward systems.

Opioid substitution treatment (OST)

Prescribing a replacement opioid medicine to people who are dependent on heroin or other opioids. Oral methadone and buprenorphine are most commonly used. Other medicines are available, including long-acting or depot injections (buprenorphine) and shorter-acting injections (diamorphine, methadone), but these are beyond the scope of this guidance.

Overdose prevention

Practices, along with policies, protocols and training to support them, to prevent overdose and related deaths. It includes information and advice on the risk of overdose and how to reduce it. It usually includes providing naloxone.

P

Pharmacological intervention

Prescribing of medicines for drug misuse and dependence, including medicines to support stabilisation, maintenance, withdrawal and relapse prevention

Psychosocial intervention

Psychosocial interventions incorporate psychological approaches and practical support to someone to help them overcome their drug use and dependence, and support recovery.

R

Recovery

Recovery should be:

• an individual process or journey rather than a predetermined destination
• built on hope to sustain motivation and support expectations of an individually fulfilled life
• about enabling people to gain a sense of control over their own problems, the services they receive, and their lives
• about helping people to find opportunities to participate in wider society
• culturally appropriate

Relapse prevention

Interventions to help someone not to return to drug use. Psychosocial interventions develop the service user’s abilities to recognise, avoid or cope with thoughts, feelings and situations that are triggers to substance use. They include a focus on coping with stress, boredom and relationship issues and skills such as drug refusal and craving management. Medication can also be prescribed, including naltrexone for opioid relapse prevention.

S

Stabilisation

In OST, stabilisation is the process of titrating someone onto a regular dose of opioid substitute medicine at which they are not experiencing withdrawals, cravings, highs or side effects. Stabilisation is also used to describe a range of processes in inpatient treatment.

Supervised consumption

A pharmacist or other competent pharmacy staff watches the OST medicine being taken by the service user immediately after it is dispensed in the pharmacy. This ensures that the full dose prescribed has been swallowed (if oral) or has dissolved (if to be absorbed under or on the tongue) and none is missed or available to be diverted.

T

Titration

The initial adjustment of a dose of OST so that it is safe for the service user and stops their withdrawals.

Treatment and recovery care plan or planning

The process for, and product of, agreeing with a service user a plan for what they wish to address in their treatment and recovery, and how.

U

Use on top

Continued use of illicit opioids while in OST. It may be regular and frequent or occasional and infrequent. It may signal that the OST dose is too low, or that the social and emotional links with the drug and its users have not been broken. It may also be triggered by external pressures.

W

Withdrawal

A variable group of symptoms occurring when someone reduces or stops using a psychoactive substance, such as an opioid, after using it persistently.