Why the word “drug” promotes a public bias in chronic pain treatment

by Jack Cain

In the United States, there is a heated debate at all levels over the increased use of narcotic pain relievers, especially as part of a long-term treatment regimen for chronic pain.  Part of that debate is fueled by the pejorative use of the term “drug” instead of “medication” in conjunction with the legal prescribing, dispensing and consumption of these substances.

Bias is extremely insidious and difficult to eradicate once in place.  It masquerades as common sense and logic.  It causes normally rational people to express themselves in illogical ways.  In this case, it results in bad policy as the medical use of the term “drug” is pulled into the media where the public has been conditioned to respond to this word as detrimental while the word “medication” is viewed as beneficial.

Here are some examples:

Our government has declared a “war on drugs”, not a “war on medication.”

There is a government position to coordinate this “war” filled by the “Drug Czar”, not the “Medication Czar.”

The media commonly reports on large “drug busts” when referring to seizures of illegal substances conducted by the DEA or Coast Guard.

The suppliers of large amounts of illegal substances are collectively known as “drug cartels.”

Finally, for decades the term “drug” has been associated with the word “abuse” when reporting the negative social results of the non-medical use of heroin, cocaine and methamphetamine.

Using only a dictionary and a thesaurus, the difference in perception between “drug” and “medication” is easily demonstrated.  At the Visual Thesaurus, entering the word “drug” shows a 1st order association with “doing drugs”, “being drugged by kidnappers” and “narcotic”.  Entering “medicine”, two of the large number of beneficial 1st order associations are “treating or alleviating disease” and “remedies”.  In the Free Medical Dictionary, the word “drug” is directly associated with “narcotic”, “recreational drug”, “designer drug”, and “any substance that can be abused”.  “Medicine” is associated almost exclusively with the legitimate “treatment of disease”.

In today’s social media culture, many details are lost when “The Twitter Effect” is applied to accurate and informative scholarly articles on this topic.  What is left are the emotional impressions of the topic rather than the complete analysis of the subject the author intended.  Therefore, the emotional content of words becomes much more important than the actual definition, especially when articles are quoted by the media or by public officials to justify one political or legislative position or another.

If medical professionals are going to claim “Primum non nocere” (First do no harm) as a guiding principle, they need to acknowledge when to use the word “drug” and when, to do no harm, to use the word “medicine”.

Jack Cain is a Pain Policy Advocate at the Consumer Pain Justice Cooperative.

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  • http://steveariens.com Steve Ariens, PD

    Imagine that… a decade ago JCAHO makes pain assessment/management a major standard in hospitals and labels it as 5th vital sign .. and the use of opiates/pain meds increases… Who could have seen that coming ?
    I would suspect that any disease that there is increased concern about -preventative care/disease management – the drugs used to treat those disease states will have a increase in sales.

    • Jack Cain

      Of course they do – although there is almost no reason to include most of them as they are not as flashy as fighting against those naughty narcotics.

      I do have to ask why you chose this place to point that out and also chose to use the word “drug” instead of “medicine” which was the point in the first place.

      Care to contribute?

  • http://steveariens.com Steve Ariens, PD

    I tend to use med therapy, meds, & drugs interchangeably .. on the other hand .. why do “we” use the word “narcotics” when just about any controlled substance is subject to abuse… that is why they are classified as a controlled substance.
    All opiate derivatives are narcotics and are controlled substances… not all controlled substances are narcotics nor derived from the opium plant.

  • http://www.elainejesmer.com Elaine Jesmer

    Take it from someone who participated fully in the “Summer of Love”, until drugs – all drugs, not just those deemed worthy – are legalized, there will never be standards developed that differentiate between “need” with “want”. Standards wouldn’t provide substantive answers for every situation, but what they would do is form a framework from which individual cases might, in the best of all possible worlds, be effectively tracked, monitored, and adjusted. If there’s any evidence that Calvinism still exists in America, it’s where pain and drugs are concerned.

    • http://steveariens.com Steve Ariens, PD

      Right now… we allow criminals to control… where drugs are sold/distributed… their quality…. their price… and to whom they are sold to… Who believes that the “war on drugs” is able to take more than 10% of the drugs off the market that are available to be consumed/abused annually.
      decriminalizing MJ/opiates etc would reduce the prison population by 20%.. DEA budget is 2.25 BILLION.. that does not count budgets at state/local levels. Tax revenues – priceless… number of criminals that would have to find a new line of work…uncountable… number of people harmed/dead by substance abuse… virtually unchanged.
      The war on drugs started with the Harrison Narcotic Act 1914… after nearly 100 yrs… anyone want to comment on how well it is doing…

  • Reta

    I have to agree with Jack, words are extremely powerful. The use of the word “drug” impart a negative context and will continue to cast all pain patients in a negative light.

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