Hopefully, you learned about the importance of language in Module 1 and have started to alter your vocabulary. In this lesson, you will learn how language surrounding the use of medications perpetuates misconceptions about addiction treatment. My hope is that dispelling these myths will make you more open-minded and more enthusiastic about the role of medications in a treatment plan. The first term we will explore is opioid substitution therapy. Often health care providers describe the use of medications as opioid substitution therapy. The word substitution supports the myth that using medications to treat opioid use disorder is just substituting one drug for another. That is not the case. Medications for opioid use disorder are pharmacokinetically different from drugs that are misused and are not a substitute for a drug. When used properly, medications do not create a new addiction. Like many medications we use to treat chronic diseases including medications for blood pressure, depression, diabetes and so on, individuals treated with medications cannot just stop taking them once they're stabilized on them. However, this does not mean they're addicted to the medications. It means if they decide in conjunction with their provider to come off of medication, they will need to do so in a coordinated way. Another term that is often used by providers is Medication Assisted therapy. The word assisted diminishes the power of medications. It makes it seem supplemental. Unfortunately, there is a myth in the healthcare community that medications are a second line of defense and should only be considered if a patient feels detoxification or counseling. In fact, medication should be considered first-line treatment for patients that you have screened and diagnosed with opioid use disorder. Medications are highly effective and have numerous benefits and therefore should not be considered an adjunct treatment option. In fact for opioid use disorder, medications are far superior to counseling alone. Well, we've talked about it before. Let's look at clean and dirty again. As you know, dirty is often used when a patient opens up about relapse or when indicated on monitoring tests. But returning to use is an ongoing sign of the disease. Compare this with diabetes treatment. Would we ever call patient dirty if their sugars were high despite insulin treatment? Would we call someone else clean if their sugars were normal? Would we kick a patient off insulin because their sugars were elevated? Of course not, we would increase their dose, add in psychosocial support, increase behavioral modification, and see that patient more often. So why should addiction be any different? Why do we think exhibiting signs of a disease is a reason to end treatment? Unfortunately, there is a myth that returning to use during treatment is considered a treatment failure and should result in treatment discontinuation. Although this is beginning to change, this is a widely accepted approach and it's a risky approach. The highest risk of opioid overdose death occurs in patients who are not ready to discontinue treatment or in those who are released from incarceration or detoxification stays and have decreased tolerance. Rather than thinking that the patient has failed treatment, we should realize that treatment has failed the patient. In summary, medications do not substitute one addiction for another. Medications particularly for opioid use disorder should be a first-line treatment. Medication should not necessarily be discontinued if a patient returns to use. You'll learn more about the medications available for opioid use disorder in the next lesson. See you there.