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I would be interested in any advice the CRG can provide on the following question which has been raised by one of our members countries:
The issue is around the terminology for substance use/misuse/abuse. At present there is inconsistency in this area of the terminology and we are keen to rationalise this to the most up to date clinical representation. In some instances misuse and abuse terms are used synonymously, attached to the same concept as below – in this instance Substance misuse is flagged in the terminology as the UK preferred description so a system would pick this up for display in the record:
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In other instances these terms are used on separate distinct concepts:
| conceptId1 | Description1 | conceptId2 | Description2 |
|---|
| 84758004 | Amphetamine abuse (disorder) | 428659002 | Amphetamine misuse (finding) |
| 231462006 | Barbiturate abuse (disorder) | 428623008 | Barbiturate misuse (finding) |
| 37344009 | Cannabis abuse (disorder) | 428823006 | Cannabis misuse (finding) |
| 78267003 | Cocaine abuse (disorder) | 429782000 | Cocaine misuse (finding) |
ICD-11, though still in Beta, seems to be proposing “harmful pattern of use of <substance>” (with ‘abuse’ as a narrower term) and <substance> dependence as distinct categories.
DSM-V , I believe has dropped the abuse and dependence descriptions (used in DSM IV) and uses ‘substance use disorders’ on a continuum of severity, mild, moderate, severe.
Advice sought from UK Clinical Lead for addictions who advised that ‘abuse’ is not used. Misuse, harmful use and dependence are clinically useful terms. Misuse is used as a collective term for the ICD-10 categories of ‘Harmful use’ and ‘dependence’. But the latter are used instead of misuse if referring to specific pathways of care as they are different clinical pathways.
Please could you include this on the agenda of your next call, 21 May if possible
Many thanks
Jane Millar, SNOMED Internatio