What Is A Narcotic?

I do not like the word narcotic. As any reader will have gathered at this point, I believe words should be used precisely and be well defined. The word "narcotic" lacks a precise definition. In the medical community, it is essentially used synonymously with opioid. An opioid is any medication that binds to and activates an opioid receptor. While this kind of makes sense from the ancient Greek meaning "to make numb," I don't like it. Why don't we call local anesthetics narcotics?

Outside of the medical community, the word narcotic carries a negative connotation. The narcotics division of a police department deals with drug crimes, including the distribution, sale, and use of illegal drugs. Knowing this, and having grown up watching a lot of police shows, my skin crawls at the idea of someone referring to a medication that I prescribe as a narcotic.

Imagine being a patient with a chronic pain syndrome that has not responded to non opioid medication management. After trying everything else, you eventually trial an opioid. The medication helps with your pain, providing some normalcy to your life. You are not having side effects. You use it responsibly. How do you feel about being on a "narcotic?" Personally, I just think it is an awful term. Why are we using a term for a medication with a legitimate medical purpose that we also use for cocaine, methamphetamine, and a police department that deals with the distribution, sale, and use of illegal drugs?

Not infrequently, I hear the following story. A patient will have been taking an opioid for a chronic pain syndrome, but it will have been discontinued by a new doctor after someone retires or moves. The opioid is then discontinued. The patient is then miserable and in worse pain. I ask why it was discontinued and they say something along the following lines. "My doctor said she didn't want me on a narcotic." The worst description I heard from a fellow physician was "we have a clean clinic here, no narcotics." In a note, I also saw a note that said "to this patient's credit, he has never been on an opioid." This language is so frustrating to me. Why are we treating an opioid as inherently "dirty" or it is somehow wrong for a patient to be on one?

If you are a patient, please forgive the medical community's use of the word narcotic and its negative connotation. In my opinion, as health care providers, we need to adopt better terminology. If a patient is on an opioid, the word "opioid" should be used. "Narcotic" should be reserved for law enforcement.