(2003; 31 pages) [French] [Spanish]
5. Terminology used in reporting abuse-related adverse drug reactions
The main function of the WHO Programme for International Drug Monitoring is to provide early warnings of drug-related problems, including drug abuse, dependence and withdrawal syndrome. Since the initiation of the Uppsala Monitoring Centre (UMC), nearly three million reports of adverse drug events have been received from health care professionals (reporters) from 69 different countries. Reports are originally sent as text, and then coded to provide medically useful terms. Unfortunately, the terms used by the reporters can be imprecise or contained within a large body of text. To enable the programme to provide early warnings, any terms that can possibly have a value as a pointer to dependence are coded as “dependence” to ensure that early signals are not missed.
There is a need for caution in the interpretation of the UMC data. At present, health care professionals do not use terminology related to drug abuse and dependence in a consistent manner. For example, the selective serotonin reuptake inhibitors (SSRIs) are important psychoactive substances where terminology possibly indicative of dependence poses a major problem (see Annex). The use of broad terms such as “drug discontinuation syndrome” instead of “withdrawal” also hampers data coding and interpretation.
The International Classification of Diseases (ICD) (14) is the most widespread tool used in health epidemiology. While it is correct to say that withdrawal and tolerance are neither required nor sufficient for a positive diagnosis of dependence syndrome, excessive emphasis on this aspect can lead to the misconception that withdrawal is unrelated to dependence.
Definitions should be consistent within WHO, but it must be recognized that terms may be used differently for different purposes. The terms used in reporting adverse drug reactions are intended to describe drug effects and to communicate them to patients and health care professionals. Avoiding terms that may be confusing for nonprofessionals as well as ensuring translatability into all languages are particularly important.
It was agreed that the Secretariat and the UMC should continue to work together to provide the best data to meetings of the Committee. The Committee discussed the definition of terms and emphasized the need for careful interpretation of the UMC data.