Stigmatizing Language in Substance Use-related International Classification of Diseases Codes

Healthcare-associated stigma is a critical barrier for treatment engagement for patients with substance use disorders. Although there are efforts to combat stigmatizing language in clinical documentation, little is known about the presence of substance use-related stigmatizing language in structured diagnosis codes ubiquitous in clinical medicine.

We examined the presence of substance use-related stigmatizing terms contained within the International Classification of Diseases, 10th revision, clinical modification (ICD-10-CM) diagnosis code descriptions. Stigmatizing terms were compiled from guidelines authored by the National Institute on Drug Abuse, while ICD-10-CM codes were obtained from the United States Centers for Disease Control and Prevention.

We evaluated 74,259 ICD-10-CM code descriptions and identified 173 substance use-related codes with stigmatizing language. The stigmatizing terms detected were "abuse" (157 code descriptions), "alcoholic" (16), and "drug abuser" (2). The term "abuse" was used in relation to multiple substances including alcohol, opioids, cannabis, sedatives, hypnotics and anxiolytics, cocaine, stimulants, hallucinogens, inhalants, other psychoactive substances, tobacco, and other medicinal products.

Stigmatizing language is used in multiple ICD-10-CM code descriptions. Subsequent iterations should bring ICD-10-CM code descriptions in line with current recommendations for destigmatized descriptors to avoid the perpetuation of stigma in healthcare.