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The current issue of AJPH includes an article by Griesler et al.(p. 1258) that characterizes prescription opioid medical users and misusers in the US adult population. The authors analyzed cross-sectional National Survey on Drug Use and Health (NSDUH) data from 2016 through 2017 and found that 12% of prescription opioid users reported misusing prescription opioids. In this group of misusers, 27% exclusively misused their own prescription, 38% exclusively misused prescription opioids without a prescription, and 31% misused prescription opioids both ways (the remaining 4% could not be classified). Thefinding that 12% of opioid users misuse prescription opioids is striking, but it is critical to understand how misuse is defined to contextualize the problem. The terms “misuse” and “abuse” are often used interchangeably, and there is not one agreed on definition. NSDUH’s definition of misuse is “use in any way …