The death certificate of Ryan Bagwell, a 19-year-old from Mission, Texas, states that he died of a fentanyl overdose.
His mother, Sandra Bagwell, says that’s wrong.
On an April night in 2022, he swallowed a pill from a bottle of Percocet, a prescription painkiller that he and a friend had purchased earlier in the day at a Mexican pharmacy just across the border. The next morning his mother found him dead in his bedroom.
A federal law enforcement laboratory determined that none of the pills from the bottle tested positive for Percocet. But they all tested positive for lethal amounts of fentanyl.
“Ryan was poisoned,” said Mrs. Bagwell, a reading specialist at the elementary school.
As millions of fentanyl-tainted pills circulate in the United States under the guise of common drugs, grieving families are pushing for a change in the language used to describe drug-related deaths. They want public health officials, prosecutors and politicians to use “poisoning” instead of “overdose.” In their view, an “overdose” indicates that their loved ones were addicts and were responsible for their own deaths, while “poisoning” indicates that they were victims.
“When I tell someone my child overdosed, they assume he was a drug-addicted junkie,” said Stefanie Turner, co-founder of Texas Against Fentanyl, a nonprofit that successfully lobbied Gov. Greg Abbott has to authorize nationwide awareness campaigns about so-called fentanyl poisoning.
“When I tell you that my child was poisoned by fentanyl, you ask yourself, ‘What happened?'” she continued. “It keeps the door open. But ‘overdose’ is a closed door.”
For decades, “overdose” has been used by federal, state and local health and law enforcement agencies to record drug deaths. It has permeated the vocabulary of news reports and even popular culture. But over the past two years, family groups have questioned its reflexive use.
They have some success. In September, Texas began requiring death certificates Saying “poisoning” or “toxicity” instead of “overdose” if fentanyl was the primary cause. Legislation for a similar change has been introduced in Ohio and Illinois. A Tennessee bill states that if fentanyl is involved in a death, the cause must be listed as “accidental fentanyl intoxication” rather than an overdose.
Meetings with family groups helped convince Anne Milgram, the head of the Drug Enforcement Administration, which seized more than 78 million counterfeit pills in 2023, to routinely use “fentanyl poisoning” in interviews and at congressional hearings.
In a hearing last spring, Republican Rep. Mike Garcia of California praised Ms. Milgram’s choice of words, saying, “You did a great job of calling these ‘poisonings.'” These are not overdoses. In many cases, victims do not know they are taking fentanyl. They think they’re taking Xanax, Vicodin, OxyContin.”
Efforts to label fentanyl-related deaths as poisonings emerged last year in several states, including Louisiana, New Jersey, Ohio, Texas and Virginia, according to the National Conference on State Legislatures. Typically, these bills spend weeks or months raising awareness of fentanyl poisonings as a public education initiative.
“Language is really important because it shapes policy and other responses,” said Leo Beletsky, an expert on drug policy enforcement at Northeastern University School of Law. In the increasingly politicized field of public health, word choice carries ever-increasing message power. For example, during the pandemic, the term “anti-vaxxer” fell into disrepute and was replaced by the more inclusive term “vaccine hesitant.”
Addiction is an area undergoing rapid language change, and words like “alcoholic” and “addict” are now often seen as reductive and stigmatizing. Research shows that terms like “drug addict” can even influence the behavior of doctors and other health care workers toward patients.
The word “poison” has an emotional power and is reminiscent of the Bible and classic fairy tales. “‘Poisoning’ feeds into the victim-villain narrative that some people are looking for,” said Sheila P. Vakharia, a senior researcher at the Drug Policy Alliance, an advocacy group.
But while “poisoning” offers many families protection from stigma, others whose loved ones have died from taking illegal street drugs find it problematic. Using “poisoning” to distinguish certain deaths while labeling others “overdose” creates a judgmental hierarchy of drug-related deaths, they say.
Fay Martin said her son Ryan, a commercial electrician, was prescribed opioid painkillers for a work-related injury. When he became addicted to them, a doctor withdrew his prescription. Ryan turned to heroin. He eventually sought treatment and stayed sober for a while. But he was ashamed of his history of addiction, kept to himself and gradually started taking drugs again. Believing he was buying Xanax, he died in 2021, the day after his 29th birthday, from taking a pill tainted with fentanyl.
Even though he, like thousands of other victims, died from a counterfeit pill, his grieving mother feels as if others are looking at her askance.
“When my son died, I felt people’s stigma and personal responsibility because he had used illegal drugs,” said Ms. Martin, of Corpus Christi, Texas. “But he didn’t get what he expected. He did not ask about the amount of fentanyl that was in his body. He tried not to die. He was trying to get high.”
According to a growing number of prosecutors, when someone was poisoned by fentanyl, the person selling the drug was a poisoner — someone who knew or should have known that fentanyl could be deadly. More states are passing fentanyl homicide laws.
Critics point out that the idea of a toxic villain does not explain the complications of drug use. “That’s a bit of an oversimplification because many people who sell substances or share them with friends also have a substance use disorder,” said Rachael Cooper, who leads an anti-stigma initiative at Shatterproof, an advocacy group.
People who sell or share drugs are typically many steps removed from those who mixed the batches. They probably didn’t know their medications contained lethal amounts of fentanyl, she said.
“In a non-politicized world, ‘poisoning’ would be accurate, but the way it is used now reframes what was likely a random event and reinterprets it as a premeditated crime,” said Mr. Beletsky, who directs Northeastern’s “Changing the Narrative” project Addiction stigma examined.
In toxicology and medicine, “overdose” and “poison” have value-neutral definitions, said Kaitlyn Brown, the clinical executive director of America’s Poison Centers, which represents and collects data from 55 centers nationwide.
“But the public will understand the terminology differently than people who are knowledgeable in the field, so I think there are important differences and nuances that the public may miss,” she said.
“Overdose” describes a larger dose of a substance than was considered safe, Dr. Brown. The effects may be harmful (heroin) or not (ibuprofen).
“Poisoning” means that damage has actually occurred. But it can be poisoning from countless substances, including lead, alcohol and food, as well as fentanyl.
Both terms are used regardless of whether an event results in survival or death.
Until about 15 years ago, the Centers for Disease Control and Prevention, a respected source of data on drug deaths nationwide, often used the two terms interchangeably. A CDC report on rising drug-related deaths in 2006 was titled “Accidental Drug Poisoning in the United States.” Reference was also made to “accidental drug overdose deaths.”
To streamline the growing data on drug deaths from federal and state agencies, the CDC has switched to “overdose” only. (It now also collects statistics on reported nonfatal overdoses.) The CDC’s Division of Overdose Prevention notes that “overdose” refers only to drugs, while “poisoning” refers to other substances, such as cleaning products.
When asked which unbiased word or phrase might best characterize drug-related deaths, drug policy and treatment experts struggled.
Some preferred “overdose” because it is embedded in data reporting. Others use “accidental overdose” to emphasize lack of intent. (Most overdoses are actually accidental.) News outlets occasionally use both, reporting that drug overdoses have occurred due to fentanyl poisoning.
Experts in addiction medicine point out that most of the drug supply on the street has now disappeared distorted, “poisoning” is in fact the simplest and most accurate term. They find that patients who purchase cocaine and methamphetamine die because of the fentanyl in the product. Fentanyl addicts succumb to bags that contain more toxic mixtures than they bargained for.
Ms. Martin, whose son was killed by fentanyl, bitterly agrees. “He was poisoned,” she said. “He received the death penalty and his family received a life sentence.”
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2024-03-11 07:00:12
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