OD or poisoning? A new debate over what to call a drug death
The death certificate for Ryan Bagwell, a 19-year-old from Mission, Texas, states that he died from a fentanyl overdose.
His mother, Sandra Bagwell, says that is wrong.
On an April night in 2022, he swallowed one pill from a bottle of Percocet, a prescription painkiller he and a friend bought earlier that day at a Mexican pharmacy. The next morning, his mother found him dead in his bedroom.
A federal law enforcement lab found none of the pills from the bottle tested positive for Percocet. But they all tested positive for lethal quantities of fentanyl.
“Ryan was poisoned,” said his mother, an elementary-school reading specialist.
As millions of fentanyl-tainted pills inundate the United States masquerading as common medications, grief-scarred families have been pressing for a change in the language used to describe drug deaths. They want public health leaders, prosecutors and politicians to use “poisoning” instead of “overdose.” In their view, “overdose” suggests that their loved ones were addicted and responsible for their own deaths, whereas “poisoning” shows they were victims.
“If I tell someone that my child overdosed, they assume he was a junkie strung out on drugs,” said Stefanie Turner, a co-founder of Texas Against Fentanyl, a nonprofit that successfully lobbied Gov. Greg Abbott to authorize statewide awareness campaigns about so-called fentanyl poisoning.
“If I tell you my child was poisoned by fentanyl, you’re like, ‘What happened?,’” she added. “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 fatalities. It has permeated the vocabulary of news reports and popular culture. But over the past two years, family groups have challenged its use.
They are having some success. In September, Texas began requiring death certificates to say “poisoning” or “toxicity” rather than “overdose” if fentanyl was the leading cause. Legislation has been introduced in Ohio and Illinois for a similar change. A proposed Tennessee
bill says that if fentanyl is implicated in a death, the cause “must be listed as accidental fentanyl poisoning,” not overdose.
Meetings with family groups helped persuade Anne Milgram, administrator of the Drug Enforcement Administration, which seized more than 78 million fake pills in 2023, to routinely use “fentanyl poisoning” in interviews and at congressional hearings.
In a hearing last spring, Rep. Mike Garcia, R-calif., commended Milgram’s word choice, saying, “You’ve done an excellent job of calling these ‘poisonings.’ These are not overdoses. The victims don’t know they’re taking fentanyl in many cases. They think they’re taking Xanax, Vicodin, Oxycontin.”
Last year, efforts to describe fentanyl-related deaths as poisonings began emerging in bills and resolutions in several states, including Louisiana, New Jersey, Ohio, Texas and Virginia, according to the National Conference on State Legislatures. Typically, these bills establish “Fentanyl Poisoning Awareness” weeks or months as public education initiatives.
“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 realm of public health, word choice has become imbued with ever-greater messaging power. During the pandemic, for example, the label “antivaxxer” fell into disrepute and was replaced by the more inclusive “vaccine-hesitant.”
Addiction is an area undergoing convulsive language change, and words such as “alcoholic” and “addict” are now often seen as reductive and stigmatizing. Research shows that terms such as “substance abuser” can even influence the behavior of doctors and other health care workers toward patients.
The word “poison” has emotional force, carrying reverberations from the Bible and classic fairy tales. “‘Poisoning’ feeds into that victim-villain narrative that some people are looking for,” said Sheila Vakharia, a senior researcher at the Drug Policy Alliance, an advocacy group.