Drug “poisoning” or “overdose”?

~ Jason Schwartz

The NY Times has an article on the debate between characterizing drug deaths, fentanyl deaths in particular, as poisonings or overdoses. Much of the argument focuses on destigmatizing drug-related deaths.

“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 organization 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 continued. “It keeps the door open. But ‘overdose’ is a closed door.”

“Overdose or Poisoning? A New Debate over What to Call a Drug Death.” The New York Times, 2024, www.nytimes.com/2024/03/11/health/overdose-poison-fentanyl.html. Accessed 12 Mar. 2024.
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One argument in the article is that this change in language creates “innocent” victims that will need to be contrasted with villains or guilty victims.

I’d also add that how we frame the problem determines how we frame the solution.

  • Framing the problem as “poisoning” sets up “safe supply” as the solution.
  • Framing the problem as addiction sets up treatment and recovery as the solutions.
  • Framing the problem as a medical condition sets up a doctor as the solution.
  • Framing the problem as a bio-psycho-social-spiritual condition sets up whole-person recovery and multidisciplinary medical and nonmedical interventions as the solutions.
  • Framing the problem as crime sets up law enforcement as the solution.
  • Framing the problem as public health sets up surveillance, education, and policy change as solutions.
  • Framing the problem as stigmatizing language sets up language change as the solution.
  • Framing the problem as criminalizing a health problem (driving people into the shadows) sets up legalization as the solution.
  • Framing the problem as despair sets up social engineering or economic aid as the solution.

More than one thing can be true at the same time. There’s truth in both poisoning and overdose. It’s true that the drug supply has more unpredictable high-potency doses than ever before. It’s also true that this is nothing like the Tylenol poisonings and that, in some ways, fentanyl and tranq are innovations that serve a particular function rather than contamination — to ensure higher potency, lower price, and extend the duration of the effects of the drug.

We demonstrated that preference for fentanyl was increasing between 2017 and 2018 among our cohorts of PWUD who used opioids. In a multivariable analysis, younger age and daily crystal methamphetamine injection remained independently associated with preference for fentanyl. Most commonly reported reasons for preferring fentanyl included more euphoria, longer effects, and development of high opioid tolerance.

Ickowicz, S., Kerr, T., Grant, C., Milloy, M. J., Wood, E., & Hayashi, K. (2022). Increasing preference for fentanyl among a cohort of people who use opioids in Vancouver, Canada, 2017-2018. Substance abuse, 43(1), 458–464. https://doi.org/10.1080/08897077.2021.1946892

I believe that alcohol and other drug problems are complex with multiple dimensions and require comprehensive solutions that simultaneously address multiple dimensions. There may have been times when public discourse overemphasized addiction at the expense of other dimensions. However, I fear that many of the trending frames obscure the role of addiction and, in some cases, erase addiction. I tend to think “poisoning”, while it contains some truth, contributes to that trend. After all, the opioid crisis began with prescription opioids — a safe and regulated supply. And, alcohol and tobacco have massive social and health costs — safe, accessible, and regulated supply.

Published by Jason Schwartz

I have been an addiction professional and social worker since 1994. I started blogging in 2005 as the Clinical Director at Dawn Farm. I no longer work at Dawn Farm and am now the Director of Behavioral Medicine at a community hospital, and a lecturer at Eastern Michigan University’s School of Social Work. Views expressed here are my own. Keep in mind that the field, the contexts in which the field operates, and my views have changed over time.

One thought on “Drug “poisoning” or “overdose”?”

  1. In my home city of Detroit, and other cities (from reading regional radical newspapers) it was clear and evident. It was discussed by Advocates working at the time. The Police put drug overdoses on the open file homicide list. They were considered murders for numerous reasons. Who, making money off selling dope makes it too strong? Not impossible but rare. Who adds adulterants that are poison and kill? Go back and look and that was true for the mythical 27 Rule. The rock musicians, etc. who died by 27 years old. The Jim Morrison’s and Janis Joplin’s (and if you goggle the list is quite high). They went on the open Homicide list. Musicians around Greenwich Village at that time all knew (I worked with them and they told me personally) that Jimi Hendrix was murdered. A sad tale I will not regale with here. 

    Now this does not apply to drug mixing, where consuming multiple drugs (heroin and barbiturates or benzodiazepines…and/or, alcohol….and) can lead to accidental death. But here’s a thing I never see referenced. It is quite hard to die/overdose from just heroin. Don’t believe me, please research. The nature of it and it’s “half-life” means it’s usually drug mixing. And at times, murder. And unless someone’s quite ….a putz who will not last in the streets long, poisonings are deliberate. They are murder.

    Meanwhile, “More than one thing can be true at the same time.” Recovery Review has worked and championed this sort of seemingly simple yet important concept that asks us to open our minds every day and I applaud that.

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