Language Matters: Defining Death in the Age of Fentanyl
As fentanyl has spread throughout the illicit drug supply, it has cut many lives short and left many families grieving. Discussions highlight two classes of victims: those who died from overdose and those who died from poisoning. For many people, these two words will evoke different feelings. But the reality in both cases is that someone died from consuming too much fentanyl.
The narrative around these deaths often differs, too. Accidental poisoning narratives typically revolve around a person dying because they took a drug that they did not think would contain fentanyl. Frequently, the victims are portrayed as people experimenting with drug use or infrequent drug users. In contrast, overdose narratives often involve a person who is known to be addicted to illicit drugs, usually heroin, and imply that the person should have known their drugs may contain fentanyl. The poisoning narrative often blames the drug supplier for the person’s death, whereas the overdose narrative either blames the person who overdosed or splits the blame between the person who overdosed and the drug supplier. The stigma of using drugs contributes heavily to these narratives, with the person who overdoses being stigmatized more than the person who is poisoned.
However, the circumstances around a poisoning and an overdose are likely quite similar. In both cases, a person obtains a substance from the illicit market or a social source. Whether the person thinks they are buying heroin, oxycodone, cocaine, ecstasy, or any other drug, what they receive is contaminated with fentanyl. The person then takes the drug in a quantity that they expect will produce the desired results (e.g., euphoria, focus, energy, sedation, pain relief). Sadly, the person unwittingly consumes a highly potent drug, and the effects of that drug lead to their death.
The person who is poisoned and the person who overdosed have another thing in common: In most cases, they did not intend to take a lethal dose of a drug. Both people died unintentionally, otherwise we would likely say they died by suicide or homicide. Death certificates even account for this difference by requiring the medical examiner to specify the manner of death as accidental, suicidal, homicidal, pending investigation, or unable to be determined. Furthermore, death certificates use a globally recognized coding system to define causes of death, and the codes used for drug overdoses are the same codes as poisonings.
While the person who took the drugs died accidentally, the word “poisoned” implies an intentional action by an outside party—in this case, the person who sold or manufactured the drugs. Again, stigma impacts how the person who sold or manufactured the drugs is viewed. Often, if a person dies from taking too much fentanyl, it is difficult to find the people who supplied the drugs. However, we know a few things about how people typically obtain drugs. For most people who use drugs, social sources like family and friends or other people who use drugs, supply their drugs. Also, the vast majority of people who sell drugs also use drugs, and many have a substance use disorder. Given that many people access their drug supply through social connections who are likely using the same supply, it seems improbable that these people intend to supply potentially lethal drugs.
Illicit opioid manufacturers or “high-level dealers” are rarely the people directly selling drugs to the end user. Determining manufacturers’ and “high-level dealers’” intent for adding fentanyl to other drug products is difficult, but, given that killing your customer would be bad for business, the supply-side benefits (it is inexpensive to make and highly potent making it easier to transport) of fentanyl are likely why it has proliferated.
No matter your views about the morality of drug use and where you choose to place blame for a death resulting from tainted drugs, both poisoning and overdose involve similar decisions. The person risks using a substance that they did not obtain directly from an authorized, regulated source. Dividing deaths into those that merit sympathy and those that do not won’t undo the pain of losing a loved one and does nothing to prevent future deaths. We must set aside the stigma of drug use and acknowledge that all death deserves compassion.