Don’t Fix the Fentanyl Crisis, Just Change What We Call It

CBC has a new article of the fentanyl crisis, but this time, they’re arguing semantics: Is the fentanyl situation an overdose crisis or a poisoning crisis? Worrying about what we call the current situation, seems completely irrational.

When someone drinks too much, we call it alcohol poisoning.

And we shouldn’t. It is clearly an overdose.

When someone takes too much of a drug, we call it an overdose.

Which is by definition what it is.

The difference in language may seem slight, but it says a lot about how our society differentiates between alcohol users and drug users.

There may be something to this argument.

Poisoning is a technically accurate diagnostic term for what’s happening inside the body. Meanwhile, the word overdose, meaning “to administer medicine in too large a dose,” implies that a drug user knows what the dose is, and chooses to take too much.

Illegal drug users do choose to take the risk of taking too much. Users know the risks that the lack of quality control in the illegal drug stream means that doses are highly variable.

Dr. Christy Sutherland, with the BC Centre on Substance Use and medical director for the Portland Hotel Society, says the word ‘overdose’ implies blame for victims of the ongoing crisis.

Holding people responsible for their actions is not “blaming” them. Not holding people responsible for their actions infantilizes them, which is discriminatory. There is much more to the crisis than simple overdoses.

That implication of personal responsibility can exacerbate stigma, and the stigma is all too real. Every time CBC News covers the crisis, we receive harsh calls and emails. At best, the negative comments say drug use is a choice. At worst, they say the drug users’ death is somehow deserved.

Drug use is a choice. I don’t think anyone deserves to die, but clearly, those who use illegal drugs are putting themselves in harms way.

Words matter and stigma is powerful. Medical professionals tell us that stigma prevents people from seeking help, from using with others, from having naloxone kits on hand. It discourages supervised consumption sites from being built.

Stigmatizing drug users for their poor life choices is unhelpful. Even if you don’t believe, as I do, that people who are ready to change deserve the chance to, you should still want to help people get clean for purely pragmatic reasons: drug users are a financial burden on society, and helping them means they will require fewer resources from our medical system.

Anyone familiar with the crisis will tell you that most drug users don’t intend to take fentanyl, but their drug supply happens to be contaminated with it. With B.C.’s drug supply so badly tainted, and stigma putting drug users at risk, is this an overdose crisis, or a poisoning crisis?

In the case of fentanyl, I’d say we have a clear case of poisoning. Normally, the government steps in to regulate products–for example, making sure people don’t spike wine with propylene glycol. Since drugs like heroin are illegal, there are no such controls. If a drug user knew they were taking fentanyl and overdosed, I wouldn’t consider it poisoning, but if they thought they were getting something safer, I would have to agree, they were poisoned.

“When the drug supply in B.C. is so toxic, and patients are at such high risk — I’ve had patients who’ve had more than 30 overdoses this past year,” said Dr. Christy Sutherland. “Really we could say that they’re being poisoned by this toxic drug supply.”

No! They are being poisoned by the dealers in illegal drugs who are putting fentanyl into the supply. These are not accidental poisonings.

​”As a society, we have to value each other and care about each other … our neighbours, and our brothers and sisters, and parents…. They deserve safety,” she said.

We don’t have to do any such thing, but it is a good thing if we do. The erosion of the Christian morality has led us away from caring. Too often, the progressive mantra is that the government, and not individuals, should be responsible. While I disagree that people engaging in dangerous behaviors deserve safety, they certainly deserve to be protected from criminals who are poisoning them to make a buck.

But while [the term overdose] may be widely accepted, it’s not actually technically accurate in describing what’s happening in the body.

No, its describing what caused the problem (which the article goes on to point out).

The province of B.C. commonly uses the term “overdose.”  And while the deputy provincial health officer, Dr. Bonnie Henry, recognizes that it’s not a technically accurate medical term, she says that it still has value. “It is a word that resonates with people…. It was a general enough term that it could be a whole variety of things … but also, it’s something that people understand,” she said.

Agreed. If you start changing terminology, there is potential for confusion, which could be dangerous.

With the term “overdose” so entrenched, it will take time to change the way people speak.

Or we could not bother, and recognize that in the case of drugs other than alcohol, when we speak of overdose, we’re talking about causes.

Sutherland recently spoke at the Canadian Medical Association annual meeting, where she advocated for more progressive and accurate language to limit the level of stigma surrounding drug users.

Changing a word is not going to remove the stigma of drug use. Legalization and regulation will, to some degree. But engaging in a dangerous, self harming activity will always hold stigma. Even with something as accepted by the majority of society as alcohol, there is still stigma for alcoholics. Once pot has been legalized for a while, the stigma of being a “stoner” will likely be greatly reduced.

Some might dismiss the debate over the language we use in this crisis as semantics. But with four people dying in this province on a daily basis, this has become less a crisis, and more a new reality that we must approach in new and innovative ways. If discarding a stigmatizing, technically inaccurate word can contribute to saving even one life, shouldn’t we do it?

If confusing a doctor by saying that one person who has overdosed was poisoned could lead to even one death, shouldn’t we not do it? Instead, why not expend energy on legalization, which would eliminate fentanyl and allow us standardize doses of heroin and other drugs.


About jimbelton

I'm a software developer, and a writer of both fiction and non-fiction, and I blog about movies, books, and philosophy. My interest in religious philosophy and the search for the truth inspires much of my writing.
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