Overdose or Poisoning? It depends.
Pigeonholing the discussion surrounding fentanyl will not solve anything.
Jan Hoffman of The New York Times recently wrote an article stating that there is a new debate over what to call drug deaths (Overdose or Poisoning? A New Debate Over What to Call a Drug Death.). As someone who has been affected by this conversation I want to chime in with my own thoughts.
Language is important. Vocabularies are as large as they are because it is expedient to have available individual words that can be used to express complex ideas. Words, however, can be more than just descriptive. Words can be leading, and the choice to use one word or phrase rather than another has the power to influence the trajectory of people’s thoughts. This is precisely why some people, apparently, want overdoses to be referred to as “poisoning”.
Hoffman states that over the last two years family groups have challenged the reflexive use of the word “overdose” to describe overdoses. If a problem is being caused by a single word being used to describe a diverse litany of situations then simply replacing that word with a different word will not solve the problem, at least not without creating new problems. Hoffman quotes Sheila P. Vakharia of the Drug Policy Alliance as saying that “‘[p]oisoning’ feeds into the victim-villain narrative that some people are looking for.” Sometimes one person is an unwitting victim and it would not be incorrect to use such a narrative. But many overdoses actually are accidents and the “victims” really were responsible for their own deaths. I have overdosed once (of the thousands of times that I have used fentanyl) and I do not blame anyone but myself. I was not tricked, I was not forced, I simply had a low tolerance and smoked more than I should have.
The death on my case was also an accident. A 25-year-old man with a history of opioid abuse sought out “china white”, purchased a gram of this substance (from an unfamiliar supplier in an unfamiliar location), and died after injecting a considerable dose while alone in the early morning. This situation might be compared to someone who goes swimming in the ocean by himself early in the morning and drowns after getting caught in a riptide. Had he acted less carelessly then he would not have died, just as I would not have overdosed if I had acted less carelessly. And yet, because I was revived with naloxone and he was not, he is a victim and I am a victimizer.
There seems to be two related but distinct goals attached to this proposed change of wording. The first, which I fully support, is to destigmatize drug addiction and lessen the perception of people who die from overdoses as deserving their fate. People do sometimes make decisions that are so extremely foolhardy that it is hard to feel sorry for them when the predictable consequences inevitably follow (this is actually the basis of the show 1000 Ways to Die), but there are many routes to drug addiction and most drug addicts I don’t think are undeserving of sympathy. But the second goal, to increase the stigmatization of drug distributors, goes completely against the spirit of the first. The rationale seems to be that culpability is zero sum and the only way to remove the stigmatization of the “victim” is to transfer it to someone else, and who better to blame than the distributor?
In my discovery there is an audio recording of the lead detective telling the father of the deceased that he is a victim and that the person in custody (i.e. me) is responsible for causing his son’s death. At this point I was the primary suspect (partly because no attempt had been made to identify other suspects, even though he had acquired drugs from multiple sources) but very little investigation had been done and all that was really known was that he reached out to me seeking “china”, he died from acute fentanyl intoxication (probably), and I was in custody pending trial for distribution of fentanyl resulting in death. I don’t know what the mindsets of the parents were prior to conversing with this detective but it would not surprise me to find out that they were not thinking of themselves as victims prior to a law enforcement officer putting this idea into their heads.
My case is not unique. I was sentenced to 13 years for my role in this accidental overdose, but the mandatory minimum for someone who loses at trial is 20 years, or life with a prior felony drug conviction. The circumstances do not matter; if you distribute drugs to someone who subsequently overdoses you will face a sentence which actually might be longer than what you would get for intentional murder. The people who receive these sentences are people as well, many, probably most, of them also users who are struggling with addiction. The poisoning narrative takes the very problem that it is aiming to fix, the black-and-white stereotyping and stigmatization of a routinely misunderstood class of people, and applies it to distributors as if to do so with this class (which overlaps significantly with the class of “users”) is appropriate.
The circumstances surrounding overdoses are not all identical and should not be treated as if they were. If there really was malice involved (which, legally, can mean either intent or callous disregard for human life) then it might be appropriate for the word “murder” to be used to describe the death and for murder charges to be filed (but prosecutors bear the responsibility of not filing murder charges in cases that are clearly not murders; see my post Drug Induced Homicide). Many, if not most, overdoses, however, are neither murder nor manslaughter. “When my son died, I felt that stigma from people, that there was personal responsibility involved because he had been using illicit drugs.” There is personal responsibility involved. People are responsible for their actions. People choose to start using drugs, they choose to continue using drugs, they choose to blindly trust doctors without making any effort to understand the effects and risks of their prescriptions. Quitting opioids is not easy, but it is still a choice, and when people fail to make this choice they may be risking death. That does not mean that they should be blamed and demeaned and not mourned when they do die but only that someone else should not be blamed for their death, not unless someone else actually was culpable in some way.
“The victims don’t know they’re taking fentanyl in many cases.” This is a point that needs to be addressed. When I was 15 I liked to do ecstasy. Ecstasy pills were supposed to contain MDMA, but they would often contain MDA, 2C-B, meth, caffeine, piperazine (“pipes”). Everyone I knew who also did ecstasy was fully aware of this. In fact, it was from other high schoolers that I learned of the websites pillreports.net and drugsdata.org which provide data about the contents of and people’s subjective experiences (“trip reports”) with different pills. The conclusion should not automatically be drawn when a person dies from taking a “counterfeit” pill that they were unaware that it might contain fentanyl, especially today now that there is substantial public awareness about the existence of fentanyl and its prevalence in street drugs. I would not go so far as to say that a person who does not realize that street drugs are often cut deserves to die, but such naivety is on par with someone not realizing that websites do not actually give out prizes to their millionth visitor. Someone who wants to live a long and prosperous life must learn at some point that you cannot expect the rest of the world to take precautions for you. Don’t assume that someone you just met is free of diseases, don’t assume that a car salesman is giving you a good deal, and don’t assume that street drugs are dosed properly.
Hoffman’s article was very balanced impartial, citing both proponents and opponents of the proposed narrative change. To restate my own position, the issue of drug overdoses is complex, and to oversimplify it, in either direction, is harmful. The fact that a death resulted from the ingestion of a drug should not affect the definitions of homicide and murder (given that homicide laws already exist, “fentanyl homicide laws” serve no purpose except to lower the standards of homicide in fentanyl cases so that people can be convicted of and punished for murder or manslaughter who have not actually committed these crimes according to their established definitions). To change these definitions has real, and serious, effects on real people. I was 25 when I was arrested (and also when I overdosed) and I will be 35 when I am released. Some people convicted of this charge will never be released; they have been sentenced to die in prison (which I, personally, would consider to be a worse outcome than dying of an overdose). Words can be powerful and words that implicate people as murderers should not be thrown around lightly. It is tragic when people die preventable deaths, but not all preventable deaths are murders.
