The death certificate for Ryan Bagwell, a 19-year-old from Mission, Texas, indicates that he died of a
fentanyl overdose.
His mother, Sandra Bagwell, says that's false.
On a night in April 2022, he swallowed a pill from a bottle of
Percocet
, a controlled-sale painkiller that he and a friend had purchased earlier that day at a Mexican pharmacy across the border.
The next morning, his mother found him dead in his bedroom.
A federal law enforcement laboratory discovered that none of the pills in the bottle tested positive for Percocet.
But all tested positive for lethal amounts of fentanyl.
“Ryan was poisoned,” said his mother, an elementary-level reading specialist.
As millions of
fentanyl-tainted
pills flood the United States masquerading as common medications, bereaved families have lobbied to change the language used to describe drug deaths.
They want public health officials, prosecutors and politicians to use “poisoning” instead of “overdose.”
In their opinion,
“overdose”
suggests that their loved ones were addicts and responsible for their own death, while “poisoning” shows that they were victims.
Sandra Bagwell, from Mission, Texas, holds the remains of her son Ryan, who died in 2022. "Ryan was poisoned," she said.
Photo Verónica Gabriela Cárdenas for The New York Times
“If I tell someone my son overdosed, they assume he was a drug addict,” said Stefanie Turner, co-founder of Texas Against Fentanyl, a nonprofit that got Gov. Greg Abbott to authorize nationwide awareness campaigns. state about so-called
fentanyl poisoning.
“If I tell you that my son was poisoned by fentanyl, you ask, 'What happened?'” he added.
“That keeps the door open.
But 'overdose' is a closed door.”
For decades, health and law enforcement agencies at the federal, state, and local levels have used “overdose” to record drug deaths.
It has permeated the vocabulary of news reports and even popular culture.
But in the past two years, family groups have questioned whether it is used instinctively.
They are having some success.
Changes
In September, Texas began requiring death certificates to write “poisoning” or “toxicity” instead of “overdose” if the primary cause was fentanyl.
In Ohio and Illinois, bills have been introduced to introduce a similar change.
A Tennessee bill states that if fentanyl is involved in a death, the cause “must be listed as accidental fentanyl poisoning,” not an overdose.
Ryan died after swallowing a pill from a bottle of what he believed was Percocet, a prescription painkiller.
Photo Verónica Gabriela Cárdenas for The New York Times
Meetings with family groups helped convince Anne Milgram, administrator of the Drug Enforcement Administration, which seized more than 78 million
counterfeit pills
in 2023, to routinely use “fentanyl poisoning” in interviews and hearings. in Congress.
At a hearing last spring, Rep. Mike Garcia, R-Calif., praised Milgram's choice of words, saying:
“You have done an excellent job calling these cases 'poisoning.'
They are not overdoses.
In many cases, victims do not know they are taking fentanyl.
They think they are taking
Xanax, Vicodin, OxyContin
.”
“Language is very important because it determines policy and other responses,” said Leo Beletsky, a drug policy enforcement expert at Northeastern University School of Law.
In the increasingly politicized realm of public health, the choice of words has taken on increasing communicative power.
For example, during the pandemic, the label “anti-vaccine” fell into disrepute and was replaced by the more inclusive “vaccine-hesitant.”
Fay Martin of Corpus Christi, Texas.
Her son Ryan died in 2021. Photo Verónica Gabriela Cárdenas for The New York Times
Addiction is a field undergoing convulsive linguistic change, and words like
“alcoholic” and “addict”
are now often seen as reductive and stigmatizing.
Research shows that terms like “drug addict” can even influence the behavior of doctors and other healthcare workers toward patients.
The word “poison” has an emotional force, with echoes of the Bible and classic fairy tales.
“'Poisoning' feeds into that victim-villain narrative that some people seek,” said Sheila Vakharia, senior researcher at the Drug Policy Alliance, a drug rights advocacy group.
However, while “poisoning” offers many families
protection from stigma
, others whose loved ones died from using illegal street drugs find it problematic.
Using “poisoning” to distinguish certain deaths while letting others be labeled “overdose” creates a hierarchy of judgment of drug-related deaths, they say.
Ryan's urn at Mrs. Martin's house.
He was an avid fan of the Denver Broncos.
Photo Verónica Gabriela Cárdenas for The New York Times
Fay Martin said her son Ryan, a commercial electrician, was prescribed opioid painkillers for a work injury.
When he became dependent on them, a doctor stopped prescribing them.
Ryan turned to heroin.
Eventually, he underwent treatment and stayed sober for a time.
But, embarrassed by his history of addiction, he retreated into himself and slowly began using drugs again.
Believing he was buying Xanax, he died after taking a pill contaminated with fentanyl in 2021, one day after his 29th birthday.
Although he, like thousands of victims, died from a smuggled pill, his grieving mother feels as if others view her with suspicion.
“When my son died, I felt that stigma from people, that there was personal responsibility involved because he had used illicit drugs,” said Martin, who lives in Corpus Christi, Texas.
“But he didn't get what he wanted.
He did not ask for the amount of fentanyl that was in his system.
He didn't want to die.
He was trying to get high.”
For a growing number of prosecutors, if someone was intoxicated by fentanyl, the person who sold the drug was a poisoner:
someone who knew or should have known that fentanyl could be lethal.
More and more states are passing laws against
fentanyl homicide
.
Denomination
Asked what unbiased word or phrase could best characterize drug deaths, drug policy and treatment experts struggled.
Ryan Bagwell left behind his dog, Macy.
Photo Verónica Gabriela Cárdenas for The New York Times
Some preferred “overdose,” because it is entrenched in data reporting.
Others use “accidental overdose” to emphasize the lack of intent.
(Most overdoses are, in fact, accidental.)
The media sometimes uses both terms to report that an overdose occurred due to fentanyl poisoning.
Addiction medicine experts point out that since most of the street drug supply is adulterated, “poisoning” is actually the most direct and accurate term.
Patients who buy
cocaine and methamphetamine
die from the fentanyl present in the product, they point out.
Fentanyl addicts succumb to bags containing more toxic mixtures than they had anticipated.
Martin, whose son died from fentanyl, bitterly agrees.
“They poisoned him,” he says.
“They sentenced him to death and his family to life imprisonment.”
Jan Hoffman writes about behavioral health and health law. Her topics span opioids, tribes, reproductive rights, teen mental health, and vaccine hesitancy.
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