Is the fentanyl situation an overdose crisis or a poisoning crisis?

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

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

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

Some medical professionals working in the field say that if we speak about the fentanyl crisis in a more clinical, straightforward fashion, we can see it for what it is: a public health issue that can be addressed through the medical system.

"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.

That implication of personal responsibility can exacerbate stigma, and the stigma is all too real, say those on the frontlines of B.C.'s fentanylcrisis. 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.

Stigma puts drug users in danger

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

It puts drug users at risk, they say.

Between 2015 and 2016, fentanyl was found in the bodies of 46 per cent of those who died from what the BCCoroner's Service describedas an "illicit drug overdose."

Anyone familiar with the crisis will tell you that most drug users don't intend to take fentanyl, but their drug supply iscontaminated with it. With B.C.'s drug supply so badly tainted, and stigma putting drug users at risk, some are asking: Is this an overdose crisisor a poisoning crisis?

Dr. ChristySutherland,anaddiction medicine physician withthe BCCentre on Substance Use and the medical director for the Portland Hotel Society,says "overdose" is the wrong word.

"When thedrug 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 really, we could say that they're being poisoned by this toxic drug supply," she said.

With 780 dead in B.C. between January and July of this year, Sutherland worries that the victims of the crisis will be blamed for their own deaths.

Poisoning more accurate than overdose

"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.

"Overdose" is an accepted term in medicine. It's used in hospitals and clinics, by the provincial government, health authorities, law enforcementand the BC Coroners Service. The word is commonly found in medical journals, too.

But while it may be widely accepted, it's not actually technically accurate in describing what's happening in the body.

The Canadian health care system uses a document called the International Statistical Classification of Diseases and Related Health Problemsto determine what terms are used by medical professionals.

In that document, the term "overdose" is used only to describe the action that led to the recommended diagnostic term, which is poisoning.

Dr. Edward Xie, an emergency room doctor with the University Health Network in Toronto and a lecturer at the University of Toronto, thinks medical professionals' language should be focused on what's happening to thepatient'sbody.

"If a cyclist falls and breaks a bone, we call it a fracture and not a bicycle fall," Xie said.

"What's happening in the body of the patient is a poisoning. We shouldn't need to refer to how the patient got there, which is an overdose. They'retwo separate issues."

Xie points to the way we talk about alcohol, a legal andsocially acceptable substance, as proof that the word "overdose"stigmatizesdrug users.

"When a patient has over-consumed alcohol, we call it alcohol poisoning. We don't write about it as an alcohol overdose," hesaid.

Changing the lexicon

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 atechnically accurate medical term, she says 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,"Henry said.

With the term "overdose" so entrenched, it will take timeto change.

Sutherlandrecently spokeatthe Canadian Medical Association annual meeting, where she advocated formore progressive and accurate language to limitthe level of stigma surrounding drug users.

Meanwhile, Xie and a number of his colleagues are writinga letter to the Canadian Medical Association Journal urging doctors to move away from the term "overdose."

Some might dismiss thedebate over thelanguage we use in this crisis as semantics.But withfour people a day dying in the province as a result of fentanyl, this has become lessa crisisand morea new reality that some observers saymust be approached in new and innovative ways.

If discarding astigmatizing, technically inaccurate wordcan contribute tosaving even one life, they say, shouldn't we do it?