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As convenors of International Overdose Awareness Day, the language we use is important in uniting a global movement to reduce drug-related harms and end overdose. Our challenge is to select terminology that is as universally understood and appropriate as possible across diverse cultures and contexts.
Recently, there has been growing discussion about the suitability of the term ‘overdose’ in the public sphere. In 2024, we have decided to continue using the term ‘overdose’ and retain the name of this vital awareness day. Here’s why.
People describe overdose in many ways around the world, influenced by linguistic, cultural, political, and contextual factors. What is appropriate in one place may not be in another, and language is always evolving. Health agencies like the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), European Union Drugs Agency (EUDA), and Statistics Canada use varied terminology, with no single agreed-upon term.
Among these key agencies and in many healthcare settings, ‘overdose’ is usually the more commonly used, understood, and relevant English-language term for drug-related harms and deaths.
An ‘overdose’ occurs when there is more of a drug – or a combination of drugs – in the system than the body can cope with, leading to harm or death. This definition does not refer to circumstance, intent, criminality, nor the type of drug implicated, but is a simple definition of a physiological response.
The critical factor is that the body is unable to process the substance, regardless of whether the overdose is accidental or intentional, fatal or non-fatal, the supply was contaminated, the dose was large or small, it involves legal or illegal drugs, or where it occurs.
We recognize that many people use terms such as ‘drug toxicity’ or ‘drug poisoning’ in place of overdose. ‘Poisoning’ or ‘toxicity’ are seen by some families and loved ones of people lost to overdose as more neutral terms focusing on the effects of a substance, rather than the behaviors or intentions of the people who use them. For some, the term ‘overdose’ can inaccurately suggest dependence or addiction, emphasize immoral or illegal behavior, or imply self-inflicted harm. This can lead to feelings of shame and blame for families and friends left behind.
Yet, while attempting to reduce the stigma and shame associated with losing a loved one to overdose, the choice to use alternative words might unintentionally increase stigma. That is, when people emphasize the use of alternative words, they can imply that overdose is a more deserved outcome for some people and not others.
The words ‘toxic’ or ‘poisoned’ are often used to highlight the thousands of lives lost and serious harms caused by unintentional ingestion of contaminated, mislabeled or counterfeit products seen in North America in particular. Sometimes ‘fentanyl poisoning’ is specifically used to emphasize the dangers of the unregulated drug supply. This can certainly be a helpful and accurate use of these terms.
However, there’s another side to the use of the word ‘poisoning’. On one hand, this term accurately draws attention to the ‘toxic’ or ‘poisoned’ drug supply we are now facing in many parts of the world. But on the other hand – in the US in particular – ‘poisoning’ is a term used to support the case for expanding criminal penalties, including for people who supplied drugs socially or were merely present at an overdose. The use of the term in this context is dangerous, shifting the focus from overdose being addressed as a health issue to a criminal one.
As we see, using different terms can help provide context and accuracy but can also have unintended and harmful consequences.
We acknowledge the range of personal preferences and the rights of all people to use different terminology and we encourage the community to use language that works best for them. At the same time, we do respectfully invite people take time to consider the options and implications of the language they use. Reflect on how these terms may be perceived by others and think about how words can be used helpfully to shape a public conversation that supports our collective overdose prevention efforts.
We wish there was no need to use any of these terms. However, since our fight to end drug-related harm and deaths continues, we need to. International Overdose Awareness Day will continue to use the word ‘overdose’ as a broad, accurate, and well-recognized term in our global campaign, while also respecting the choice of the community to use alternative words as they see fit. There is certainly room for multiple terms in our broader conversation about overdose. However, let’s choose these words wisely.
