Phrases like “acute intravenous narcotism” seem to speak to the stigma that surrounds opiate use: even the doctors tasked with reporting overdoses are careful to use euphemistic, cautiously-worded language to describe opiate abuse. As Oxman’s findings suggest, these inconsistencies allowed opiate use to increase steadily without much notice. It’s possible that a more up-front, consistent pattern of recording overdose deaths might have allowed officials to address the epidemic earlier.