Addressing Parental Loss in Children of Overdose Victims

By Iris Smith, Ph.D.

Substance use within a family is considered a risk for adverse childhood experiences (ACEs). In addition to the association with child abuse or neglect, the death of a parent due to overdose can have significant impact on a young child or adolescent.

A cross-sectional study of the U.S. population estimated that between 1999 and 2020 over one million youth lost a parent to a drug overdose.  Most of the parental deaths were among individuals between the ages of 15 and 54. Black, American Indian and Alaskan Native youth are disproportionately affected, with Black youth more likely to experience the death of a father.1  

A 7-year prospective study of children who lost a parent to sudden death (suicide, accident, or sudden natural death) found higher rates of psychiatric disorders such as post-traumatic stress disorder (PTSD) and functional impairment. Depression was more likely in the first two years following the parental death and was more prevalent in youth whose parents died when they were less than 12 years old. Adults who lost a parent during childhood report increased depressive symptoms, diminished self-confidence, educational attainment, and dissatisfaction with interpersonal relationships. This study also found that predeath risk factors, post bereavement child disorder, disruption or loss of social support, and negative life events contributed to severity and duration of impairment.2 Another study of children who experienced parental loss because of opioid-related overdoses between 2002 and 2017 found that within 3 months following the parent’s death, nearly 1 in 10 (11.1%) of the Medicaid-enrolled children had used mental health services. With 5 years this had increased to 1 in 5 (24.8%) and 19.8% had been involved in the child welfare system.3

Families of individuals with substance disorders often face challenges that can affect their physical, emotional, and even financial well being. Children of substance-using parents often grow up in chaotic and sometimes abusive family environments which put them at risk for developing social and emotional problems. Children who reside in marginalized and under-resourced communities are also more likely to be exposed to community level drug-related violence.  

At present there are few interventions focused on this growing population of children.  Development of evidence-based interventions that address parental loss and bereavement in collaboration with mental health providers are needed to prevent negative developmental outcomes in these children.


Aguirre, L. V. C., Jaramillo, A. K., Saucedo Victoria, T. E., & Botero Carvajal, A. (2024). Mental health consequences of parental death and its prevalence in children: A Systematic Literature Review. Heliyon10(2), e24999.

Hulsey EG, Li Y, Hacker K, Williams K, Collins K, Dalton E. Potential Emerging Risks Among Children Following Parental Opioid-Related Overdose Death. JAMA Pediatr. 2020;174(5):503–504. doi:10.1001/jamapediatrics.2020.0613

Jones CM, Zhang K, Han B, et al. Estimated Number of Children Who Lost a Parent to Drug Overdose in the US From 2011 to 2021. JAMA Psychiatry. Published online May 08, 2024. doi:10.1001/jamapsychiatry.2024.0810

Kentor, R. A., & Kaplow, J. B. (2020). Supporting Children and Adolescents Following Parental Bereavement: Guidance for Health-Care Professionals. The Lancet. Child & Adolescent Health4(12): pp. 889–898.

Schlüter B, Alburez-Gutierrez D, Bibbins-Domingo K, Alexander MJ, Kiang MV. Youth (2024). Experiencing Parental Death Due to Drug Poisoning and Firearm Violence in the US, 1999-2020. JAMA. 2024;331(20): pp. 1741–1747. doi:10.1001/jama.2024.839

1 Schlüter B, Alburez-Gutierrez D, Bibbins-Domingo K, Alexander MJ, Kiang MV. Youth Experiencing Parental Death Due to Drug Poisoning and Firearm Violence in the US, 1999-2020. JAMA. 2024;331(20):1741–1747. doi:10.1001/jama.2024.8391

2 Pham, S., Porta, G., Biernesser, C., Walker Payne, M., Iyengar, S., Melhem, N., & Brent, D. A. (2018). The Burden of Bereavement: Early-Onset Depression and Impairment in Youths Bereaved by Sudden Parental Death in a 7-Year Prospective Study. The American journal of psychiatry175(9), 887–896.

3 Hulsey EG, Li Y, Hacker K, Williams K, Collins K, Dalton E. (2020). Potential Emerging Risks Among Children Following Parental Opioid Related Overdose Death. JAMA Pediatr. 174(5); pp. 503-504.

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