A new study from the National Institutes of Health quantifies the vast number of children in the United States who have lost a parent, or become orphans, because of the overdose crisis. In doing so, it highlights a pressing need to address widespread trauma.
The research, published in the Journal of the American Medical Association on May 8, was led by Dr. Christopher M. Jones, director of the federal Center for Substance Abuse Prevention. The researchers ran a cross-sectional study looking at a decade of data between 2011 and 2021.
They estimated that over 321,000 children lost at least one parent to overdose in that period, with the numbers worsening over time.
“It is devastating to see that almost half of the people who died of a drug overdose had a child,” Nora Volkow, MD, director of the National Institute on Drug Abuse, said in a press release. According to the data, 650,000 adults aged 18-64 died of overdose between 2011 and 2021.
The devastation is impacting some demographics far more than others.
“No family should lose their loved one to an overdose, and each of these deaths represents a tragic loss that could have been prevented,” she continued. “These findings emphasize the need to better support parents in accessing prevention, treatment, and recovery services. In addition, any child who loses a parent to overdose must receive the care and support they need to navigate this painful and traumatic experience.”
The devastation is impacting some demographics far more than others. Indigenous children, in particular, lost parents to overdose at more than twice the rate of non-Hispanic white and Black children. And while parents of all demographics died at increasingly high rates over the study period, the rate for young, non-Hispanic Black parents—those aged 18-25—increased faster than for any other group, rising by an annual average of 23.8 percent. Parents of all genders died at increasingly high rates, but fathers were significantly more likely to die than mothers.
The trauma of losing a parent can extend for years—or generations—to come. A 2021 study, for example, found that children whose parents die for any reason are more likely to develop conditions like anxiety, depression, bipolar disorder or substance use disorder. Research has also found that children are likelier to engage in substance use and in suicidal behavior around the anniversary of a parent’s death. And being in the foster care system is associated with harmful or challenging outcomes, especially for youth “aging out” of foster care, like becoming homeless or incarcerated.
Many drug laws make it less likely for parents with issues around substance use to seek help that could keep them safer, for fear of punishment. For example, according to the study, at least 25 states and Washington, DC, consider drug use during pregnancy as “child abuse”—potentially leading to fines, loss of custody, involuntary commitment or even incarceration.
Better drug laws and more accessible harm reduction would reduce the toll for parents and children. But what are some measures that might help within the health care system, and what’s holding them back?
“We should be much more proactive in screening for opioid use disorder, certainly among women who are pregnant or have children,” Volkow told Filter. “We don’t screen sufficiently, so we are missing the opportunity to do an intervention. What’s clear is patients don’t necessarily report to their doctor they have an OUD. If the doctor doesn’t ask, most patients won’t tell them.”
“Patients may not want to go to the doctor because they don’t want to face the consequences as far as being put in jail and losing custody of their children.”
But she described obstacles to regular and ethical interventions of this kind. For one, health care providers who do screen and treat people for OUD find it difficult to be reimbursed by health insurance companies, leaving clinics covering the cost of services. For another, providers in many states are required by law to report pregnant people who are using drugs.
“If you have these two challenges, one of them not sufficient reimbursement, and the other one these punitive practices by the state,” Volkow continued, “then on the one hand you have clinicians not interested in screening or treating because they won’t be reimbursed, but then the patients may not want to go to the doctor because they don’t want to face the consequences as far as being put in jail for being a women who’s pregnant taking drugs and seeking medication, and losing custody of their children.”
Parental drug use is the leading cause for children being separated from their parents and put in the foster system. One analysis found that from 2011-2017, the number of infants entering foster care grew by 10,000 every year. Black and Indigenous children are overrepresented in child welfare systems, which—like the mass incarceration that also separates families—is another way the drug war targets families of color.
Photograph by Eli Solitas via Unsplash
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