Hundreds of thousands of parents have died from drugs. Their children need more help, activists say. • Oregon Capital Chronicle

In recent years, opioid manufacturers, distributors and retailers have paid billions of dollars to states to settle lawsuits accusing them of contributing to the overdose epidemic. Some experts and advocates want states to use some of that money to help these children cope with the loss of their parents. Others want more support for caregivers and specialized mental health programs to help children process their long-term trauma — and break a pattern of addiction that often continues for generations.

The number of children who lost their parents to drug overdoses more than doubled during the decade covered by the study – from 27 children per 100,000 in 2011 to 63 per 100,000 in 2021.

Nearly three-quarters of the 649,599 adults ages 18 to 64 who died during this period were white.

Children of American Indians and Alaska Natives lost a parent at a rate of 187 per 100,000, more than twice the rate of children of non-Hispanic white and black parents (76.5 and 73.2 per 100,000, respectively). The largest increase in loss per year was among children of young black parents between the ages of 18 and 25, at a rate of nearly 24%, according to the researchers. The study did not include overdose victims who were homeless, incarcerated or living in institutions.

The data included deaths caused by illegal drugs such as cocaine, heroin or hallucinogens, prescription opioids, including painkillers, as well as stimulants, sedatives and tranquilizers. Danielle Stanley, Emma's mother, had a combination of different drugs in her system at the time of her death.

Children at risk

Children need help to overcome their immediate grief, but they also need longer-term support, says Chad Shearer, senior vice president for policy at the United Hospital Fund of New York and former deputy director of the Robert Wood Johnson Foundation's State Health Reform Assistance Network.

According to the Hospital Fund, an estimated 2.2 million children in the United States were affected by the opioid epidemic in 2017. That means they lived with a parent with opioid use disorder, were in foster care because of a parent's opioid use disorder, or had a parent who was incarcerated for opioids.

“This is a particularly vulnerable subgroup of children, and they need coordinated and ongoing services and supports that take into account: what does the remaining family actually look like and what supports do these children have access to or not?” Shearer said.

Ron Browder, president of the Ohio Federation for Health Equity and Social Justice, an advocacy group, said “respect for families' cultural traditions” is essential to effectively supporting them. The state has one of the 10 highest overdose death rates in the country and the fifth highest number of deaths, according to 2022 data from the U.S. Centers for Disease Control and Prevention.

The goal, Browder said, should be to keep children in the care of a family member whenever possible.

“We just want to make sure the kids aren't sitting in a strange room somewhere,” said Browder, the former director of child and adult welfare, adoption and kinship services at the Ohio Department of Job and Family Services and executive director of the Children's Defense Fund of Ohio.

“The child has suffered trauma from the loss of his parent and the overdose, and now you're bringing him into a stranger's home and traumatizing him again.”

This is particularly worrying for Indigenous children who have been disproportionately separated from their families and culturally assimilated over generations.

“What hits me the most and hurts my heart is that we have another generation of children who may not be connected to their culture,” said Danica Love Brown, a behavioral health specialist and member of the Choctaw Nation of Oklahoma. Brown is vice president of behavioral health transformation at Kauffman and Associates, a national tribal health consulting firm.

“We know that culture is healing, and the more connected people are to their culture… the more connected they are to their country and their community, the more connected they are to their cultural activities, the healthier they are,” she said.

Ana Beltran, a lawyer with Generations United, an organization that supports relatives and extended families, said extended families often still need money and counseling to care for orphaned children. (UNICEF defines an orphan as a child who has lost at least one parent.) She noted that multigenerational households are common in black, Latino and indigenous families.

“It can seem like they have a lot of support because they have these huge networks, and that's such a strong part of their culture and such a cultural strength. But on the other hand, service providers shouldn't just walk away because they say, 'Oh, they're good,'” she said.

According to a 2023 study from East Tennessee State University, counties with higher overdose death rates were more likely to have children whose primary caregivers were grandparents. This was especially true in counties in the Appalachian Mountains. Tennessee has the third-highest drug overdose death rate in the country, after the District of Columbia and West Virginia.

'Get well soon'

AmandaLynn Reese, program director at Harm Reduction Ohio, a nonprofit that distributes kits containing the opioid antidote naloxone, lost her parents to the drug epidemic and struggled with addiction herself.

Her mother died of an overdose 10 years ago when Reese was in her mid-20s, and she lost her father when she was 8. Her mother was a waitress and cleaned houses, and her father was an auto worker. Both had problems with prescription opioids, particularly painkillers, as well as illegal drugs.

“Maybe we couldn't save our mom, but you know, somebody's mom is out there,” Reese said. “Kids who have experienced loss are left out of the conversation. … This is bigger than we've seen, and it has long-term implications.”

In Ohio, Emma's grandmother opened a small store called Nina's Closet where caregivers or addicts can come and collect donations of clothing and naloxone.