The stigma surrounding a death due to an opioid overdose is especially strong and leaves the child feeling isolated, outcast or even abandoned completely without any familial or community connections.

The child at the time of the overdose death has already accumulated at least one Adverse Childhood Experience (ACE) score due to life in a household with a grown-up who is abusing substances. ACEs comes from the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), groundbreaking research that looked at how 10 types of childhood trauma affect long-term health

If the parent suffered from mental health problems, like opioid use disorder or depression, was incarcerated, or abused, the child accumulates additional ACE’s, which make them more likely to succumb to mental health problems or substance use themselves. The child may have been present and witnessed the death and sat, frightened, in shock, until help arrived. Having then experienced another traumatic event, whether they witness it or not, they acquired another ACE point making them among the most at risk children in our country today.

Since opioid deaths exceed heart disease as the leading cause of death for Americans under age 55 (Center for Disease Control) and the frequency of these deaths is increasing annually, you can expect to see more parentally bereaved children since those are peak child bearing years. Supporting grieving children who experience deaths that result from addiction or overdose requires an understanding of the factors which make these deaths difficult to grieve.

These children will have a harder time adapting to their life without their parent/guardian who died than children who had no history of exposure to trauma, abuse, mental illness or substance abuse prior to the death. Roughly 10% of all grieving children will go on to develop mental health problems including substance use themselves and those that do are more likely to come from backgrounds where there was a substance addicted parent/guardian (Melham et al, 2011).

Another factor that makes it harder for children who’ve survived deaths due to Opioid Use Disorder is the fact that these deaths are due to “invisible diseases.” Younger children are often not told the truth about their grown-ups addiction or invisible disease so have trouble understanding why they died. Understanding what caused the death is an important task according to grief expert J William Worden’s Task Model of Mourning (1989).

Most grief specialists agree that being truthful with children is an essential part of helping them with this first task. Children often overhear conversations about the death and almost certainly will learn the truth about the cause eventually, so it’s best to be truthful from the start. Otherwise when they do learn the truth, trust will be broken and it will be hard to regain that trust. You can determine how much information to give the child in the same manner that you’d teach how ‘babies are born’. Start with the basic facts and then be prepared to answer the child’s questions because the child’s questions are the best indication that they are cognitively ready for additional information.

Children are more likely to blame themselves for an overdose death than other types of deaths. Because children are egocentric, they are likely to blame themselves with any death, but it is particularly painful to see a six year old who believes they could have prevented the death if they’d “taken their pills away”. Telling children “it’s not their fault” won’t take away the guilty feelings. Instead explain that overdose deaths happen when people are suffering from the following:

“An invisible disease called addiction or opioid use disorder which makes it impossible for them to control their drug use themselves. The only thing that could have helped them would have been to go into treatment with a doctor.”

Participation in grief support groups like those offered at OUR HOUSE Grief Support Center in Los Angeles, California or in grief camps like Camp Erin relieves the isolation grieving children experience, normalizes feelings, teaches coping skills and offer opportunities for them to honor their special person who died. For more information about these programs visit: www.OurHouse-Grief.Org