An estimated 1.4 million U.S. children — 2% of all children nationwide — had lost a family member to a drug overdose as of 2019, according to a study by researchers at the USC Dornsife College of Letters, Arts and Sciences and Penn State University.

The findings, published in the American Journal of Public Health, shed light on the often-overlooked emotional toll of overdose deaths on the youngest and most vulnerable members of society and provide the first concrete data quantifying its impact.

Since 2006, opioid-related deaths have been rising faster than those caused by other substances. In 2019, opioid overdose deaths were 2.4 times more common than non-opioid-related deaths. By 2022, they had become three times more common.

Drug overdose and the opioid crisis are reshaping childhoods

The study uncovered a troubling trend: About 2% of children born in 2009 lost a family member to an overdose by age 10, compared to just over 1% for those born in 2001.

“We predict this percentage will climb even higher — possibly reaching 5% — by the time children born in 2009 turn 18,” said Emily Smith-Greenaway, Dean’s Professor of Sociology and professor of sociology and spatial sciences at USC Dornsife. “It’s alarming how much younger children are losing loved ones.”

Co-author Ashton Verdery of Penn State underscored the concern. “We found that 5-year-olds are now experiencing loss at the same rate as 10-year-olds did 15 years ago,” he said.

Meanwhile, the researchers noted that the rate of family deaths from other causes has remained stable.

Drug overdose deaths fray family systems

The death of a family member, regardless of cause, can destabilize a child’s life, often leading to long-term mental health struggles, academic challenges and even substance abuse later in life, according to childhood bereavement research. One study found that adolescent boys, especially those who have lost a parent, are prone to alcohol and substance abuse.

When the loss is due to a drug overdose, the trauma is often more intense because of the suddenness of the loss and the stigma that surrounds it, the researchers explained.

“Children not only lose the support they need during critical developmental stages, but these losses often occur under traumatic and painful circumstances — the toll can last a lifetime,” Smith-Greenaway said.

While it wasn’t surprising to the research team that children are 2 to 2.5 times more likely to lose a male relative than a female relative to overdose, the recent rise in overdose deaths among women is particularly concerning. Overdose deaths of women aged 35 to 44, especially those who are pregnant or postpartum, more than tripled between 2018 and 2021, according to the National Institutes of Health. Smith-Greenaway noted that this trend could further strain already fragile family systems.

Broadening the research on drug overdose deaths

To estimate the number of children affected by familial overdose deaths, the researchers combined CDC data on causes of death related to drugs and fertility with U.S. Census population data from 2000 to 2019 — a period unaffected by the COVID-19 pandemic.

While the study focused on immediate family members, Smith-Greenaway and Verdery suggest that the number of affected children would likely be higher if the deaths of friends, neighbors or stepparents had been included. Additionally, the sharp rise in overdose deaths between 2020 and 2023, not covered by the study, suggests that their estimates may understate the full scope of the crisis.

About the study

In addition to Smith-Greenaway and Verdery, the research team included Cayley Ryan-Claytor and Nilakshi Sarkar from Penn State University and former USC Dornsife PhD student Michelle Livings, now at Princeton University.

The study was supported by the National Institute on Aging grant 1R01AG060949 and the Pennsylvania State University Population Research Institute, which is supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development infrastructure grant P2C-HD041025.