A young boy places a stone on the grave of his father as friends and family gather to commemorate the first anniversary of his death from heroin overdose. Between 2011 and 2021, more than 321,000 children across the U.S. lost a parent to a drug overdose, according to a recent federal study. (Photo by John Moore/Getty Images)

Every day, 8-year-old Emma sits in a small garden outside her grandmother’s home in Salem, Ohio, writing letters to her mom and sometimes singing songs her mother used to sing to her.

Emma’s mom, Danielle Stanley, died of an overdose last year. She was 34, and had struggled with addiction since she was a teenager, said Brenda “Nina” Hamilton, Danielle’s mother and Emma’s grandmother.

“We built a memorial for Emma so that she could visit her mom, and she’ll go out and talk to her, tell her about her day,” Hamilton said.

Lush with hibiscus and sunflowers, lavender and a plum tree, the space is a small oasis where she also can “cry and be angry,” Emma told Stateline.

Hundreds of thousands of other kids are in a similar situation: More than 321,000 children in the U.S. lost a parent to a drug overdose in the decade between 2011 and 2021, according to a study by federal health researchers that was published in JAMA Psychiatry in May.

In recent years, opioid manufacturers, distributors and retailers have paid states billions of dollars 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 special mental health programs to help the kids work through their long-term trauma — and to break a pattern of addiction that often cycles through generations.

The rate of children who lost parents to drug overdoses more than doubled during the decade included in the study, surging from 27 kids per 100,000 in 2011 to 63 per 100,000 in 2021.

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

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

The data included deaths from illicit drugs, such as cocaine, heroin or hallucinogens; prescription opioids, including pain relievers; and stimulants, sedatives and tranquilizers. Danielle Stanley, Emma’s mother, had a combination of drugs in her system when she died.

At-risk children

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

An estimated 2.2 million U.S. children were affected by the opioid epidemic in 2017, according to the hospital fund, meaning they were living with a parent with opioid use disorder, were in foster care because of a parent’s opioid use, or had a parent incarcerated due to opioids.

“This is a uniquely at-risk subpopulation of children, and they need kind of coordinated and ongoing services and support that takes into account: What does the remaining family actually look like, and what are the supports that those kids do or don’t have access to?” Shearer said.

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

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

“We just want to make sure children are not sitting somewhere in a strange room,” said Browder, the former chief for child and adult protection, adoption and kinship at the Ohio Department of Job and Family Services and executive director of the Children’s Defense Fund of Ohio.

“The child has gone through trauma from losing their parent to the overdose, and now you put them in a stranger’s home, and then you retraumatize them.”

This is a particular concern for Indigenous children, who have suffered disproportionate removal from their families and forced cultural assimilation over generations.

“What hits me and hurts my heart the most is that we have another generation of children that potentially are not going to 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 do know that culture is healing, and when people are connected to their culture … when they’re connected to their land and their community, they’re connected to their cultural activities, the healthier they are,” she said.

Ana Beltran, an attorney at Generations United, which supports kin caregivers and grandfamilies, said large families still often need money and counseling to take care of 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 look like they have a lot of support because they have these huge networks, and that’s such a powerful component of their culture and such a cultural strength. But on the other hand, service providers shouldn’t just walk away because, ‘Oh, they’re good,’” she said.

Counties with higher overdose death rates were more likely to have children with grandparents as the primary caregiver, according to a 2023 study from East Tennessee State University. This was particularly true for counties across states in the Appalachian region. Tennessee has the third-highest drug overdose death rate in the nation, following the District of Columbia and West Virginia.

‘Get well’

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

Her mother died from an overdose 10 years ago, when Reese was in her mid-20s, and she lost her dad when she was 8. Her mom was a waitress and cleaned houses, and her dad was an autoworker. Both struggled with prescription opioids, specifically painkillers, as well as illicit drugs.

“Maybe we couldn’t save our mama, but, you know, somebody else’s mama is out there,” Reese said. “Children of loss are left out of the conversation. … This is bigger than the way we were seeing it, and it has long-lasting effects.”

In Ohio, Emma’s grandmother started a small shop called Nina’s Closet, where caregivers or those battling addiction can come by and collect clothing donations and naloxone.

Emma, who helps fill donation boxes, tells her grandmother she misses the scent of her mom’s hair. She couldn’t describe it, Hamilton said — just that “it had a special smell.”

And in an interview with Stateline, Emma said she wants kids like her to have hobbies — “something they really, really like to do” — to distract them from the sadness.

She likes to think of her mom as smiling, remembering how fun she was and how she liked to play pranks on Emma’s grandfather.

“This is what I would say to the users: ‘Get treatment, get well,’” Emma said.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: [email protected]. Follow Stateline on Facebook and X.