“I don’t go to funerals anymore”: how people who use opioids grieve drug-related death in the US overdose epidemic

Abstract

Background Opioid-related overdose death is a public health epidemic in much of the USA, yet little is known about how people who use opioids (PWUO) experience overdose deaths in their social networks. We explore these experiences through a qualitative study of opioid-related overdose death bereavement among PWUO. Methods We recruited 30 adults who inject opioids from a syringe service program in the Midwestern USA and interviewed them using a semi-structured guide that addressed experiences of opioid use, opioid-related overdose, and overdose reversal via the medication naloxone. Interviews were transcribed verbatim and analyzed thematically. Findings Participants described overdose death as ever-present in their social worlds. Most (approximately 75%) reported at least one overdose death in their social network, and many came to consider death an inevitable end of opioid use. Participants described grief shaped by complex social relations and mourning that was interrupted due to involvement with social services and criminal legal systems. They also reported several ways that overdose deaths influenced their drug use, with some increasing their use and others adopting safer drug use practices. Despite the high prevalence of overdose deaths in their social networks, only one participant reported receiving grief support services. Discussion Findings underscore the need for interventions that not only maintain life, such as naloxone distribution, but also improve quality of life by attending to grief related to overdose death bereavement. We discuss policies and practices with the potential to address the unique psychological, social, and structural challenges of grief for this population.

Grieving a Drug-Related Death in the Context of One's Own Drug Use: An Exploratory Study

“…The burdens are so overwhelming, and there is so much to deal with, that the coping strategies they are using at the time are not viewed as sufficient. That the death of a loved one leads to, sustains, or increases, drug use is in line with other research (Caparrós & Masferrer, 2021; Lee et al, 2020; Macmadu et al, 2022; Parisi et al, 2019; Schlosser & Hoffer, 2022).…”

“…People whose lives are dominated by drug use often have close relationships with others who use drugs and are at particular risk of witnessing a DRD and of losing people close to them through a DRD (Kenny et al, 2022; Schlosser & Hoffer, 2022; Wojtkowiak et al, 2019). Drug use and the so-called “complicated grief” are also found to be interconnected (Parisi et al, 2019).…”

“…Macmadu et al (2022) point out that people who use drugs experience profound and recurring trauma, bereavement, and other emotional effects following the overdoses of people they know. Schlosser and Hoffer (2022) highlighted how complex social relations shaped the grief of people who use opioids and how their mourning was interrupted by involvement with social services and criminal legal systems. Selseng et al (2023) found that the bereaved of DRDs who use drugs had little social support and professional help related to their grief.…”

Reported xylazine exposure highly associated with overdose outcomes in a rapid community assessment among people who inject drugs in Baltimore

“…This level of mortality is consistent with overdose statistics, but is a striking when examined on a community level. In addition to ending the overdose epidemic, grief support is also needed [ 24 ]. One of the primary predictors of fatal overdose is a prior non-fatal overdose [ 25 ].…”

Opioid harm reduction and stigma: proposed methods to improve the perception of people with addiction

“…The opioid overdose education and naloxone distribution programs (OEND) aim to reduce the risk of opioid death by facilitating educational training and increasing access to medications ( 32 ), which are also essential and effective in saving lives and reducing harm to individuals and communities ( 33 ).…”