42% of Americans Know Someone Who Died of Overdose

Evan Banks

You're listening to Policy Minded, a podcast by RAND. I’m Evan Banks. Fatal overdoses in the U.S. dropped significantly last year. Overdose deaths were down almost 27 percent in 2024, according to the CDC. This decline is good news, obviously, but… the scale of America’s overdose crisis remains staggering: There were still more than 80,000 overdose deaths in 2024, most of which were linked to synthetic opioids such as fentanyl. That’s twice the number of people who died in traffic accidents that same year. And beyond those whose lives were cut short by overdose, there are millions of loved ones who've been left behind—family and friends who, after losing someone, often struggle to pick up the pieces, manage their grief, and overcome trauma. Their experiences… have largely been ignored. Alison Athey, a Behavioral Scientist at RAND, is here to discuss this overlooked emergency.

Before we hear from Alison, listeners should know that, beyond fatal overdoses, this episode includes discussions of suicide. If you or someone you know needs support, then please call the 988 Suicide and Crisis Lifeline.

Alison, thank you so much for being here. We appreciate your time.

Alison Athey

Thanks for having me.

Evan Banks

Before we get started, tell us a little bit about your background and maybe your path to RAND, how you got here.

Alison Athey

I'm a clinical psychologist by training and I practice in Baltimore city where I'm from. My training background really centered on responding to suicidal crises in high risk groups, particularly among veterans, as well as people who experience both mental health and substance use disorders. During the pandemic, I fell in love with public health and population level responses to problems like suicide, which are really prevalent. That work led me to Johns Hopkins, where I cross-trained in public health, and where I started thinking more about how we can serve people who are left behind after a suicide loss. My work involved engaging with medical examiners to study people who died by suicide by learning from those who knew them before their death. And the more and more that I did that work, I recognized that there's a great deal of overlap between suicide and overdose risk and a huge gap in services for people who have lost loved ones to overdose. Suicide loss survivors are recognized as being at higher risk for suicide and are eligible for a lot of grassroots and clinical services. Unfortunately,similar networks are just emerging for people who have lost a loved one to overdose, and so that motivated me to come to RAND to address these problems, these dual problems of suicide and overdose in our country.

Evan Banks

So, Alison, you analyzed data from a nationally representative RAND survey of more than 2,000 American adults asking whether they knew someone who had died of a drug overdose, and then if they did, how that loss had affected them. And what did you learn?

Alison Athey

Well, we learned quite a lot because of the lack of basic epidemiological numbers, how many people are affected, how are they affected. So first we learned that it's very common for people to lose someone to overdose. More than 40% of American adults personally knew someone who died by overdose, which was a strikingly high number. The second thing that we learned is that If you've lost one person to overdose, odds are that you've lost at least one more person to overdose, that this risk clusters together. The third thing that we learned is that even when we ask a really broad question, have you ever known any single person who's died by overdose? How has it affected your life? That a third of the 42 percent of American adults report that the loss disrupted their life. With millions reporting that the loss affected their life profoundly and in a lasting way.

Evan Banks

So you also found that about a third of those people who know someone who has died feel that their lives were disrupted as a result of that. What do these disruptions look like? And how does losing someone to an overdose impact people in their daily lives?

Alison Athey

That's a really great question. And unfortunately, there is such a big gap in our understanding about people who are bereaved by overdose that we can't point to empirical studies that say somebody's X percent more likely to develop depression, X percent more likely to develop a post-traumatic stress disorder and so on. But what we know from communities that are responding to this risk, and what we know from qualitative studies that ask that very same question, what happens when you lose someone in this way? We know that those who are left behind suffer a great deal, and often they suffer in isolation because either they have experienced stigma from others saying that the person who they lost was unworthy in some way, or that their grief is unworthy, in someway. Or they fear that stigma, so they keep the grief to themselves. What we know from broader grief studies is that grieving alone increases risk for bad outcomes, health outcomes of all kinds, physical and mental. And so we can expect that those who experience overdose loss are really vulnerable. There's one really interesting empirical study that addresses this question through really rigorous research, and it was conducted in Norway. What they did in that study was they used the really rich records that are available in Norway and they looked at what happened to parents who lost their children to overdose. And it turned out that those parents were significantly more likely to die by an external injury death themselves compared to their peers who didn't lose children to overdose. That particular research study wasn't able to tease that out and say, are these parents more likely to die by their own overdose deaths? Are these parents were likely to died by suicide or other types of injury deaths? But we know that the risk is there and it's deadly risk.

Evan Banks

I know a few people in my life who have died of overdoses, and I know how that affects not just me, but an entire community. There's a sense of so young, too early, but I also know people that have passed away under mysterious, unknown circumstances and the community won't even talk about it, and I suspect that sometimes those are overdose deaths as well. How do we know in the survey that we run that we're including that as well.

Alison Athey

That's a really great question because the ambiguity around a loss is also a risk factor when it comes to healthy versus prolonged or complicated grief. And that same question is true when we think about suicide, right? Unless there was a witness, it's hard to know exactly what happened to someone. And even when there are witnesses, you don't know what's happening in someone's mind when they're in a crisis. So, the short answer is that that we don't know for sure and that's because we don t have great measures of overdose grief. This area has just been completely overlooked when it comes to research so we don't t even know how to ask the right questions to detect if we're picking up on people who only knew for sure that their person died of overdose or people who believed that to be true but don't for sure. So it's probably that 42 percent is probably a motley crew of people with a range of experiences.

Evan Banks

But it strikes me that it would be on the conservative side of the estimate because it's people that self-reported.

Alison Athey

That's right, that's right. The panel that we used is made up of everyday Americans and something that's different about them is that they regularly answer questions that are asked about their opinions and their experiences. So we're not likely in that sample to have people who are being really mischievous and trying to mislead us in the research. So that small percentage of people who may be false positives and report an experience that they didn't have, to be mischievous is unlikely to be there. In my personal experience, in my clinical experience, people take this topic very seriously because so many of us have been touched by it. So I agree. I think we're more likely to be missing people in that estimate than we are to be counting people who didn't really experience an overdose loss.

Evan Banks

I want to read a quote from an NPR interview you did back when the study first came out. You said, this type of bereavement is creating vicious cycles within communities where there's a death that spurs suffering, that spurs more death, that's spurs more suffering. You've mentioned that there's more research about this phenomenon as it refers, as it relates to deaths from suicide, but it sounds like you see signs that this is with overdoses too.

Alison Athey

In some ways we do, but unfortunately we don't have the research to say that for sure at this point. In suicide, what we see is something called a contagion effect, where within a community there will be multiple suicides that happen in quick succession. And that's because losing someone to suicide or even learning about suicide in the media in certain ways can increase risk for people. To engage in suicidal behaviors. And so that concept of suicide contagion has been really well-studied and established, and it's led to changes in practice. So if somebody is reporting that they have risk factors for suicide, their good clinician will ask, have you lost anyone, when they're trying to calculate that individual's own risk for suicide. In many ways, there are similarities between suicide and overdose loss. And so it seems reasonable to think that there may be such a thing as overdose contagion, where people who lose someone to an overdose and are suffering themselves, especially if they already are using drugs, may be using substances in a riskier way. We can also think about the other type of suicide contagion when we talk about overdose. And people who are in the same community share risk factors within that community. And that is true for overdose as well. So Baltimore is a great example of this. We tragically had a mass overdose event recently. Thank goodness nobody died in that mass overdose event because of lifesaving efforts. But that shows another way in which this cycle can exist. The people who were affected by that mass overdose were getting their drugs from the same supplier. So, that community level risk factor is there. But what I'm hopeful to see is more research that helps us to understand that cycle, to make sure that it actually is occurring, and to help us understand what could break the cycle. What can we do for people who are affected by grief? What can do for communities that are affected by grief that can make it so that they not destined to experience increases in their own risk for overdose.

Evan Banks

You also mentioned stigma or shame as a common experience for people who've lost someone to overdose. You even described some of the ways that people are treated by others, other grieving, as horror stories. Is there a particular horror story that's stuck with you?

Alison Athey

I think when people are grieving, words really matter and I've heard horror stories of people being told that their person invited their own death, their person deserved to die because their life had no value simply because they suffered from the disease of addiction. And that sort of experience when when someone is grieving is really toxic and really contrary to the natural things that occur when people are grieving. Grief is a universal experience, we'll all have it and for millennia people have learned to help each other and support one another and even ritualize grief and none of those rituals involve telling someone that their person didn't have value or telling someone that maybe they in some way are part of the reason why their person died, because they didn't raise them right, didn't do something or did do something that that person perceives they shouldn't have. So I think that that happens pretty often. And I think the stigma that we all sort of pick up on as we move through the world instills fear in grievers. Often, grievers are watching their loved one go through hell. The hell of addiction and are waiting for a call one day where they're told that their person died. And so the stigma that those people experience while they're watching their person suffer may keep them quiet and may cause them to isolate when in grief connection is helpful.

Evan Banks

Your study found that not all groups are affected equally. What are some of the demographic and geographic differences you found?

Alison Athey

We saw some really interesting results there. It seems like the folks who are really socially connected, who have social networks that include a lot of people, are more likely to report that they lost someone. So when I say that, I'm talking about women compared to men. I'm taking about people in urban settings compared to in rural settings. So we know, unfortunately, because of the problem of loneliness among men in the United States, that women tend to know more people, to be socially engaged with more people. And so their odds of knowing someone who dies of an overdose are higher, maybe because they just know more. Same story with people living in urban environments. They're interacting with many more people and... Because of that they may encounter higher levels of risk. The other really fascinating trend was geographic. So we looked to see if there were certain regions, census regions in the United States where people were more likely to report that they lost someone. And we found that people who live in New England and people who lived in the Southeast, so Alabama, Mississippi and adjacent states, that those folks were significantly more likely to report that they lost someone to overdose. That's really interesting because the overdose crisis started in some communities earlier. It started in New England, it started in the southeast United States, and then the Midwest in consecutive sort of time series. So those communities where the overdose crisis started earlier were the ones where folks were more likely to say that they lost someone, and we didn't set a time limit when we were asking about loss, so my suspicion there is that those regions are impacted more, there are more losses there, and those individuals who were answering about their loss were more like likely to have encountered someone just because the crisis had been going on for much longer, so there was a longer period time when they might have known somebody who died.

Evan Banks

And I suppose there would be more awareness of the crisis in general too, and more knowledge then to report.

Alison Athey

Right, so the problem that we were talking about of knowing that someone died, but not knowing how may be different in those communities, that question around more knowledge and more stigma is one that I'm also curious about. It may be the case that people in these communities are more at risk of losing someone, but are in communities that are more supportive, have less stigma, have more resources and sort of rally around these grievers instead of isolating them. So someone who lives let's say on the west coast and loses someone to overdose, they may be alone and not have places that are ready to help them.

Evan Banks

Let's move on to how this problem might be addressed. What resources are available to people who have been impacted by an overdose death?

Alison Athey

This question reminds me what motivates me to do this work that can be really demoralizing at times. What is happening in our country is that there are grassroots movements of people who have experienced this type of loss, rallying together with one another to create resources that otherwise wouldn't exist, to create awareness that wouldn't exists. So we know that in many communities. There are non-profit organizations that people can find if they want to receive support, whether it's clinical interventions from a grief counselor, peer-led interventions. There are resources that exist. There are also resources for people whose grief leads them to advocacy. Their grief may lead them to want to prevent future losses, like the one that they experienced, and they are incredible grassroots organizations that are doing this. One of the organizations that I work with is Peer Support Community Partners. They're based in New England. And even before I came along and started working with them, they had developed a model of best practices for supporting people who are grieving. And they've partnered with the state of Massachusetts to deliver grief support to people who lost someone to an overdose. But they're one of many others. There's the Overdose Lifeline in the Midwest. There's an organization called GRASP. There's this huge populist movement of folks who are doing the work that hasn't happened because the research and the public health response has lagged behind.

Evan Banks

What do we know about how frequently people are using these sorts of grassroots services?

Alison Athey

Well, there's the rub, right? So it takes a level of motivation and also effort and knowledge to find these resources. So, unfortunately, it seems like most people don't find these resources and those who do often need a lot of time to search around and find resources. Way back in the pandemic when I started doing this work, with suicide loss survivors, I met a policymaker who was a go-getter, who was a leader in her community. And when she lost someone to suicide, it took her staff coming to her and saying, we're concerned about your well-being and we need to get you help. And I think that's just such a beautiful case that shows that grief changes people's capacity to find help and what we need to do is set up systems so that it's very, very easy to find help, and so that help is proactively offered to people who are grieving, that they don't have to, in their grief, settle the affairs of their loved ones, arrange a funeral, make it to work, look after their kids, get to the grocery store, process their emotions, and find resources that are there but that are harder to find. And so as part of that work, I have continued to engage with medical examiners. Medical examinars are on the front lines of this crisis and they're required by law. Jurisdictions are all a little bit different, but broadly they're require by law to make death notifications to the legal next of kin of a person who's died. And so they have this literally list, list and list of grievers who may be interested in resources. So I'm in the early stages, but with partners, including peer support community partners and Dr. Karen Osilla at Stanford, we're investigating, is it feasible to reach out to these next of kin to proactively offer support and get them connected to peer grief allies who have that lived experience and training from peer support community partners on how to be there for other people and their grief, to break up that isolation and to allow that natural grief process that humans have experienced for millennia to unfold in a supported way.

Evan Banks

That's a really good answer to my next question as well. Any other recommendations for policymakers on community supports?

Alison Athey

So there's low-hanging fruit here. We know that there are many, many funds that are being dispersed across the nation as part of opioid settlements and opioid restitution funds. Those funds are earmarked by law by the, I'm probably gonna guess the wrong word here, but the settlement language and the lawsuit, they're earmarked to be used to prevent overdose. I think one way that policymakers could impact change at a community level would be to use a portion of those funds to support people who are grieving overdose deaths, who may themselves be at higher risk for their own overdose. I think that that's particularly important when it comes to people who are already using drugs. We need to make sure that there is funding, that there's legislative support, that there are staff and resources made available to those who serve people who use drugs so that they can address their grief as that group in particular is probably at even higher risk than other grievers who don't struggle with drug use.

Evan Banks

I mentioned this in the intro, but the effects of drug overdose deaths on loved ones have been largely overlooked. Why do you think this issue has received so little attention?

Alison Athey

I think there are two reasons. There's a good reason and a not-so-good reason. The not-so-good reason is stigma. We're just now getting to a place where people can reach out for help. People who use drugs aren't seen as unworthy or undeserving, although that anti-stigma movement is incomplete. But my sense is that the stigma of these types of losses have kept grievers quiet, and it's also made it harder for those who would want to support them to mobilize, either because they don't know there's the lack of awareness piece of the stigma, or they feel like it's too complicated, too dark, too unworthy for them. So that's one piece. The good reason I think that this area has been overlooked is that everyone has in this field of overdose prevention has been focused on saving lives, on preventing every single overdose that we can prevent. And that is a huge undertaking that's resource intensive and knowing that there are going to be some people who we can't keep alive, who we can't save from overdose is the heartbreaking result of failures in overdose prevention, and that makes it hard for those who are having their hands full trying to keep people alive to then also be there for those who are grieving, although many of them themselves are grieving.

Evan Banks

So Alison, you're one of many RAND researchers who’s working hard to better understand and address this crisis. Are there other recent studies on this topic here at RAND—or elsewhere—that you’re really thinking about moving forward?

Alison Athey

So this is a really interesting one, also really sad, but motivating. Here at RAND, there's this incredible economist, David Powell, who studies the overdose crisis. What he has shown is that the overdose crisis and the crisis of suicide among our youth are linked, that just like we saw in my study that showed that communities that were first affected by the overdose crises have higher levels of grief. Those communities are also the ones that are experiencing increases in child suicide deaths. And there is a time trend: so we know that there's first the overdose crisis and next the increase in child's suicide. So when we're thinking about the problems of overdose and suicide, which are very severe in our country, we need to be thinking about them as twins, as epidemics that occur together and we need to be taking public health approaches to these problems. There was a study that was put out by an incredible investigator at the National Institute on Drug Abuse that showed that 100,000 children have lost their parent to an overdose death. So this is not a problem that's going to go away even if we're able to save every future person from overdose. This grief problem is deeply rooted and it's going to affect the lives of 125 million people for the rest of their lives. And we need to be thinking about the long-term systemic approach that we can take to support and protect these people, especially children.

Evan Banks

What's one thing that you would like our listeners to take away from this episode?

Alison Athey

I think the main takeaway for 42% of the people listening is that you're not alone in your grief. You're not alone in your overdose grief. There are many people who have shared that experience, who understand and who value you. So, in those moments of darkness and isolation, know that you don't have to be alone in your grief.

Evan Banks

Well, Alison, thank you for your time and thanks for your work and for sharing your research on the show.

Alison Athey

My pleasure. It's nice to know that we can make change in this area.

Evan Banks

You can learn more about the research we discussed on this episode at rand.org/policyminded. This episode was produced by Deanna Lee, it was recorded by me, Evan Banks, and edited by Harper Rupert. RAND's director of digital outreach is Pete Wilmoth. We'll see you next time on Policy Minded. RAND is a nonprofit institution that helps improve policy and decisionmaking through policy and analysis.