Today, drug-related deaths (DRD) are a significant contributor to non-accidental deaths worldwide, particularly due to accelerating fatality rates across the West in the past decade. DRDs have reached “epidemic proportions” in the United States, with 91,799 deaths in 2020, increasing by 30% in 2021. In the UK, DRDs have been growing yearly, with 4,879 people dying in 2021. This trend is also true for many other European countries. Scotland has the highest rates in Europe, and DRDs significantly contribute to an overall fall in life expectancy.
However, there has been a strange silence about those who grieve these deaths, those who are left behind with the guilt, blame, stigma and lack of support for what they have been through.
The impact of bereavement
Bereavement, as the act of being deprived of the company of someone close to us, is felt by everyone. Due to this, having strong social connections is essential to support someone through their grieving process. This support is often inadequate for people bereaved by a DRD within their family or social group due to stigmatising and negative societal attitudes towards drugs. These deaths are often seen as caused by family dysfunctions, or failure to properly intervene before someone’s death.
It’s common to label DRDs, suicides, HIV-related fatalities and murder as “special deaths”, as there is a higher amount of societal stigma and trauma faced, which can often lead to longer and more intense periods of mourning and grief.
How those grieving are treated can cause long-term issues such as social isolation, prolonged grief disorder and post-traumatic stress disorder, which perpetuates the cycle of despair around deaths.
Research has also found that those bereaved can be targets of negative comments after their loss: as many as 57% of negative comments towards a DRD can come from close family and friends to the deceased person. These remarks were perceived as dehumanising, where people who use drugs (PWUDs) were defined as lesser members of society, as well as called junkies, selfish, weak, coward, among other terms. Drug-related problems were understood as self-inflicted; an overwhelming amount of blame was given to the deceased, which can actually develop into guilt experienced by the bereaved. Due to this, shame, guilt, and self-blame surround those grieving DRDs.
Some comments from family members descriptions of these deaths:
“Maybe people don’t think we are grieving since he is just a drug addict.”
“You should be glad he is dead because now you have no trouble with him anymore.”
There is a meagre amount of work done into the extent of harm faced by those left behind. One study interviewed people who use opioids who had lost someone in their social circle; they noted that their worlds felt saturated with death, with 75% of those interviewed reporting at least one death in their network. Interviewees were often felt their mourning was interrupted or incomplete: they were unable to attend funerals to avoid social conflict like being blamed for their death or felt guilty for having used drugs with the deceased.
Systemic and media-compounded grief
Criminal and social services then compound this trauma: in the same study, only one participant received grief support, while others were incarcerated. This reveals a wider structure that insists on criminalising those that use drugs, which also prolongs the period of suffering from bereavement. One person strikingly noted that, upon putting his friend to bed who later died there, no one ever asked him how he felt about their death. This encapsulates not only the state-level abandonment experienced by people who use drugs, but how accustomed to death people who use drugs must be in today’s drug markets. They are somehow responsible for this fate, and also deserve it.
Similarly to unexpected or sudden deaths, a drug-related death is often investigated by police and/or highly mediatised. Those grieving report a lack of compassion from police officers, meaning good experiences were rare; grief was felt as secondary to justice. The media can be particularly dehumanising with such deaths; it’s not uncommon for parents to have to sue newspapers to prevent libel and avoid headlines such as these:
The media has a macabre focus on the final moments of death, obsessing over details like the exact location, treating people’s deaths as a public spectacle for entertainment. By focusing on “newsworthy” aspects, death and grief are thrusted into media attention, usually preventing any focus on the systemic issues that led to it in the first place. This is particularly insidious, as drug-related deaths are usually connected to wider socioeconomic factors: as we see in Scotland, where people living in the most deprived areas are 17 times more likely to die of drug-related causes.
Deaths in public places should not just highlight the individual. The public treatment of DRDs means those grieving have to deal with undue media attention, reductive views that perceive the deceased as “just an addict”, and their own personal memories of them.
Naming DRDs as ‘special deaths’ also stems from the high levels of disenfranchised and complex grief. Disenfranchised grief is grief that is not acknowledged by the social network of the bereaved, or by wider society; this is usually applied on people that “didn’t deserve to be grieved over”. Such grief can be seriously detrimental: those experiencing complex grief struggle to find meaning in their loss, and can remain confused by their feelings, particularly feeling that they don’t have the right to grieve.
DRDs are also distinctly impacted by anticipatory grief. Those close to people using drugs will often anticipate the loss of that person, especially given a surrounding toxic drug supply. Anticipatory grief also means people may being their grieving process before someone has died; this can provide both pain and relief for the bereaved, although it was felt to help when the actual event of death occurred. It can also exacerbate anxiety around death, especially if there are multiple overdoses or “close calls” leading up to the moment.
We need to end stigma around drug deaths
Those grieving have been neglected in research, policy, and practice, as much of the focus on DRDs remains on the statistics. Anyone’s Child, a charity set up of family members of those lost to the drug war, helps humanise the tremendous cost of each life lost. Nevertheless, support for those grieving continues to not be enough, with stigma defining much of their experiences. This cannot be expected to change while drugs continue to be criminalised.
This must be challenged: it is essential to improve society’s knowledge about the experiences of people who use drugs, and to humanise the suffering around the tragedy of someone’s life ending prematurely.
We must ensure professionals are trained to address stigmatising behaviours. It is not only important to change the dehumanising and blaming language around drugs, but to address the structural faults that lead to stigma and death in the first place.
As long as drug use remains stigmatised, the disenfranchised, interrupted and complex grief of bereaved friends and family will persist. Tragically, research has highlighted that not one person grieving a DRD has come to terms with their loss, even years later. This should be a stark reminder of the importance of finding relief for those dealing with long-lasting pain.