Advice to policy-makers for improving services to the drug-death bereaved

Aims: The objective of this study is to contribute to an improvement of bereavement services and experiences for the bereaved after drug-related deaths (DRDs) by investigating their expressed opinions on what would constitute improvements. Methods: As part of a larger survey questionnaire, we asked people bereaved by DRDs what advice they would give to politicians to improve bereavement services. Out of 255 respondents, we received 196 written statements of advice, 83 focusing on the time after death. Two-thirds of these respondents were either parents or siblings, the other third were other family members or close friends. A thematic analysis was conducted to examine the written statements. Results: We found four central themes: broad-spectrum help, routinised help, respectful help and competent help. The advice represents a long list of psychosocial support to ideally be offered on a regular and long-term basis. Furthermore, the bereaved also discussed the cognitive and normative side of the services by including considerations about stigma and respect, and the need for more research- and experience-based knowledge about their experiences both before and after DRDs. Conclusions: Many of the services sought by the bereaved are already in place and described in national guidelines for follow-up strategies after sudden unexpected deaths. DRDs, however, has not been included as a task for the services and are not explicitly mentioned in these guidelines. The scope of research and policymaking on drug problems and DRDs should be broadened to include families and social networks in order to make the group more visible and strengthen their influence on policy.

Geographical Aspects of Recent Trends in Drug-Related Deaths, with a Focus on Intra-National Contextual Variation

Background. Recent worldwide estimates are of 53 million users of opioids annually, and of 585,000 drug-related deaths, of which two thirds are due to opioids. There are considerable international differences in levels of drug death rates and substance abuse. However, there are also considerable variations within countries in drug misuse, overdose rates, and in drug death rates particularly. Wide intra-national variations characterize countries where drug deaths have risen fastest in recent years, such as the US and UK. Drug deaths are an outcome of drug misuse, which can ideally be studied at a relatively low spatial scale (e.g., US counties). The research literature suggests that small area variations in drug deaths to a considerable degree reflect contextual (place-related) factors as well as individual risk factors. Methods. We consider the role of area social status, social cohesion, segregation, urbanicity, and drug supply in an ecological regression analysis of county differences in drug deaths in the US during 2015–2017. Results. The analysis of US small area data highlights a range of factors which are statistically significant in explaining differences in drug deaths, but with no risk factor having a predominant role. Comparisons with other countries where small area drug mortality data have been analyzed show differences between countries in the impact of different contextual factors, but some common themes. Conclusions. Intra-national differences in drug-related deaths are considerable, but there are significant research gaps in the evidence base for small area analysis of such deaths.

Parental mortality following the loss of a child to a drug-related death

Background The drug-related death of a child has been linked to higher prevalence of complicated grief and mental health problems than bereavement by other causes of death. Whether this leads to an increased risk of mortality following the loss has not yet been examined. Methods Employing register data covering the years 1986–2015 and encompassing the entire Norwegian population, parents with at least one child aged 15 or older were analyzed using Cox regression. Drug-death bereaved parents were compared with both non-bereaved parents and parents bereaved by other causes of death. Results Parents bereaved by a drug-related death generally had a higher natural cause mortality throughout the follow-up. Drug-death bereaved parents had a particularly high external cause mortality in the first 2 years subsequent to bereavement when compared with non-bereaved parents (mothers: hazard ratio 4.82, 95% CI = 3.11–7.47; fathers: hazard ratio 2.50, 95% CI = 1.57–3.97). There was also an elevated, but significantly lower mortality risk from external causes 2 to 10 years subsequent to bereavement. This indicates that the associations observed are not solely due to selection. Conclusions Parents bereaved by the drug-related death of a child had a higher mortality than both non-bereaved parents and parents bereaved by other causes of death. Drug-death bereaved parents had particularly high external cause mortality. Our results indicate that losing a child to a drug-related death is associated with adverse health outcomes and that these might be more severe than bereavement due to other causes of death.

How Do Drug-Death-Bereaved Parents Adjust to Life Without the Deceased? A Qualitative Study

Knowledge about how bereaved persons grieve can enhance quality in providing the support and potential services that they need. We aimed to identify ways in which drug-death-bereaved Norwegian parents go on with their lives and what inhibits or promotes adaptation during their grieving. Reflexive thematic analysis was used to analyze 14 semistructured in-depth interviews. We generated three themes: (I) processing grief emotions, (II) proactive coping, and (III) giving and receiving support and assistance. Processing guilt rumination, reflections on blame and a burden of grief emotions characterized grieving early on. Using cognitive strategies and functional-support-giving were found to be the most frequently used strategies. Oscillation between processing stressors and reorientation to the world promoted adjustment to ongoing life. We discuss characteristics of parents who struggle to reorient and outline important implications for policy and practice.