Parental overdose fatalities have adverse and lasting effects on children’s mental health – heightening the risk of depression, anxiety, post-traumatic stress disorder and suicide. The period leading up to a parent’s fatal overdose may also involve trauma and instability, shaping the conditions in which negative outcomes emerge and persist for children and their families. These consequences may extend far beyond the fatal overdose itself, affecting children’s wellbeing into adulthood and straining the stability of their support systems, including family members who take on increased caregiving responsibilities.
Despite the profound and harmful impacts of parental overdose fatalities, no federal or state data systems currently link parental overdose deaths to their children. This gap in human service infrastructure makes it difficult to (1) identify affected children and families and (2) provide timely, targeted support—especially for those most in need.
This report presents insights drawn from Allegheny County’s integrated data system, which helps illuminate the demographics and service involvement of children and families impacted by parental overdose fatalities.
Key Takeaways
Scope
From 2016-2023, there were 1,694 parents who died of an overdose, leaving behind more than 3,500 children – an average of 447 children per year.
Demographics of the Children
- The most common age group at the time of parental overdose was 13-17 (25%), but half were under 13 at the time of their parent’s death and 14% (503) were under five.
- Although most of the children (63%, 2,223) were White, Black children disproportionately lost their parents.
Parent’s System Involvement
- Most of the parents had prior — and recent — engagement with behavioral health services; more than half received substance abuse treatment services in the 12 months prior to their death.
- Although most had no child welfare involvement at the time of death, many had prior contact, with most first entering the child welfare system more than four years before the fatal overdose.
- In the year prior to their death, more than 70% visited an emergency department.
- More than one-quarter were in the Allegheny County Jail that year.
Children’s Service Involvement
- Most children had no connection to human services in the year before or after their parent’s death, and interaction with most services stayed consistent pre- and post-death.
- Compared to other Medicaid-enrolled children and youth, this group had higher rates of mental health outpatient care before their parent’s death.
- Involvement in mental health outpatient services increased in the nine months after a parent’s death, suggesting increased support during that period.
- After nine months, treatment rates returned to pre-death levels.
- Over 30% had a prior child welfare removal – 7% were in a placement at the time of their parents’ death.
Special Focus: Children Under Five
Children under five represent a critical population:
- Fourteen percent (503 children) were under five at the time of their parent’s death, and more than 80% did not use early childhood services in the year before or after the death.
- Seventy-five children were under the age of 1 at the time of their parent’s death.
- More than a third of these children had an open child welfare case at some point prior to their parent’s death.
- 1 in 5 were in placement at the time of the death.
- Eleven percent (8) of these children had a referral to child welfare alleging a substance-exposed newborn prior to the parent’s death.
How DHS Uses This Information
DHS uses these data to:
- use public funding — such as opioid settlement funds — responsibly and equitably to provide care and support to those most in need.
- strengthen intervention strategies aimed at supporting the wellbeing of children and families.
- promote transparency and build shared understanding around child bereavement and parental overdose fatalities.
- surface a critical gap—linking parental overdoses to bereaved children — in human service work and systems.
What’s Next
Allegheny County will receive annual installments of opioid settlement funds (OSF) through 2038. Settlement dollars augment annual HealthChoices and Block Grant funds for behavioral health treatment and supports to help county residents. These are the current and upcoming ways DHS plans to use investments and collaborate with community partners to prevent and reduce substance use harm and fatalities in the community:
- Expanding Early Head-Start Child Care for children impacted by substance use
- Launching a County-wide campaign to promote safe medication storage and offer guidance on naloxone (Narcan) use for households with small children
- Improving school-based assistance for children impacted by substance use
- Increasing medication for opioid use disorder (MOUD) availability, including in the Allegheny County jail
- Creating warm handoffs to treatment from emergency departments, to facilitate rapid referrals to treatment for patients with SUD.
- Testing innovative strategies, such as contingency management (i.e., offering rewards when individuals achieve specific milestones or behaviors related to recovery), for stimulant addiction (e.g., cocaine, methamphetamine)
- Gathering continued input from the community to identify the most effective ways to support families and children affected by overdoses
These current and upcoming efforts aim to deepen DHS’s understanding of community needs and ensure the use of public funds strengthen community wellbeing.
Questions or Feedback?
We welcome your questions and suggestions. To share feedback, you can reach us at DHSResearch@alleghenycounty.us. If you’d like to stay informed, consider signing up for our newsletter. To learn how to use DHS data in your research, please visit our Requesting Data page. Thank you for your time and interest. Your engagement helps shape and improve how we share data that matters.