We have an unprecedented crisis happening in our country. Every day, 115 people die of opioid overdose. From 1999 to 2016, 350,000 people have died. A recent survey by the AP and Center for Public Affairs Research found that 1 in 10 Americans know a relative or close family member who died of opioid overdose. In April, the Surgeon General issued the first national health advisory since 2005, urging families and friends of addicts to carry naloxone, the drug that can reverse the acute effects of an overdose and give a greater chance of survival.
Clearly, we are have a huge public health problem with more people dying per day due to opioids than were dying of AIDS at the height of that epidemic. Just as we found the will and resources to combat AIDS over 30 years ago, we need to do it now for opioids.
In addition to scope, there is another aspect of these two epidemics that is similar. When people died of AIDS, their family members were often reluctant to tell others the cause of death because of the stigma. The same is true with the opioid crisis, leaving families unsupported and isolated. It’s bad enough that our society knows so little about how to effectively support the survivors of a loved one’s death; with a stigmatized death, the situation is exponentially worse.
Many people don’t realize that opioid addicts generally begin taking the drugs to relieve intense pain from a medical condition, not to get high. Yet one of the ways opioids work is to increase the levels of dopamine in the body, resulting in a feeling of euphoria while relieving some of the pain. Even if all the pain is not relieved, that which remains seems tolerable because of the underlying “high”.
Addiction begins when the drug rewires the reward centers of the brain, causing the person to perceive anything less than the euphoria as being painful and creating a physiological craving for more of the drug. Tolerance requires higher doses, the euphoria increases, the drug continues to affect the brain, and the addict sinks into an ever-deepening need for opioids just to feel normal. For those who try to reduce or quit, withdrawal symptoms are intense, and they often give up, relapsing into drug abuse to eliminate the pain. It reaches the point where an addict will do anything to get the next hit.
How to Help
After an overdose death, the grief is profound. The family loses a beloved family member. They lose the future they hoped for with that person and the unique place that person held in the family structure. They have exhausted themselves with worry and attempts to help. There are feelings of guilt and inadequacy that the loved one couldn’t be saved. These reactions are combined with anger at the lack of resources for addiction and resentment towards the addict who wasn’t able to kick the habit despite whatever help the family could offer. At the same time, rather than the outpouring of support they would receive if their loved one died of something like cancer, the support is muted, tentative, or absent, replaced by judgment or simply the would-be comforter’s inability to know what to say.
Here are five suggestions on how you can help a friend or family member dealing with this kind of loss:
- Be there. Listen to their stories of the addiction and death over and over again. Rather than attempting to cheer them up, offer a strong shoulder and a listening ear.
- Share memories of the good times with the person who died, so they can remember the life as well as the death. Acknowledge the void that can never be filled in the same way again.
- Do concrete things to help. Run errands for them, take them to coffee, or help address the thank-you envelopes. Take younger siblings/children out for a “treat” afternoon that gives them extra attention while allowing parent(s) time and space to grieve, or whatever you can think of that they may need.
- Don’t ask “How are you?” Instead, ask “What do you wish people knew about what this is like for you?” or “What kind of a day is it today – an up day, a down day, or an all-over-the-place day?”
- Don’t go away. Their grief will not be over in a couple of weeks or months, as our society seems to assume. Especially be present on days like the birthdays, anniversaries, and holidays, all of which will be extremely painful.
- Research local support groups such as Not One More, which has chapters in 15 locations; GRASP, which has meetings in 24 states; or more localized groups like Lifeline for Loss in Indianapolis, IN. Although not all organizations have a nationwide database, find out what is available in your community to help grieving families reduce their isolation.
Don’t let the stigma of opioid addiction cloud your ability to companion families you care about when they are grieving. Be there for them, especially in these tragic situations when so many others disappear.
Originally published in the Daily Herald, June 2018.