This letter to JAMA Pediatrics reports the findings of a study that sought to determine the number of children who experienced unexpected parental loss because of opioid overdoses in Allegheny County, Pennsylvania, from 2002 to 2017. In that period, more than 1,000 children lost a parent because of an unintentional drug overdose and experienced elevated risks for mental disorders, as observed by increased mental health service use in the years following parental death. Public discourse regarding clinical approaches and policies to address the effect of unexpected loss among children is warranted, as it is an underrecognized dimension of the opioid epidemic in the United States.
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