It’s difficult to explain death to a 4-year-old.
Miles Lussier didn’t understand what death meant. His goldfish died the previous year. Their dog, Copper, had died a month earlier, and his mother, Tricia Regan, tried to explain that the same thing had happened to her half-sister, Sarah. However, Copper lived to be 105 years old in dog years. Sara Saponara was only 21 years old.
His mother said his sister took medication that wasn’t hers. It contained something dangerous and caused her death. She explained that death meant she would never see Sarah again.
Two years passed before Miles and Tricia really talked. how She died again. The words “Tell me how Sarah died” appear randomly in grocery stores, parks, and zoos.
As Miles grew older, he began to wonder: Where did Sarah get the medicine? Did the doctor give it to her? Can all medicines harm you?
Sibling grief is real and powerful, but often overlooked, especially when the grieving sibling is young. In an era when drugs like fentanyl are widely available, death from overdose has become a heartbreaking reality for more families. For parents, that means facing the impossible task of helping young children understand loss too early.
“We went through something horrible.”
At age 17, Sarah was prescribed opioids after a routine medical procedure. She began searching for other drugs to capture the same feelings. First it was weed, then ketamine and Xanax.
Although she suffered from bipolar disorder and ADHD, her brain felt more balanced when she was on medication.
By the time Sarah went to college, there were no drugs of choice, but she was addicted to developing an altered state. She eventually dropped out after four semesters.
During an acid trip, she once threw herself from a moving car on the highway. It was one of those times when Tricia felt like she might lose herself.
Sarah’s addiction uprooted their lives. If Tricia had 100 metaphorical marbles to give to others, she gave 96 of them to Sarah. At one point, Tricia was worried that someone selling drugs to Sarah would come to her house, so she sent her middle child, Liliana, then 13, to live with her uncle.
Panic attacks, anxiety, and anger hit Liliana in waves. How was Sarah able to buy medicine without being able to buy food? Why did she continue to use?
It took years for her to truly understand how addiction had controlled Sarah’s behavior.
Liliana, now 18, says: “It was really heartbreaking to have to go through all that negativity from Sarah. I was so angry when she passed away.”
They didn’t know the name at the time, but anticipatory grief, the process of grieving a future loss, can involve feelings of anxiety, sadness, and anger. In the case of overdose loss, the feelings are often more complex and grouped with the stigma of losing someone materially.
“It wasn’t until after she passed that I could say we went through something horrible,” Tricia said. “It was really bad.”
Fentanyl-laced pills took her life
Sarah first tried heroin in August 2020. She was with her girlfriend and her roommate. Just hours after inhaling the drug, Sarah woke up to find her girlfriend next to her unresponsive.
Tricia received a call in the middle of the night. They’re in the hospital and they hear that Sarah’s girlfriend has passed away. She was by her daughter’s side. During a short break to participate in a conference call, Tricia left the apartment. When she returned with lunch and knocked on Sarah’s roommate’s door, there was no answer. She and Sarah also found him dead. Fatal overdose from the same batch of drugs.
Sarah then admitted that she knew heroin killed her girlfriend, but that she used it again anyway.
“I couldn’t understand why she would do that,” Tricia said. “Even from a distance, it was clear that matter had powers that I could not understand… Her brain could no longer process it in a rational way.”
Six months later, Sarah was gone. She could never forgive herself for surviving that tragedy, her mother says. She had overdosed at least twice and was in the ER just three days before her death. It was counterfeit Percocet laced with fentanyl that ultimately killed her on February 17, 2021.
During the last year of Sarah’s life, Tricia hardly slept.
She checked Sarah’s location and social media every morning. After hours passed without hearing from her, Tricia drove by her apartment, heart racing, to see if she was there.
Even though Sarah had imagined how she would die a thousand times, nothing could match the wall of sadness that hit her when it actually happened.
Sarah was the soundtrack of their lives. She played 17 instruments. At her rural conservative high school in Ashland, Virginia, she became the first openly gay member of the homecoming court and was chosen as the class clown. When she passed away, it was as if the music had stopped.
Tricia wanted to collapse, but she had two other children to raise. The fear was paralyzing.
“One of the most difficult things about parenting, when I lost my child to an overdose, was thinking about what role I played in getting Sarah to where she came from. And how do I make sure I don’t make the same decision for my other children?” Tricia says.
Liliana, who is seven years younger than Sarah, has memories. But Miles was only 4 years old. How can you help a child grieve a sibling they barely know?
Parenting in the shadow of sadness
For Tricia, parenting these days can seem scary.
Today’s teens navigate an ecosystem where they can access counterfeit oxycodone, Xanax, Percocet, and Adderall on platforms like Facebook, Snapchat, and Telegram. According to the Drug Enforcement Administration, which led the “One Pill Kills” campaign, six out of every 10 counterfeit prescription pills contain potentially lethal doses of fentanyl.
More than 100,000 people die from drug overdoses in the United States each year, and nearly 70% of those deaths are caused by synthetic opioids, primarily fentanyl. But Tricia says that’s a reality her parents don’t want to talk about.
“I think the alienation I felt was because…because of our daughter’s death, we didn’t want to imagine that happening to us,” Tricia said.
Liliana became acutely aware of the dangers around her. She has had three surgeries since Sarah’s death, and each time she was adamant that she did not want to use opioids, despite her doctors’ objections.
“I felt like they were diminishing me and my character when I said I didn’t want to use opioids,” Liliana says. “I wish more people knew that opioids don’t have to be the norm.”
In Liliana’s room, neon lightning lightly illuminates the bed. It belonged to her sister. Sarah was once almost struck by lightning, and that Christmas Tricia gave her a lamp and a bracelet with a poem on it that read, “Trust me, girls like you are made of lightning. Unforgettable and memorable.”
Losing a loved one to overdose is often accompanied by feelings of anger, regret, and guilt, so it’s important to seek out grief resources specific to overdose. The Dougie Center, which focuses on grief for children and families, says it’s important to tell the truth when explaining overdose deaths to young children, even if it’s in simple terms.
Tricia takes Liliana and Miles, now eight years old, to a local support group for people who have experienced losses related to substance abuse through the Full Circle Grief Center and participates in the GRAPLE initiative, a peer-led grief support group for losses related to substance use disorders.
Tricia also sent Liliana and Miles to Comfort Zone Grief Camp, a program for children ages 7 to 17 who have lost a parent or sibling to an overdose, where they also participated in a parent program.
One year, on the way home from camp, Miles said to Tricia: “I don’t think I remember Sarah. Sometimes they ask me to take pictures of our fondest memories, and I don’t have one.”
That’s part of the challenge. But a volunteer at the camp taught Miles that he could create new memories with Sarah by taking something of her with him, honoring her legacy and remembering her in each new moment.
This year, Miles decorated his light bag with lightning bolts for the camp memorial service.
For young children, grief does not always follow the path we expect. Find your own quiet home. In the corner of the kitchen is a small space that Miles calls “Sarah’s home.” For years he has been packing little things for her. Photos of family vacations, small toys, and one Christmas, a small doll bed.
“She needs a bed at home,” he told Tricia.
She smiled and asked gently, “Do you think she’s sleeping there?”
Miles shook his head. “No,” he said. “She’s among the stars.”
If you or a loved one is struggling with a substance use disorder, contact the SAMHSA National Helpline at 1-800-662-HELP (4357) for information and resources.
Rachel Hale’s role covering youth mental health for USA TODAY is supported by a partnership with Pivotal and Journalism Funding Partners. Funders do not provide editorial input.
Contact X at rhale@usatoday.com and @rachelleighhale.
