More than 40 percent of Americans know someone who has died of a drug overdose and about one-third of those individuals say their lives were disrupted by the death, according to a new RAND study.

Analyzing a national representative survey of American adults, researchers found that the lifetime exposure to an overdose death is more common among women than men, married participants than unmarried participants, U.S.-born participants than immigrants, and those who live in urban settings as compared to those in rural settings.

Rates of exposure were significantly higher in New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) and in the East South Central region (Alabama, Kentucky, Mississippi, Tennessee) than in other parts of the nation.

The findings are published by the American Journal of Public Health.

“The experiences and needs of millions of survivors of an overdose loss largely have been overlooked in the clinical and public health response to the nation’s overdose crisis,” said Alison Athey, the study’s lead author and a behavioral scientist at RAND, a nonprofit research organization. “Our findings emphasize the need for research into the prevalence and impact of overdose loss, particularly among groups and communities that experience disproportionate rates of loss.”

More than 109,000 people died from a drug overdose in 2022, placing the national total since 2000 at more than 1.1 million overdose deaths.

While the overdose crisis has had wide-ranging negative impacts on people who use drugs, their employers, and public health systems, little research has explored the experiences of those left behind by fatal drug overdoses.

Researchers say that it is important to consider a parallel line of research that has focused on those left behind by suicide to understand the impact that an overdose loss may have on those who have experienced it.

There appears to be a continuum of survivorship following suicide deaths, leaving overlapping groups of those exposed, those who are psychologically distressed, and those who are significantly impacted by suicide. Each suicide death is estimated to affect the lives of as many as 135 U.S. adults.

“It is likely that a similar continuum of survivorship exists among overdose loss survivors,” Athey said.

RAND researchers asked 2,072 adults who participate in the RAND American Life Panel about whether they knew someone who had died of a drug overdose and to characterize how the death affected their life.

In the study, 42.4 percent of respondents reported personally knowing at least one person who died by overdose, suggesting that 125 million American adults have experienced such a loss.

The study found that 13 percent of those who responded had had their lives disrupted by an overdose loss. More than 4 percent of those surveyed reported that the loss conferred a significant or devastating effect that they still feel.

Other authors of the study are Beau Kilmer of RAND and Julie Cerel of the University of Kentucky.