The Overdose Crisis Leaves Gaps in End-of-Life Care

When someone is living with the effects of trauma, mental illness, or substance dependence, especially in the context of precarious housing, they are often excluded from traditional health and palliative care systems. If their health begins to decline, they may not have a consistent care provider. If they die suddenly from an overdose, the death is often traumatic for loved ones, and support for processing that grief is scarce. 

Stigma also compounds suffering. Families may feel isolated in their mourning. Friends who also use substances to cope may be left to navigate their grief in silence, fearing judgment. The person’s final days, if they were seen at all, may have been marked by loneliness, misunderstanding, or even hostility. This is disenfranchised grief: grief that is unrecognized, unsupported, or minimized by society. 

These are the realities we must change.

Photo from Wix.com

How Death Doulas Can Help  

A death doula’s role is simple but profound: to provide non-judgmental presence, emotional support, and practical guidance for people who are dying and for the loved ones they leave behind. In the context of the overdose crisis, this can mean being there before a crisis happens, building trust, talking about wishes, and connecting people with harm reduction resources.   

It can also mean holding space before, during, and after a loss, offering immediate emotional first aid to friends and family members navigating shock, guilt, or complicated grief. Death doulas create affirming rituals such as memorials, bedside vigils, and legacy projects that honour the whole person, not just their relationship with substances. They bridge gaps by connecting individuals to resources when they fall through the cracks of traditional systems. 

At its core, death doula work is about dignity, humanity, and love, and in overdose-related loss, these are often the very things most missing. 

H.O.P.E. Mobile Hospice: Taking Compassion to the Streets  

Later this year, Home Hospice Association will launch the H.O.P.E. Mobile Hospice, a first-of-its-kind initiative to bring death doulas directly to people at the end of life, wherever they are.  

For someone living unhoused, “home” might be a tent, a shelter bed, or a familiar corner of a park. The H.O.P.E. Mobile Hospice will make it possible for Death Doulas to mobilize care on the spot, whether that means sitting vigil with someone in their final hours, holding their hand as they talk through fear, or simply making sure they are not alone.  

For those who survive an overdose but are left shaken, the H.O.P.E. Mobile Hospice can offer immediate emotional support and connection to follow-up care. For those who lose a friend or loved one, it can be a lifeline in the rawest moments of grief.  

This is kindness, the way we would want it for ourselves. 

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Paula DeLeon is a Registered Social Service Worker, a Life Celebrant, a Spiritual Care Provider, and an HHA Death Doula Candidate.