Researchers say the opioid epidemic has resulted in a rise in children living with unmet social needs that any aid programs are ill-equipped to address.
An estimated 8.7 million children ages 17 and younger currently live in households with at least one parent with a substance use disorder, according to a new report released Monday by the Urban Institute. Among those with substance use disorder, about 623,000 parents had an opioid use disorder and lived with children.
"Children and families are very much a key part of the opioid epidemic that has been evolving over a long time in this country," said report co-author Laudan Aron, a senior fellow at the Urban Institute's Health Policy Center. "I don't think the ripple effects beyond the individuals that are immediately affected are being fully acknowledged, understood or attended to."
A 2019 analysis found as many as 2.2 million children and adolescents in the U.S., or 2.8%, had a parent with opioid use disorder in 2017, with the highest rate found in West Virginia where 5.4% of children were affected.
The effects of the opioid crisis on children and families are likely to worsen as a result of the COVID-19 pandemic. Since January, opioid overdose deaths have increased for the first time after two straight years of decline.
The report examined the impact of the opioid epidemic within rural communities in West Virginia, Kentucky and Ohio, all of which have been among the hardest hit by the opioid crisis in terms of hospitalizations and deaths from drug overdose.
Unsurprisingly, the report found those communities continued to have high levels of need for addiction prevention, treatment and recovery supports.
But the report also found disconnects between existing addiction treatment programs and child protection systems that often hindered efforts to effectively address the opioid crisis and penalized families. The amount of time many child welfare programs provided parents to get into a treatment program before permanently placing their children in a new home was often shorter than the time it took parents to find a program that was available. The analysis found some communities had wait times to get into a treatment program that exceeded the 30-day limit child welfare programs mandated parents to enter into a program in order to be eligible to have their children returned.
Aron said many communities and states vary on when and how they decide to remove children from their homes when a parent has a substance use disorder. While some may penalize a parent for not seeking treatment fast enough, others may punish individuals for even acknowledging they have a problem and need treatment.
"It's just all over the map," Aron said. "I'm sure that there's a lot of room for policy and practice improvement within that system."
Researchers found schools had a vital role to play in supporting families affected by the opioid crisis by providing children free or heavily discounted meals, including breakfast and dinner, as well as offering non-perishable items and supplies they can take home to maintain their basic food and hygienic needs. Schools could also help to identity at-risk children in order to provide supports earlier.
Aron said hospitals had a duty to consider how the trauma a child may have experienced from having a parent with a substance use disorder has impacted their health, and to make such factors a more common standard of how they deliver care.
Efforts toward that end have been seen in recent years. A growing number of healthcare providers have made efforts to identify social needs in their patients and connect them to local social support agencies as mounting evidence has shown socioeconomic issues like poverty, food insecurity, and a lack of stable housing can lead to poorer health outcomes.
Aron said healthcare providers could also leverage their standing as economic anchors within their communities to raise greater awareness about the effects of trauma, which she said would help to reduce the stigma still often associated with addiction.
"There are very concrete things that can be done that are smart and effective and recovery-oriented for the whole community they can be advancing," Aron said. "They have a lot of power and influence."