Association for Public Policy Analysis & Management

Prescription opioid pain relievers are effective therapies, and use of prescription opioid medications has increased greatly in the U.S. over the past decade. These drugs are highly addictive, however, which can lead to dependence and abuse. Indeed, deaths due to drug overdose have more than doubled between 2000 and 2014 (Rudd et al., 2016) – exceeding deaths from motor vehicle accidents and firearms since 2009 (Paulozzi, 2012) – driven largely by overdose deaths from prescription opioid pain relievers (CDC, 2016). Although the literature on opioid users is growing, whether and how children are affected by the increase in opioid drug use is not well understood.

The expected relationship between opioid use and child well-being is ambiguous. Prescription opioids manage pain, which may improve a parent’s ability to care for a child. The addictive nature of the drugs, however, may lead to substandard parenting. To comprehensively study the relationship between opioid use and child well-being, we use data on child maltreatment reports, records of foster care entrance, retail opioid prescription transactions, and drug-induced mortality records from 2003-2015. Our analysis (at both the state and county levels) controls for time-varying characteristics such as macroeconomic conditions, access to medical care, sociodemographic composition, social safety net program participation, time-invariant differences across states or counties, temporal changes that occur nationwide, and underlying secular trends specific to each state or county.

Preliminary results indicate a higher rate of prescription opioid distribution leads to lower rates of child maltreatment reports. These results are especially pronounced among reports of severe neglect of infants, physical abuse of all children ages 0-17, and caretaker absence/inability among all ages. On the other hand, counties with a higher drug-induced death rate have higher rates of reported maltreatment, driven by increases in reports of neglect across all ages (0-17). These increases in child maltreatment reports, however, do not reach the level of removal from the home. We find no consistent relationship between either the distribution of prescription opioids or the drug-induced death rate and the rate of entry into foster care. These results suggest the benefits of opioid use (e.g. pain relief and management, ability to work) have positive spillovers to children, but the consequences of opioid abuse negatively affect children, too.

This study contributes to understanding the true scope of opioid use and dependency, and has implications for what the goals of public policy should be regarding the problem. For example, these results imply – from a child welfare perspective – policies to reduce the negative effects of opioid addiction should focus less on reducing the supply of opioids and more on improving the ability to predict addiction and dependency. Future analysis will examine disparities across rural and urban areas, study more closely the heterogeneity across opioid drug type, and incorporate Prescription Monitoring Program (PMP) laws.