Panel Paper: Unintended Consequences of Safer Pharmaceuticals: The Effect of the 2010 Oxycontin Reformulation on the U.S. Foster Care System

Saturday, November 10, 2018
Jefferson - Mezz Level (Marriott Wardman Park)

*Names in bold indicate Presenter

Scott Dallman, University of Minnesota

Since the mid-1990's, there has been an increasing number of cases of opioid addiction and related deaths in the U.S. To combat misuse, Purdue Pharma introduced an "abuse-deterrent" formulation of OxyContin in 2010 which made the pill less soluble or crushable. In response to the safer formulation, users may still abuse OxyContin with greater effort or many have opted to substitute other opiates. However while popular substitutes for OxyContin, such as heroin, are readily available, highly potent, cheap and easy to use, abuse of street-level heroin poses greater risk of morbidity and addiction to its users.

This study examines the effects of the recent rise in opioid abuse on public foster care systems. While greater public attention has increased efforts to provide assistance to individuals addicted to opioids, the provision of support for their dependent children is also critical to consider. Children who enter the foster care system most likely already come from troubled homes and entry into foster care can compound cognitive and socio-emotional development for children of opioid abusers. Yet, children within the foster care system are also a well-defined, high-risk population whom could potentially benefit enormously from interventions narrowly-targeted to their developmental needs. Further, a large influx of children into foster care can pose major costs for the child welfare system.

Increased opioid abuse by parents would likely lead to greater numbers of children entering the child welfare system, yet the effects of a greater general availability of opioid medications on foster care systems is theoretically ambiguous. Higher rates of prescriptions and therefore increased availability of opioids may cause more substance abuse among individuals with dependents, leading to a greater number of children entering foster care system. However, if used for its intended medical purpose, prescribed opioids may improve household circumstances for some families leading to less child entry into foster care and increased family reunification.

Using data collected on U.S. national drug prescriptions merged with child foster care entry records from 2006- 2015, the effects of county level opioid prescription rates on county foster care systems are estimated using Poisson Quasi-Maximum Likelihood within a difference-in-differences framework. This paper shows that the re-formulation of OxyContin was found to increase the proportion of short foster care stays (less than 1 year) for the sample of available U.S. counties. However, using information on the population of U.S. state foster care cases, the reformulation significantly increased the number of drug-abuse related foster care entries.