How the Opioid Epidemic Impacts Child Welfare

Everyone agrees that there is a major problem with the levels of opioid addiction in this country. Many people know someone who is dealing with an addiction. Many more know someone who is currently impacted or has been impacted in the past by someone with an addition issue. But how did this national problem start?

In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers. Based on this, healthcare providers began to prescribe opioid pain relievers at a much greater rate. The result was widespread diversion and misuse of these medications before it became clear that they could become highly addictive. Opioid overdose rates quickly began to increase. In 2017, more than 47,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl (a powerful synthetic opioid). That same year, an estimated 1.7 million people in the United States suffered from disorders related to prescription opioid pain relievers.

So how does a prescription lead to an addictive disorder?

  • Roughly 21% to 29% of patients prescribed opioids for chronic pain misuse them.
  • Between 8% and 12% of people using an opioid for chronic pain develop an opioid use disorder.
  • About 80% of people who use heroin first misused prescription opioids.
  • The likelihood of developing an opioid use disorder depends on many factors, including length of time a person is prescribed to take opioids for acute pain, and length of time that people continue taking opioids (whether prescribed or misused).

The important thing to remember is that the person addicted to opioids is not the only person impacted.

The number of children under the supervision of state welfare systems nationwide has climbed to record highs. As an example, the number of children served by foster care (out-of-home care) increased by nearly 50,000, from 638,041 in 2013 to 687,345 in 2018. The rate of child removals attributable primarily to parental substance abuse doubled from 18.5% in 2000 to 36% in 2018. This has dramatically changed the composition of American families and challenged state systems trying to simultaneously combat an addiction crisis while protecting children and families.

The opioid epidemic has been very impactful on families. As many as 12 million adults misusing opioids in the United States are parents. And there’s no surprise the number of foster care placements and permanent terminations of parental rights have risen parallel to the trends in opioid misuse. This would indicate that parents are struggling to meet child welfare system requirements for being reunited with their children. In fact, parental substance abuse has become the second most common circumstance associated with child removal.

The most frequent circumstance that leads to child removal from the home is neglect, cited in 62% of cases. This is routinely linked to parental substance abuse. There is also considerable evidence of intergenerational risks associated with parental substance abuse. Nearly 6,300 youth removed from their homes in 2017 were misusing substances themselves.

There is also a great deal of evidence that the impact on the children of parental substance abuse is long lasting and is one of the factors tracked in the Adverse Childhood Experiences Study (ACEs).

  • Among women who struggle with opioid abuse, 86% of pregnancies are unintended, compared to 56% of all pregnancies. This leads to more children receiving insufficient or delayed prenatal care and higher risk for low birthweight and poor mental and physical health.
  • Between 14% and 22% of women nationwide filling an opioid prescription, do so during pregnancy. This puts thousands of infants at risk of neonatal abstinence syndrome (NAS).
  • By 2013, an infant was born with NAS on average every 25 minutes in the United States. That’s an increase of nearly 300% between 1999 and 2013.

The impact of the opioid crisis on child welfare systems across the country has been staggering.

  • After years in decline, the number of children in foster care has been steadily rising since 2012, also in parallel with the rise in parental opioid addiction.
  • In 2014, over 40% of children in relative foster homes were there because of parental substance abuse. Relatives (often grandparents) also care for children outside formal foster care so as to avoid placement in “the system.” For each child raised inside the formal foster care system, 20 more live with relatives in informal arrangements.
  • Nearly a third of children entering foster care in 2015 were due at least in part to parental drug abuse. That’s an increase of nearly 50% since 2005. Some states report parental substance abuse as a factor in over 60% of all child placement cases.

In summary, the opioid epidemic affects people in all demographics and from all walks of life. It can happen to anyone. So how can you make a difference? Become familiar with the signs of opioid addiction. Symptoms can include:

  • The inability to control opioid use
  • Uncontrollable cravings
  • Drowsiness
  • Changes in sleeping habits
  • Weight loss
  • Frequent flu-like symptoms
  • Decreased libido
  • Like of hygiene
  • Changes in exercise habits
  • Isolation from family and friends
  • Stealing from family, friends or business
  • New financial difficulties

If someone in your family or someone you know demonstrates signs of addiction, encourage them to seek help. You can also become involved and support those organizations like the Florida United Methodist Children’s Home who care for children who have been abused, abandoned, or neglected.


Children and the Opioid Crisis. Marian Wright Edelman. Children’s Defense Fund.

Johns Hopkins Medicine.

Juggling Child Protection and the Opioid Epidemic: Lessons from Family Impact Seminars. Brittany Paige Mihalec-Adkins, et al. National Council on Family Relations.

National Institute on Drug Abuse.

The effects of parental opioid use on the parent-child relationship and children’s developmental and behavioral outcomes: a systematic review of published reports. Magdalena Romanowicz, et al. Child and Adolescent Psychiatry and Mental Health.