Opioid addiction is well recognized as a national crisis, but the impact on children and adolescents whose parents or close family members are addicted has received little sustained attention. This far-reaching report by United Hospital Fund is the first comprehensive look at the successive waves of loss and trauma experienced by newborns, young children, adolescents, and their families affected by opioid addiction. It also looks at the needs of kinship caregivers, typically grandparents, who often step in to care for these children.
Potential remedies are proposed, and the report describes innovative programs around the nation that address these issues. It draws on lessons learned from the HIV/AIDS and crack/cocaine epidemics, which, like the opioid crisis, were characterized by stigma and failures to provide needed services to children and families. And like those earlier crises, opioid addiction is leaving too many children in foster or kinship care, caring for younger siblings, and suffering from potentially long-term behavioral and physical health issues.
How is the Opioid Epidemic Affecting Families
Drug overdoses are a leading cause of unintentional death in the United States. The major force behind this epidemic is prescription and non-prescription opioid drugs. All ages and communities everywhere are affected by opioid addiction.
Treating and preventing opioid use disorder is a responsibility we all must share. Here's why it is important for families to have access to the care they need, including help with drug addiction.
Recent high-profile litigation and settlements among states and local governments with drug companies have highlighted the costs of the opioid epidemic on communities. The dollar amounts discussed in some of these cases have been huge. For example, Purdue Pharma and Mallinckrodt agreed to a national settlements of about $10 billion and $1.6 billion, respectively, and a judge in Oklahoma recently awarded a settlement of $465 million in a suit brought against Johnson & Johnson. While these figures are notable, the costs of the opioid epidemic are likely much higher when considering indirect harm to communities and not just the direct costs associated with abatement. The opioid epidemic is a widespread societal problem, and we are only starting to understand the far-reaching consequences that will be borne by individuals and communities.
In this report, we introduce one of the unexplored effects of the opioid crisis, the link between the opioid epidemic and the education outcomes of children in hard-hit areas. Children, of course, are not immune to the effects of what may happen in their homes and communities, and there is ample evidence that negative home or community factors can be associated with lost learning opportunities. One example is that children exposed to higher levels of neighborhood violence have worse education outcomes than children who are less exposed. In a similar vein, childhood exposure to the ravages of the opioid epidemic may result in worse education outcomes.
We are aware of no research directly linking the ravages of the opioid epidemic to the educational outcomes of children in affected areas. Generally, there are two channels through which adverse public health issues like the opioid crisis could ultimately affect education outcomes. The first is a direct linkage via opioid substance-use disorder at the individual level. While we expect the negative effects of direct use to be more prevalent among older youth and young adults (and thus more likely to impact outcomes at a secondary or tertiary education level), babies can be exposed neonatally and potentially suffer subsequent harm. The second channel is a less-direct linkage that could affect the education outcomes of younger children who live in families and/or communities that are struggling with the epidemic. At this point, our work is primarily focused on this second channel and on younger children as we discuss below.
The map, along with the scatterplot, indicate that there are substantial areas of the nation where test scores are low and drug-related deaths are high. We dig further into these relationships links by estimating the linkage between test scores and drug-related mortality while controlling for observed school district and county characteristics, including per-pupil expenditures, county demographics, poverty rates, and unemployment rates.3 While these estimates offer suggestive evidence that exposure to the opioid epidemic and its collateral consequences negatively impacts the learning of children, they do not establish the causal connection that could better inform policy initiatives. This is the first of several studies in which we explore this topic, and our further studies will get us closer to credible evidence of the causal link.
Next, we examine how the link between test scores and drug-related mortality differs among rural versus nonrural counties, with rural counties designated as those with greater than 75% of their population in a rural area. Building on the results displayed in panel (A), the estimates in panel (B) allow for the epidemic-test score relationship to differ between rural and nonrural counties. We see that, among both rural and nonrural counties, test scores are lower in counties with higher drug-related mortality. However, the estimated test scores for rural counties are always lower than those of nonrural counties in the same decile of mortality rates (though not always statistically different), even when accounting for local economic and educational conditions. Moreover, panel (B) indicates that the rural-nonrural gap appears to grow as mortality levels increase. These results offer suggestive evidence that the role of the opioid epidemic in affecting educational outcomes may be especially concerning in rural areas, consistent with our expectations about community vulnerability described above. The magnitude of that difference between locales is noteworthy: Rural counties in the highest decile (10th) of drug-related mortality have 3rd-grade test scores that are almost two-tenths of a standard deviation lower than rural counties in the lowest decile (1st). This is about twice as large as the analogous comparison among nonrural counties.
It is likely that students in a community are affected differentially by the opioid epidemic. To investigate this, we next consider in Figure 5 how opioids relate to achievement gaps between students who are and are not considered economically disadvantaged (ECD).5 If ECD students have fewer familial resources to insure their children against exposure to the opioid epidemic, as suggested in our conceptual framework, we may see nonECD-ECD gaps widen as exposure to the epidemic increases. Similar to Figure 4, we set the coefficient for the first decile (i.e., the counties with mortality rates in the lowest 10%) to be equal to zero, such that each marker represents, at that decile in mortality rate, the gap in scores between less and more economically disadvantaged students relative to that gap in the first decile of mortality.
It is beyond the scope of this report to recommend specific support mechanisms in how states, school districts, and schools should respond to the problem at hand, and we are cautious to avoid strong recommendations since there is limited evidence on the efficacy of current attempted solutions. We view this report instead as a first step in raising awareness of the potential collateral damage of the opioid epidemic. Nonetheless, we can generally consider opioid-related factors that might affect the academic performance of children to highlight possible points of intervention.
The national opioid crisis affects every aspect of service providers including child welfare, courts, treatment providers, public health, and medical providers. In response, the U.S. Department of Health and Human Services is focusing its efforts on treatment, spreading awareness of the epidemic, providing support through research, and advancing better practices for pain management. The opioid crisis has facilitated collaborative responsiveness by diverse sectors that is yielding promising results in communities across the country.
The study examines the effects of the opioid epidemic and how substance use disorder treatment programs and child welfare agencies have increased caseloads and a need for increased collaboration with community partners.
In October 2017, President Donald J. Trump declared the opioid crisis a national public health emergency. The U.S. Department of Education (the Department) is joining other Federal agencies in combating the opioid crisis that is killing Americans at unprecedented rates and plaguing families and communities. While the causes of opioid misuse are complex and determined by multiple factors, the goals of prevention and recovery focus on reducing risk and promoting factors that increase resiliency. Schools play an important role in reaching these goals.
The Department is taking a two pronged approach to addressing the opioid crisis: 1) Helping to educate students, families and educators about the dangers of opioid misuse and about ways to prevent and overcome opioid addiction and; 2) Supporting State and local education agency efforts to prevent and reduce opioid misuse.
For the last two decades people across our nation have helplessly watched this rapidly escalating epidemic destroy families and entire communities. Most of us know some person or family in our community suffering from the impact of substance abuse disorder. Over 2.5 million Americans were addicted to opioid pain relievers or heroin in 2015. The Centers for Disease Control and Prevention (CDC) reports opioid-related deaths have more than quadrupled since 1999. Prescription and illicit opioids combined have killed more than 300,000 Americans since 2000. Ninety-one Americans die every day from an opioid overdose. This catastrophe of opioid addiction and deaths has fueled a heartbreaking increase of children in crisis. 2ff7e9595c
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