President Trump’s announcement yesterday reminded us all that the opioid crisis is a public health emergency, but in fact it is also a national emergency and we must do so much more.
Daily we read articles and see searing reports about the opioid crisis. We’ve learned about the role of some doctors and drug companies in exacerbating it. We heard recently about how Congress was complicit in making it harder for the Drug Enforcement Administration to stop drug companies that were shipping suspicious amounts of opioids. We read about parents whose young adult sons and daughters end up in prison and who are desperate for treatment for loved ones. We keep learning more about the variety of opioids including heroin and extremely potent synthetic opioids like fentanyl coming from China. We read about the toll the continuing crisis and all the deaths are taking on first responders, police, treatment staff, nurses and doctors, families and grandparents being asked to step in to help. But we don’t read enough about its toll on children.
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.
From the earliest days of pregnancy children whose parents abuse opioids are at high risk. In addition to prenatal drug exposure, parents distracted by drugs and without help may be unable to provide children necessary care to grow and thrive. Children and teens are also susceptible to accidental opioid exposure and misuse. Whether children are born suffering from drug exposure, their parents’ addiction struggle leads to toxic stress or involvement with the child welfare system, or they use or are accidentally exposed to drugs themselves, opioid addiction has a devastating impact. There is much renewed interest in the Adverse Childhood Experiences Study (ACEs) which tracks the impact of stressful and traumatic experiences on children’s later and adult development. Parental substance abuse is one of these ACEs as are emotional and physical abuse and separation from family which put children at risk of lifelong consequences.
Among women who struggle with opioid abuse, 86 percent of pregnancies are unintended, compared with 56 percent of all pregnancies. This means children are more likely to receive insufficient or delayed prenatal care and are at risk of low birthweight and poor mental and physical health.
Between 14 and 22 percent of women nationwide fill an opioid medication prescription during pregnancy. This puts thousands of infants at risk of neonatal abstinence syndrome (NAS), problems stemming from drug withdrawal symptoms which occur in about half of infants with prenatal opioid exposure. In 2012 the maternal opioid use rate in hospitalized births in rural counties was nearly 70 percent higher than that in urban counties.
By 2012, an infant was born with NAS on average every 25 minutes in the United States. Across 28 states, the NAS rate increased by almost 300 percent between 1999 and 2013. NAS-affected infants are at greater risk of premature birth, low birthweight, sleep and growth problems, tremors, and seizures.
NAS costs $93,400 per infant in hospital charges on average and the average hospital stay for an infant with NAS is 23 days. Medicaid covered about 80 percent of the estimated $1.5 billion tab for NAS-related hospital charges in 2012.
Opioid poisonings in toddlers and preschoolers 1 to 4 years old increased 205 percent between 1997 and 2012. Opioid poisonings increased 165 percent among all youths under 19 with younger children and older adolescents most at risk.
The teen death rate from drug overdoses that had been declining since 2007 reversed in 2015 when nationwide 772 teens 15-19 years old died. Rates were highest for opioid drugs, specifically heroin.
The opioid crisis marks the third wave of widespread drug abuse over several decades, following the crack cocaine epidemic and the methamphetamine crisis (which has seen a resurgence in some states with the opioid epidemic). All have severely impacted children and families. But veteran child welfare professionals say the opioid epidemic has had the worst impact on child welfare systems they have seen.
After years of decline, the number of children in foster care has been rising steadily since 2012. In 2015, 427,901 children were in foster care. Anecdotal evidence and expert opinion link this to the parallel rise in parental opioid addiction and overdose.
In 2014 over 40 percent of children in relative foster homes were there because of parental substance use. Relatives (often grandparents) also care for children outside formal foster care to avoid placement in “the system,” as they refer to it. Sharon McDaniel, President and CEO of A Second Chance, Inc. in Pennsylvania, told the Senate Special Committee on Aging earlier this year about the significant increases in children being cared for by relatives and shared the story of a 62-year-old grandmother with a successful career at Verizon who was suddenly asked to care for her five grandchildren due to her daughter-in-law’s opioid addition.
Unfortunately she ended up losing her job and had to rely on the Temporary Assistance to Needy Families (TANF) program and help from her faith community to raise her grandchildren in her one-bedroom apartment. A recent report by Generations United, In Loving Arms, describes the protective role of grandparents and other relatives raising children exposed to trauma. For each child raised by a relative 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 – an increase of nearly 50 percent since 2005. Some states report parental substance abuse as a factor in over 60 percent of child placement cases. Neglect, the finding in 75 percent of child abuse and neglect cases and the leading reason for foster care entry, is often a result of substance abuse. Because parental substance abuse is a voluntary collection item in our national data system and inconsistently recorded, child welfare professionals believe the true percentage of children removed from homes for substance abuse is higher than reported.
Children in households where parents struggle with substance abuse are more likely to experience long-term effects of neglect or abuse than other children. This early trauma exposure makes them more likely to suffer later mental health disorders including substance abuse and post-traumatic stress disorder. Some physicians report an increase in child and teen suicides they link to the opioid crisis.
Children can’t fix this crisis and desperately need adults to act to stem this epidemic. As the youngest victims wait they need physical, social, and emotional resources and supports to help them cope and move forward. The Washington Post asked the right question – “What kind of a childhood is that?” – in its title to a moving story about three siblings in West Virginia, two in their teens and a ten-year-old, who lost both parents to heroin overdoses.
More must be done now.
Steps were taken in the Protecting Our Infants Act of 2015 and the Comprehensive Addiction and Recovery Act of 2016, but significantly greater investments are needed. Medicaid is a lifeline for treatment opportunities for addiction and must be maintained. It is hypocritical to declare the opioid crisis a public health emergency while trying relentlessly to slash the major lifeline for that emergency’s victims. All continuing attempts to end Medicaid as we know it must be fought back. The Final Report of the Commission on Combating Drug Abuse and the Opioid Crisis is scheduled to be submitted to the President on November 1st. While its charge is enormous, it must address the tragic plight of children and the special needs of pregnant women, parents, young and school-age children, and teens. Community-based prevention and treatment, including residential programs for parents and their children together, is essential. Criminal justice reforms also must recognize the special needs of parents and the importance and urgency of maintaining parent-child connections either at home or in kin or foster care settings. Too many children of parents struggling with opioids will start life with odds stacked against them. Their urgent needs must be met now.
Marian Wright Edelman is President of the Children’s Defense Fund