Parental Opioid Misuse's Impact on Child Behavioral and Substance Use Outcomes

Background and Purpose

Since 2000, there has been a dramatic increase in the misuse of opioids. The rate of drug overdoses related to opioids has quadrupled since 1999 and, in 2014, drug overdose became the leading cause of accidental death in the United States.

After a more than a decade of reductions in the number of children served in out-of-home care, child welfare agencies saw this trend reverse in 2013, where a low of 397,000 children in 2009 had increased to 428,000 by 2015. Anecdotal evidence from child welfare administrators suggest that opioid misuse has had a major impact on the number of children entering care and a rise in termination of parental rights cases.

Infants who test positive for opioids at birth are routinely referred to child protective services, and their outcomes are well documented (e.g., low birth weight, cognitive deficits). Less is known about how parental opioids misuse impacts older children.

This study is a systematic review of the literature on the behavioral and substance use outcomes for children who live at home with at least one parent who misuses opioids.

Methods

The research articles selected for this review were chosen through a keyword search of four social science databases. The literature search was limited to English language publications conducted in the United States from 2000-2017. Keyword searches were conducted in each database with the following Boolean combinations:

• (opiates OR opioids OR heroin OR methadone) AND children
• (opiates OR opioids OR heroin OR methadone) AND parents

From results, abstracts, keywords, and reference lists were used to identify a set of articles that met the following inclusion criteria: 1.) the dependent variable(s) in the study had to be child-related behavioral or substance use outcomes; 2.) parental substance use had to be measured as a single opioid not in combination with other substances (i.e., illicit substances, narcotics); 3.) the sample had to include children living for 50% or more of the time with at least one parent who had an opioid use disorder. These inclusion criteria resulted in a set of 12 articles from 4 research studies.

Results

The literature reviewed reveal that youth residing in homes with parental opioid misuse are at risk of exhibiting elevated levels of externalizing (i.e., aggression, delinquency, or hyperactivity) and internalizing (i.e. inward distress, anxiety, depression) behaviors; risky sexual practices; impaired social functioning; and substance misuse. Poor outcomes were especially pronounced when opioids were misused in combination with parental mental illness.

Conclusions and Implications

Findings support a need for enhanced screening and risk assessment to identify this population of children when they present to child welfare agencies for services. Agencies will increasingly be called upon to develop best practice approaches for children living with opioid dependent parents. For older children who come to the attention of child welfare agencies through a variety of sources and systems, coordinating across different systems of care gives special urgency to assessment tools that have common items to best match children with services.