Does the Color of Addiction Matter? Implications of the Opioid Crisis in Child Welfare

Background: Despite opioid use disorder (OUD) reaching epidemic proportions in the United States, little is known about the prevalence of OUD among parents involved with the child welfare (CW) system. Harnessing the potential of linked administrative data from the Regional Partnership Grant (RPG-1), a program targeted towards CW-involved families impacted by substance use disorders (SUD), this study examines the prevalence of OUD among CW-involved parents, particularly among parents of color.

Methods: This is a secondary analysis of data collected between 2007-2012 from 53 sites in 29 states that participated in the RPG-1. This longitudinal dataset captures information on 8,770 CW-involved parents admitted into SUD treatment (including date on SUD problems at time of admission) and represents the largest dataset of CW-involved families affected by SUD in the U.S.. Within this sample, 69% of the parents were White and 31% were parents of color (12.4% African Americans, 8.5% Latinx, 6.1% American Indian or Alaska Native [AIAN], and 4.1% multiracial/other). Most parents were women (79.1%) and the mean age was 30.24 years old (sd = 7.35). Chi-square tests of independence tested whether the prevalence of parental OUD changed over time (annually) and explored whether changes in OUD prevalence were different for parents of color from that of White parents.

Results: The percentage of all parents admitted into treatment due to OUD increased annually between 2007 and 2012 (13.6% in 2008, 22.5% in 2009, 24.2% in 2010, 26.6% in 2011, and 28.8% in 2012; p < 0.001). When stratified by ethnicity, the percentage of White parents with OUD increased annually (p < 0.001), and more than doubled between 2007 and 2012 (16.8% to 39.3%). However, annual prevalence of OUD did not increase for parents of color overall and changes in OUD prevalence for specific ethnic groups yielded mixed results. For example, the prevalence of OUD trended towards annual decreases for Black parents (p = 0.062), increased annually for AIAN parents (p = 0.003), and fluctuated between significant annual increases and decreases for Latinx parents (p = 0.019).

Discussion: Study findings reveal a steady increase in the prevalence of OUD among CW-involved parents, indicating a clear need to explore and address OUD-related service needs for this population. Overall, the prevalence of OUD-related treatment admissions more than doubled during the study’s timeframe. However, when stratified by ethnicity, annual increases in OUD prevalence mainly held for White and AIAN parents, trended towards a decrease for Black parents, and fluctuated for Latinx parents. These findings give pause to the call for increased funding and services to address the opioid epidemic within the CW sector. While additional resources are indeed warranted to support OUD treatment for CW-involved parents, policy makers and service providers need to ensure that resources are not diverted from treatment programs and services that address other SUDs (e.g. methamphetamine and cocaine). Prioritizing OUD treatment needs above other SUDs could disproportionately and negatively impact services for CW-involved parents of color. Additional practice and policy implications will be discussed.