The Effects of Medication for Opioid Use Disorder on Subsequent Child Maltreatment and Placement in Out-of-Home Care

Background: Medication for opioid use disorder (MOUD) is the standard of care and is recommended by the World Health Organization, the American Society of Addiction Medicine, and the National Institute on Drug Abuse. In spite of the evidence supporting MOUD, only 10%-20% of the individuals in need of MOUD receive it. There are few studies of MOUD in the context of child welfare though preliminary research suggests it is associated with favorable child welfare outcomes. The aim of this study was to determine the effects of MOUD on subsequent child maltreatment and out-of-home care (OOHC).

Methods: The sample consisted of 1,327 adult opioid users from 967 families in one Midwestern state. Families were receiving services through the Sobriety Treatment and Recovery Teams (START) program, an intervention focused on families with co-occurring substance use and child maltreatment. The independent variable was months of MOUD (buprenorphine, methadone, or naltrexone; 0 – 12) within 12 months of the index event, and the dependent variables were subsequent child maltreatment (0 = no, 1 = yes) and placement in OOHC (0 = no, 1 = yes) within 12 months of the index event. Control variables included adult age and race, county, and total number of non-opioid substances used (0 – 6). First, simple logistic regression was used to assess the relationship between the independent and dependent variables. Second, months of MOUD, along with control variables, were entered into multiple logistic regression models to identify correlates of OOHC and subsequent child maltreatment.

Results: Of 1,327 adult opioid users, 242 (18.2%) received at least 1 day of MOUD, and the mean months of MOUD was 6.7 (SD = 4.0). At the family level, of the 967 families with opioid use, 194 families (20.0%) had at least one adult who received some MOUD. There was no relationship between MOUD and subsequent maltreatment within 12 months in the simple logistic regression (Odds Ratio [OR] = .955; 95% Confidence Interval [CI] .876-1.042). With regard to placement in OOHC, each month of MOUD was associated with an 8% reduction in the odds of placement within 12 months (OR = .92; 95% CI .851-.994). In the multiple logistic regression model including the control variables, months of MOUD was not associated with subsequent maltreatment (OR = .966; 95% CI .886-1.054). In the multiple logistic model for placement in OOHC, each month of MOUD (OR = .928; 95% CI .858-1.003) was associated with a 7% reduction in odds of OOHC, though the 95%CI suggested a range from 14% reduction to 0.3% increase in risk per month.

Conclusion: To our knowledge, this study is the first suggesting that duration of MOUD is associated with reduced odds of OOHC in the first year of child welfare cases. Given the negative sequelae associated with family separation, this represents an important finding for families with opioid use who are receiving child welfare services. This study did not find a relationship between months of MOUD and subsequent child maltreatment, though this outcome was relatively uncommon (8.4%) in the study.