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Abstract
This dissertation examines the needs of children growing up in families where a parent or caregiver is struggling with opioid-related problems. Because of their parents’ illness, these children may be at increased risk for exposure to adverse or traumatic experiences. Indeed, a growing number of children are coming into contact with America’s child welfare systems because of parents’ opioid-related problems. These adverse childhood experiences may then increase children’s risk for adult substance use disorder, creating a two-generational health problem. However, there are few research studies and even fewer policy initiatives focused on meeting the unique needs of these families.
This dissertation seeks to expand knowledge about children in the opioid epidemic with three aims:
1. Identify the number of families where an adult with an opioid use disorder lives with a child, and explore these adults’ access to treatment (Chapter 2).
2. Assess how childhood trauma influences the risk of heroin use at different ages in adults who have injected drugs (Chapters 3 & 4).
3. Test if Florida’s opioid prescribing reforms – designed to prevent overdose deaths – also helped reduce children’s contact with the child welfare system (Chapters 5 & 6).
I address these aims using a combination of public surveys on drug use, administrative records on contact with the child welfare system, and primary data collection from adults who injected drugs in Baltimore. I show that:
1. Around 820,00 U.S. adults with an opioid use disorder live with at least one child, but fewer than a third report receiving any substance use treatment in the past year.
2. Among adults who have injected drugs, a history of very high levels of childhood adversity is associated with elevated risk for sustained heroin use into late adulthood.
3. Florida’s opioid prescribing reforms reduced drug overdose deaths, but did not have the added benefit of reducing children’s contact with the child welfare system.
Findings suggest that existing strategies to address the opioid epidemic are not adequately meeting the unique needs of children, and specific, evidence-informed policies and programs are needed to address the unique needs of families struggling with opioid-related problems.
