The Opioid Crisis and the Child Welfare System: Launching a Response in the Face of a Landslide

The Rise of Opioid Use in the United States


Since the turn of the millennium, the number of overdose deaths in the United States attributed to opioid addiction have more than quintupled.   Individuals across the country facing opioid addiction struggle with access to safe treatment, support systems, and post-treatment care to successfully transition into sober living.  As the opioid epidemic surges, child welfare agencies face the overwhelming challenge of coping with some of its most vulnerable victims: children impacted by opioid use.



Child Welfare Agencies Across the Nation Struggle in the Face of the Opioid Epidemic

As the number of individuals struggling with addiction across the nation rises, so increases the demand on public foster care systems whose purpose is to provide temporary safe haven to children whose families cannot safely care for them.  When a parent is charged with a drug-related offence and incarcerated or ordered to enter a treatment program, children are often placed with a foster family during this time.

Foster care systems in states like Indiana are seeing a surge in the number of opioid related case entries over the past few years.   “We’ve gone from having 2,500 children in care, three years ago, to having 5,500 kids in care. It has just exploded our systems,” says Indiana juvenile court judge Marilyn Moore, who oversees cases in Indianapolis.  In Florida, the number of children living in foster care has tripled due to opioid related deaths.  In Philadelphia, systems are responding to the crisis by allowing foster care providers to apply for waivers that allow them to care for more than the state-mandated number of children per-home.  From 2014 to 2016, capacity waivers went up nearly 50%. More foster kids mean more stress on those foster families.

The Opioid Crisis is Disproportionately Impacting Women

As the scientific community continues to gather and analyze data related to opioid use across the United States, another fact is becoming clear: the use of opioid drugs is disproportionately impacting women.  Overdose deaths attributed to prescription pain relievers among women increased more than 400% from 1999 to 2010, compared to 237% among men.  Heroin overdose deaths among women have tripled in the last few years. From 2010 through 2013, female heroin overdoses increased from 0.4 to 1.2 per 100,000.

The number of opioid-related deaths among women is growing at an alarming rate.

So why is this data concerning for child welfare agencies? As the number of women struggling with opioid substance use rises, the number of infants born with prenatal exposure is also increasing.  Between 2000 to 2009, prenatal opioid exposure increased from 1.19 to 5.63 per 1,000 hospital births.  A few of the major barriers limiting access to prenatal substance abuse counseling and care include stigma surrounding substance use and pregnancy, risk of punishment related to prenatal substance abuse, and a lack of access to comprehensive, specialized treatment programs designed to care for pregnant women struggling with substance abuse disorders.

How Can We Effectively Handle the Burdens of this Epidemic?

  1. Remember that addiction is a disease. Individuals struggling with substance abuse challenges can be effectively treated by mental health professionals and deserve compassion and respect from their communities. Remaining focused on treatment and recovery is an ethical imperative for child welfare professionals and part of laying the foundation for community healing.
  2. As child welfare agencies struggle to respond to the burdens of the opioid epidemic, systems must dedicate resources to recovery-based programs with the goal of healing, not punishment. The more families fractured by addiction, the more challenging the work for systems designed to create healthy futures for children. By investing in the health of parents, we invest in the health of future generations.
  3. The disproportionate ways in which opioid abuse effects women across the United States directly impacts infants and children in our communities. Removing stigmas associated with prenatal substance abuse treatment, offering options for pregnant women to enter treatment programs without the risk of punishment, and expanding access to comprehensive substance abuse treatment programs that specialize in prenatal and postnatal exposure is a first step in removing barriers to keeping families together in the face of substance abuse challenges.
  4. In particular, child placement agencies must face the opioid crisis using a multi-pronged approach. First, by building and maintaining a network of community partners to act as a strong referral sources for clients who are struggling with substance abuse disorders, placement agencies can ensure that clients have access to treatment when they are ready.  Next, by communicating to your community that your placement plans include a strong referral network to treatment programs, your agency can help to ensure women and families struggling with substance abuse are able to access treatment. Additionally, by educating your teams to remain judgement-free in the face of challenging substance abuse issues across the country, we can signal that our doors are open to women and families who need our assistance during some of their most difficult times.  Finally, educating potential adoptive and resource families about the realities of parenting infants and children born with prenatal exposure ensures that we are continuing to build a qualified, loving pool of families for infants and children impacted by the opioid crisis.

If you or a client you work with is currently pregnant and struggling with opioid addiction and would like to discuss this with one of our counselors, please contact us confidentially:

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