Effects of Opioid Treatment Programs on Child Well-Being

• Author: Lindsey Rose Bullinger,Vivian Wang,Kenneth A. Feder
• DOI: http://doi.org/10.1177/00027162221142644
• Published date: 01 September 2022
• Date: 01 September 2022

ANNALS, AAPSS, 703, September 2022 79

DOI: 10.1177/00027162221142644

Effects of

Opioid

Treatment

Programs on

Child Well-

Being

By

LINDSEY ROSE

BULLINGER,

VIVIAN WANG,

and

KENNETH A. FEDER

1142644ANN The Annals of the American AcademyOpioid Treatment Programs and Child Well-Being

research-article2022

Children exposed to parental opioid use disorder are at

an elevated risk of maltreatment. We study whether

parents’ access to medication-assisted opioid treatment

programs (OTPs) affects the well-being of their chil-

dren. An administrative decision to lift a moratorium on

access to these programs in Indiana created the oppor-

tunity for this study. We show that after a county

opened an OTP, methadone dispensing increased and

emergency department visits related to opioid overdose

decreased there, offering evidence of the success of

these programs. We also show that the opening of these

OTPs did not have significant effects on reports of child

maltreatment, but that out-of-home foster care place-

ments were reduced by 22 percent. Our findings are

consistent with past research showing that child welfare

cases involving parental substance use tend to be com-

plex and tend to have longer times to parent/child

reunification than child welfare cases in which sub-

stance use is not present. We argue that expanding

access to opioid treatment programs may help reduce

foster care placements.

Keywords: child maltreatment; foster care; parental

opioid use disorder; medication-assisted

treatment; opioid treatment programs

Introduction

The U.S. is experiencing a decades-long epi-

demic of overdose deaths primarily caused by

opioid drugs. Since 1999, the rate of overdose

deaths involving opioids—including prescription

pain relievers, heroin, and synthetic opioids—

has nearly quadrupled (Huang, Keyes, and Li

Lindsey Rose Bullinger (lrbullin@gatech.edu) is an

assistant professor in the School of Public Policy at

Georgia Tech.

Vivian Wang (wang.vivian@medstudent.pitt.edu) is a

medical student at the University of Pittsburgh School

of Medicine.

Kenneth A. Feder (kfeder1@jh.edu) is an assistant

scientist in the Bloomberg School of Public Health at

Johns Hopkins University.

Correspondence: lrbullin@gatech.edu

80 THE ANNALS OF THE AMERICAN ACADEMY

2017; Hedegaard, Miniño, and Warner 2020). The increase in opioid overdoses

and opioid use disorder (OUD) has been driven primarily by legally prescribed

opioid pain relievers, heroin use, and illicitly manufactured fentanyl, which,

together, doubled the overall overdose rate in the U.S. from already high levels

(Paulozzi and Xi 2008; Rudd etal. 2016).

Beyond the direct harms to the user caused by opioid misuse like functional

impairment, overdose, and death, there is evidence that the opioid epidemic

has resulted in secondary harms to children who do not, themselves, use opi-

oids. For example, the rate of neonatal abstinence syndrome (NAS)—children

born with opioid withdrawal symptoms due to opioid use during pregnancy—

has increased over the past decade (Brown et al. 2016; Patrick et al. 2012).

Most of these children, approximately 60 percent, will likely become involved

in the child welfare system by their first birthdays (Prindle, Hammond, and

Putnam-Hornstein 2018). The number of children living with an adult with an

opioid or heroin use disorder has also increased (Bullinger and Wing 2019), and

fewer than one-third of these adults received substance use treatment (Feder

etal. 2018). Moreover, parents with OUD are more likely to engage in coercive

parenting and high-risk behavior for child abuse perpetration (Barnard and

McKeganey 2004; Dawe and Harnett 2007); deprive children of material

resources; and be separated from their children due to treatment, incarcera-

tion, or entry into foster care (Barnard and McKeganey 2004; Kolar etal. 1994;

McKeganey, Barnard, and McIntosh 2002; Sanmartin et al. 2020). Indeed,

more children are also living in grandparent-headed households (Buckles,

Evans, and Lieber 2020) and entering the foster care system (Meinhofer and

Angleró-Díaz 2019) because of the crisis.1

In this article, we study whether expanding access to publicly funded metha-

done treatment facilities affects child maltreatment and foster care placements.

We use hand-collected opening dates of opioid-treatment programs (OTPs) in

Indiana, combined with county-level maltreatment reports and foster care

records. We find that after a county opened an opioid treatment program, the

rate of children in out-of-home foster care declined within the county. These

results imply there are positive downstream effects of these programs on child

and family well-being.

Despite the likely impact of the opioid epidemic on child well-being, few stud-

ies have examined the effects of how policies designed to mitigate the harms of

the opioid epidemic have impacted child outcomes. Previous research shows no

consistent effect of various policies intended to alleviate the consequences of the

opioid crisis such as mandatory prescription drug monitoring programs (PDMPs),

Good Samaritan laws, pain clinic regulations, and naloxone laws on foster care

entrance (Gihleb, Giuntella, and Zhang 2018; Bullinger and Ward 2021). For

example, while naloxone access laws are associated with decreases in foster care

NOTE: The authors thank Kate Benson for careful research assistance and Kelley Fong,

Mattie Mackenzie-Liu, Analisa Packham, Alexa Prettyman, Barton Willage, and participants

at the 2021 Southern Economic Association Annual Conference and the 2021 Association for

Public Policy Analysis & Management Fall Research Conference for helpful comments.