Effects of Opioid Treatment Programs on Child Well-Being

AuthorLindsey Rose Bullinger,Vivian Wang,Kenneth A. Feder
DOIhttp://doi.org/10.1177/00027162221142644
Published date01 September 2022
Date01 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
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
Correction (April 2023): Article updated online to cor-
rect the citation Monnat, 2023 in the text and references.
80 THE ANNALS OF THE AMERICAN ACADEMY
pain relievers, heroin, and synthetic opioids—has nearly quadrupled (Huang,
Keyes, and Li 2017; Hedegaard, Miniño, and Warner 2020). The increase in opi-
oid 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.

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