Reframing the Opioid Epidemic: Lawmakers Must Put Children First

Rricha-MathurIn recent months, much attention has been drawn to the substance abuse and opioid crisis in the United States, and rightfully so. The U.S. consumes more opioids — both pharmaceutical and from illegal substances such as heroin — than any other country.

In Congress, the Senate recently held a hearing to discuss policy to address the epidemic, Examining the Opioid Epidemic: Challenges and Opportunities, and recently passed the Comprehensive Addiction and Recovery Act (CARA). Among other provisions included in CARA, the bill would help young people with addiction gain access to treatment and create a pilot program to improve treatment for pregnant and postpartum women.

What’s not included in CARA is a meaningful way to ensure the safety of children living in households where substance abuse is present.

Parental substance and opioid abuse have long been identified as factors that lead to children entering the child welfare system. In 2012, 30.5 percent of child removals — more than one in four — were due to parental use of alcohol or other drugs. Sixty-six percent of children in foster care have lived with someone with an alcohol or drug problem.

According to a recent Reuters story, newborns who are prenatally exposed to opioids also face significant developmental and safety risks. Many are born with inherited dependencies to the drugs their mother is taking. The National Institute on Drug Abuse estimates that 21,372 babies were born with neonatal abstinence syndrome in 2012, five times the number born with the condition in 2000. Many other babies are separated from their parents at birth and placed in the child welfare system, while others suffer abuse and neglect when they’re sent home with parents with substance abuse problems.

Some states have recognized the prevalence of substance abuse in their communities and are intervening to address the crisis. Massachusetts, Rhode Island, Indiana, Maryland, Michigan, North Carolina, Virginia and West Virginia have commissioned experts to substance abuse task forces to offer policy and treatment recommendations to their respective governors and attorney generals.

Other state lawmakers have recently introduced and passed legislation to curb the use of opioids. Among these reforms, the most common include establishing electronic prescription drug monitoring programs to ensure that patients are not dispensed more medications than necessary; increasing access to naloxone, which counters the effects of opioid overdose; and increasing resources and funding for substance abuse treatment and services.

We applaud lawmakers’ urgency in addressing this national crisis. However, many of these initiatives fail to draw the connections between the substance and opioid abuse epidemic and the way it’s affecting children.

CARA does recognize that youth are disproportionately affected by the opioid crisis, but does not prioritize programs or funding to ensure that children of substance abusers are protected from abuse and neglect. And CARA could go much further to provide more resources beyond a pilot program for pregnant and postpartum women whose children are prenatally exposed to dangerous substances. According to the Centers for Disease Control and Prevention, this is an epidemic, after all, and should be treated as such.

Other legislation before Congress, such as the bipartisan Family First Act proposal being introduced by Sens. Orrin Hatch, R-Utah, and Ron Wyden, D-Oregon, does recognize that states need federal funding to meaningfully intervene with parents who have substance abuse problems, before their children face serious threats to their welfare.

The senators recognize that treatment strategies should be focused on preventing children from entering the child welfare system by adequately treating their parents. The Family First Act would allow states to use Title IV-E, or Foster Care and Adoption Assistance funding, for substance abuse treatment programs focused on preventing the removal of their children from their home. This bipartisan approach to treatment would support and strengthen families who have addiction issues and protect innocent children from removal.

Even yet, much more can be done to address the epidemic and protect children. Other common-sense federal policy initiatives should include:

  • Incentives for cross-agency collaboration to address all aspects of substance abuse;
  • Increasing allocations to states and enforcing Child Abuse Prevention and Treatment Act provisions to report prenatal babies exposed to opioids to child welfare agencies;
  • Uniform practices for states in detecting and recording substance abuse as an element of child maltreatment;
  • Prioritizing treatment for child welfare-involved families; and
  • Strengthening family drug court programs to ensure courts are working with families holistically to ensure the safety and best interest of children.

While state and federal lawmakers continue to debate how to meaningfully impact this national epidemic, it’s critical that children and youth are not an afterthought when developing policies to reduce abuse. Children suffer long-term and irreversible consequences from their family members’ addiction. We ask that lawmakers put children first.

Rricha Mathur is the senior policy advisor on child welfare and child rights for First Focus and the assistant director of the organization’s State Policy Advocacy and Reform Center.


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