Supporting Children and Families Affected by the Opioid Epidemic

Executive Summary

The opioid epidemic is one of the largest public health crises in a generation, and it
takes place against a backdrop of deep and growing structural inequality in the nation’s
social, economic, and political landscapes. To date, most of the response to the opioid
epidemic has focused on people directly affected by problem drug use and addiction.
Yet, about 8.7 million children ages 17 and younger live in households with at least one
parent with a substance use disorder, and an estimated 623,000 parents with opioid use
disorder live with children.

A comprehensive approach to fighting the opioid epidemic must account for the unique needs of
children and families, acknowledge the family caregiving roles and responsibilities of people who use
drugs, and provide effective care and supports long before addiction emerges.

Drawing on interviews with national experts in the field and site visits to two Appalachian
communities significantly affected by the epidemic, we sought to identify how the opioid epidemic is
affecting children in families touched by problem drug use, how parents or caregivers could be better
supported, and how service providers and systems could be better positioned to support families
affected by the crisis. It is important to note, however, that the communities we visited do not
represent the wide range of communities and local contexts relevant to this nationwide epidemic.

We also explore how systems and settings that support children and families are responding to
the opioid crisis. These systems include early care and education, K–12 schools, primary and other
health care settings for both children and parents, and, for parents, employment and training settings.
We also investigate if and how safety net policies or practices have come into play.

Our conversations revealed wide-ranging unmet community needs and service system limitations,
often tied to historical policy failures and/or regional economic challenges. People grappling with
substance use disorders face limited access to treatment, as do their families, and child welfare
systems are not equipped to meet the complex needs of children and families touched by the
epidemic. And though schools and early childhood care programs can be a critical resource for
families, these settings are universally overstretched and underfunded. And stigma, bias, and
misinformation continue to impair efforts to address the epidemic.

But examples of promising programs and approaches also emerged. The following strategies can
help protect communities and serve vulnerable children and families in the wake of this fast-moving
and devastating epidemic:
◼ addressing long-standing system challenges and misalignments
◼ investing in community-based services and infrastructure
◼ pursuing trauma-informed care
◼ family proofing public policies while making them more adaptive and agile
◼ ensuring policies in mainstream settings reflect best practices and research-based evidence
This initial look at the opioid epidemic and its implications for child and family policy points to
both extensive needs and opportunities within the nation’s health and social care systems and the
private sector. But to thoughtfully address the opioid epidemic’s ongoing effects on children and
families, more research is needed on ways to align systems that interact with one another when
families are affected by crises.

Source: Urban Institute Health Policy Center (2020) Supporting Children and Families Affected by the Opioid Epidemic.