Building on a March report that broadly described the opioid epidemic's impact on children, United Hospital Fund this week put some numbers behind the discussion of the devastating effects of the crisis.
The Ripple Effect: National and State Estimates of the U.S. Opioid Epidemic's Impact on Children states that the opioid problem placed an estimated 2.2 million children and adolescents in crisis in 2017, mainly due to a parent's opioid use disorder. The new report also suggests, based on conservative estimates, that the number of children affected by opioid use could rise to 4.3 million by 2030 if current trends persist.
Report co-author Suzanne Brundage, who directs United Hospital Fund's Children's Health Initiative, tells Addiction Professional that it was important following the report released in March to quantify the impact the opioid crisis is having on young people. “We had a lot of anecdotes, but not a lot of firm data,” Brundage says. “That was a barrier to communicating to policy-makers, practitioners and the general public to care about the issue.”
The report offers state-by-state breakdowns of the impact of the crisis, reflecting the realization that much of the response to the epidemic is driven at the state and local level. The data should capture the attention of many states, with some smaller states having high rates of affected children while some larger states with low rates nonetheless have high raw numbers of affected youths.
“A lot of the coverage of this crisis can lean toward sensationalism,” Brundage says. “We wanted to be realistic about the size of the problem, without overdramatizing.”
The report, produced in conjunction with Boston Consulting Group, includes estimates of how many children per 1,000 in each state have been affected by the opioid epidemic. The five states with the highest rate per thousand are West Virginia, New Hampshire, Vermont, Kentucky and Delaware. The five lowest rates are in California, Illinois, Nebraska, Texas and Georgia, but because of size of state the numbers in a state such as California are still striking.
“California could look at this and say it is not as big a problem there, but its raw number is the highest,” Brundage says.
She points out that to arrive at the projected impact for 2030, those involved with the study took a balanced approach that did account for the slight improvements in the numbers around the crisis over the past year or so. Nonetheless, the report estimates that based on current projections, the cumulative lifetime cost of the epidemic's impact on children could reach $400 billion in 2030, a figure that includes additional spending in health care, special education, child welfare and criminal justice.
The report offers reason for hope that policymakers can minimize the epidemic's effects on children, citing in part the availability of opioid-focused federal funding through the SUPPORT Act and other national initiatives. The report includes 10 recommendations for priority strategies, including:
Reducing stigma surrounding opioid use and its treatment;
Encouraging a “no wrong door” approach for families dealing with a substance use disorder, through coordinated response from health care, law enforcement, child welfare and education agencies;
Encouraging schools to practice trauma-informed care;
Researching the needs of youths who are thrust into the role of family caregivers because of an adult's substance use, and developing support efforts; and
Increasing the availability of family-based mental health services.
The report's authors suggest that the strategies also are applicable to combating problems related to other drugs of abuse. Brundage says the report focused on the opioid crisis because of its major impact and the presence of significant public resources specifically devoted to combating it.
She sees the issue of strategic planning as encompassing two necessary actions. First, “We need to get parents and expectant parents connected to treatment, and medication-assisted treatment,” she says. “You can't help children without helping their parents.”
Second, “There is a lot we have learned about how to protect kids from adverse childhood experiences,” Brundage says. Creating opportunities for nurturing relationships with other adults, through efforts such as home visit and mentoring programs, will be essential, she says.