“Health statistics represent people with the tears wiped off.”
This mid-20t century statement, attributed to Sir Austin Bradford Hill, aptly describes the current opioid epidemic in the United States. From 1999-2017, almost 400,000 people died from overdoses involving an opioid, including prescription drugs, heroin, or synthetic drugs like fentanyl, according to the Centers for Disease Control and Prevention (CDC). The risk of dying from an opioid overdose today is higher than dying in an automobile accident.
But those statistics do not track the millions of children whose parents overdose, are unwilling or unable to get treatment, or simply can’t function as good parents. These children’s tears are largely hidden from public and professional view, yet the traumas they experience can be devastating. Even if the opioid epidemic ended today, the impact will last for decades in an ever-widening ripple effect.
Consider, for example, a nine-year-old who calls 911 because his mother is lying unresponsive on the floor. The EMTs will revive the mother, but who will console the child and ensure this experience doesn’t cause irreparable harm? Or consider the teenager who quietly takes over the care of younger siblings because her parents can’t get out of bed in the morning. Her schoolwork is suffering, and she is depressed. What supports are available for this young caregiver?
Grandparents are often the first line of defense — but they may have financial, health, and other problems that affect their ability to care for traumatized children. The special needs of pregnant women who give birth to babies with neonatal abstinence syndrome — a treatable but challenging neurological condition related to the mother’s drug use — are now high on maternal and pediatric agendas. Less attention is paid to the hidden but greater numbers of children and families living in a home with a person with substance use disorder.
State and federal officials are primarily focused on saving lives and stopping the flow of illegal drugs, both important and urgent goals. But we know from past epidemics that this is not enough. We need our communities and elected officials to embrace the equally important goal of stabilizing families affected by substance use.
There is a lot we can do — evidence-based programs that improve outcomes for families dealing with substance use disorder already exist, while emerging models provide holistic care for a family’s addiction, mental health, and physical health needs.
Action is needed in four specific areas. First, we must combat the pervasive stigma, misunderstanding, and fear about substance use. Stigma prevents parents from accessing treatment and shames children from reaching out for help when they are in a tough family situation; it also perpetuates a belief that children must be removed from home when, in many cases, this can be prevented.
Second, the ripple effect must become a public and political priority. For too long, society has underinvested in family-centered treatment programs that support child development. We need an infusion of resources.
Third, we must improve communication, coordination, and collaboration among government agencies, health-care providers, and community service organizations. It shouldn’t matter which door a parent enters to seek help; every door should lead to family-centered care.
Finally, we need to find compassionate and meaningful ways to identify children at risk and provide them and their families with ongoing support.
If this sounds too ambitious, here’s one innovative program that gives us hope. Handle with Care is a collaboration between law enforcement and school systems in West Virginia, one of the hardest-hit states. When police officers come to the scene of an overdose or arrest and see a child present, they find out the child’s name and school. The school administrators, who have been trained on how to respond, get a note with the child’s name and the indication “Handle with Care.” While no details are provided, the note lets teachers know to be especially mindful of the child’s behavior and needs and to enlist outside counselors if necessary.
We cannot eliminate the ripples caused by the opioid epidemic, but we can make these waters less dangerous to navigate.
Carol Levine and Suzanne Brundage are directors at United Hospital Fund and co-authors of "The Ripple Effect: The Impact of the Opioid Epidemic on Children and Families," published by United Hospital Fund