The Children of America’s Opioid Epidemic

​​ The last step necessary to complete the Boy Scouts of America program is an “Eagle Scout Project.” The sixteen to seventeen year-old boys volunteer their time and, with few resources, complete projects that are relatively tame. In the past people have built a small patio outside a church, sewn quilts for hospital patients, or collected and redistributed PPE via a local food bank. In 2018, Adam Stewart broke this mold by directing a short documentary on the American opioid epidemic titled One Decision (Stewart, 2018).

​​ The project is representative of an overlooked fact: American children have more reason than perhaps anyone else to feel personally invested in the subject of opioid abuse; their health and safety is directly impacted. Their lives have been more influenced by the opioid epidemic than perhaps any other current event. In 2019, 10.1 million Americans had misused opioids (U.S. Dept. of Health and Human Services, 2021). Roughly 82,000 people died, about 225 a day, from drug overdoses from August 2019 to August 2020. Most victims consumed synthetic opioids like fentanyl. 73% of the people who died from opioid use were aged 25-54—key parenting years (National Safety Council, 2021). The rate of death has increased much more for women than men since 1999 (The Economist, 2021).

​​ Opioids affect minors directly—roughly one in every ten deaths among adolescents is due to opioids—but the indirect impacts are of equal importance (Wilson, 2021). Before birth, fetuses are vulnerable to harm done by others’ opioid use. A new statistic reports that every 25 minutes a child is born with a condition called Neonatal Abstinence Syndrome (NAS), or opioid withdrawal. NAS causes low birth weights, respiratory conditions, feeding difficulties, and seizures in infants (American Academy of Pediatrics). As children, psychologists often see patients who have been emotionally scarred by their time in homes filled with opioids and the sight of their parents lying motionless on the ground after overdosing. Such an experience is especially tortuous if that child is living in a single parent home (Collier, 2018). One psychologist writes, “The trauma they face can be highly complex. We see kids who found their parent when they overdosed and were waiting until the paramedics came. In those cases, a parent may have died and the child is often left wondering what he or she could have done to save the parent” (Collier, 2018). This burden upon children has cascading effects across America’s entire healthcare system. Hospitals face simple logistical problems as opioid overdose rates grew by 10% over five years; already strained first responders are dispatched more frequently; and so many times hospitals are forced to offer lower quality care to emergency room patients (Ghertner, 2018 and Madhukar, 2017). The taxpayer costs do not include the specialty care children, and often their parents too, need later down the road. As healthcare providers struggle to compensate for the constant consumption of medical resources by patients connected to opioid abuse, the most likely outcome will be severely increased insurance costs for all patients (Madhukar, 2017).

​​ The foster care system faces an unprecedented burden from the opioid epidemic’s raging family destruction. More than a third of all new foster care cases in 2018 were due to parental opioid abuse (the only factor involved in more cases was parental neglect). The figure is likely a gross underestimate because it does not account for children who are sent to live with their next of kin or who are left to be raised by a single parent (American Academy of Pediatrics, 2020). The United States government published a research brief that analyzed entrance into the foster care system nationwide concluding that, “…in every community, caseworkers and court professionals perceived that increases in caseloads were due in large part to parental substance use” (Ghertner, 2018). The system is overwhelmed and there are too few financial resources or personnel to handle rehousing and complete the necessary counseling (Ghernter, 2018 and (Crowley, 2019). 

​​ Solutions to mitigate the after-effects of opioid addiction leave children in less than ideal situations. Up to 85% of youth in foster care have mental health issues as well as physical conditions like NAS associated with coming from a home with an opioid-abuser. The American Psychological Association has voiced concerns that children with psychological trauma are not being identified and helped. Due to the continued movement between foster homes, very few foster children develop critical bonds with adult role models and are never taught simple tasks associated with running a home such as paying bills, managing credit, or doing laundry. Foster children therefore have a propensity for risky behaviors like alcohol and drug use. Later in life they are more likely to be placed into juvenile corrections, incarcerated, and be at increased risk for detrimental health conditions like obesity and heart disease (American Academy of Pediatrics, 2020). Only 3% of foster children will earn 4-year degrees (Fellmeth, 2011). As rates of foster care placements rise, driven in no small part by opioids, America’s adult population will become increasingly less capable, educated, and independent.

​​ The American children of the opioid epidemic are victims in the purest sense of the word: innocent and helpless yet unfairly battered from all sides, often in life-changing ways. Many of them are physically hamstrung by their parents’ addiction before even being born. The issue therefore carries the moral weight of some of the world’s worst humanitarian issues, and according to recent research, it is worsening (CDC, 2020, and Lane, 2020, and American Medical Association, 2022).

​​ There are several insights to be drawn from this crisis. First and foremost, the opioid epidemic requires a refinement of the way in which people consume the news and educate themselves on current events. At present people are calibrated for events like the war in Ukraine, which peppers news cycles with single momentous events characterized by spectacle and the challenging of various precedents. By contrast, the opioid epidemic is a slow but steady IV drip of progressively more depressing data and stories of people slipping into the void of addiction, and therefore, while the epidemic has begun to break into the mainstream through books (like Empire of Pain) and documentaries (like The Crime of the Century) it moves slowly enough to defy the spectacle-oriented news of today and therefore sail under the radar. Secondly, the United States constantly debates the size and role of its government, and healthcare and social services are consistently at the top of the list of concerns. The opioid epidemic profoundly deepens this conversation because even if the most fantastic, all-encompassing universal healthcare system was implemented in America, it still may be too little, too late since the primary damage done by opioids, especially to children, happens within the home. As a nation, Americans need to wrestle with national health as being something beyond access to medical care if they need it; it needs to put much more emphasis on getting people to engage in behaviors outside the jurisdiction of government or institutions that prevent them from needing access to medical services in the first place. Equally strong, however, is the exact opposite truth: society cannot be functioning properly if it is so maltreating its children, and the extent and ramifications of damage done to them in opioid-filled homes is so great that there is a need to interfere to some extent in the private affairs of citizens to stop it, even though some forms of interference are much more appropriate than others. These two opposing forces—one for the incentivizing of better private behavior and one for the encroachment upon this private sphere—may pull governmental policy in endless possible directions, but however this influences the country’s response to the opioid epidemic, two facts remain indispensable: first, the direct impact of opioids on matters of national discourse, specifically healthcare, cannot be overlooked. Children—the most in need of protection in society—are withering rather than thriving under the current system. It’s time for a change, and their safety must always be at the forefront of our minds while these changes are being made.

Photo: Axios

Works Cited

American Academy of Pediatrics. 2020. “America's Opioid Crisis - The Unseen Impact on Children.” United for Youth. https://www.unitedforyouth.org/resources/americas-opioid-crisis-the-unseen-impact-on-children.

American Academy of Pediatrics. n.d. “America's Opioid Crisis: The Unseen Impact on Children.” https://adaa.org/sites/default/files/opioid_fs_united_states.pdf.

American Medical Association. 2022. “Issue brief: Nation's drug-related overdose and death epidemic continues to worsen.” American Medical Association. https://www.ama-assn.org/system/files/issue-brief-increases-in-opioid-related-overdose.pdf.

CDC. 2020. “Overdose Deaths Accelerating During COVID-19 | CDC Online Newsroom.” CDC. https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html.

Collier, Lorna, and Natasha Slesnick. 2018. “Young victims of the opioid crisis.” American Psychological Association. https://www.apa.org/monitor/2018/01/opioid-crisis.

Crowley, Daniel M., Christian M. Connell, Damon Jones, and Michael W. Donovan. 2019. “Considering the Child Welfare System Burden From Opioid Misuse: Research Priorities for Estimating Public Costs.” American Journal of Managed Care. https://www.ajmc.com/view/considering-child-welfare-system-burden-opioid-misuse-research-priorities-estimating-public-costs.

The Economist. 2021. “Opioid deaths in America reached new highs in the pandemic.” The Economist. https://www.economist.com/graphic-detail/2021/03/30/opioid-deaths-in-america-reached-new-highs-in-the-pandemic.

Fellmeth, Robert C. 2011. “The Fleecing of Foster Children.” Children's Advocacy Institute. http://www.caichildlaw.org/Misc/Fleecing_Report_Final_HR.pdf.

Ghertner, Robin, Melinda Baldwin, Gilbert Crouse, Laura Radell, and Annette Waters. 2018. “The Relationship between Substance Use Indicators and Child Welfare Caseloads | ASPE Research Brief Office of the Assistant Secretary for Planning and.” HHS ASPE. https://aspe.hhs.gov/system/files/pdf/258831/SubstanceUseCWCaseloads.pdf.

Kasarla, Madhukar. 2017. “The opioid epidemic and its impact on the health care system.” The Hospitalist. https://www.the-hospitalist.org/hospitalist/article/149858/mental-health/opioid-epidemic-and-its-impact-health-care-system.

Lane, Rashon. 2020. “Mental Health, Substance Use, and Suicidal Ideation During the ...” CDC. https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm.

National Safety Council. 2021. “Drug Overdoses.” https://injuryfacts.nsc.org/home-and-community/safety-topics/drugoverdoses/.

Stewart, Adam, dir. 2018. One Decision.

U.S. Dept. of Health and Human Services. 2021. “Home About the Epidemic Opioid Crisis Statistics.” HHS.gov. https://www.hhs.gov/opioids/about-the-epidemic/opioid-crisis-statistics/index.html.

Wilson, J. D., Kaleab Z. Adebe, and Kevin Kramer. 2021. “Trajectories of Opioid Use Following First Opioid Prescription in Opioid-Naive Youths and Young Adults.”