The epidemic of drug overdose deaths is a national disaster. It claimed more than 64,000 lives in 2016, many of them by opioid overdoses. That’s far more than the number of deaths from HIV/AIDS in the peak year of 1995.
My comparing the opioid and HIV/AIDS epidemics isn’t just a matter of statistics. Among those of us who were involved in responding to the HIV/AIDS crisis, there is a sense of dismay. We are once again facing a public health crisis for which there is inadequate research, limited funding, and much public stigma. And just as happened in the early years of HIV/AIDS, the impact on children of the opioid epidemic is not getting the attention it deserves.
About half of opioid overdose deaths occur among men and women ages 25 to 44; it’s reasonable to assume that many are parents. Imagine the impact on a child when a parent overdoses at home or in a grocery store. Statistics can’t tally the trauma felt by a seven-year-old who calls 911 to get help for an unconscious parent, or the responsibility undertaken by a twelve-year-old to feed and diaper a toddler sibling, or the impact of school absences and poor grades on a formerly successful high school student.
Parental overdoses have an immediate impact on children. There’s also a cumulative impact as these children become adults and are themselves at risk from the same influences that drove their parents to drugs, overdoses, and early deaths.
Who are these children and adolescents?
- Newborns whose mothers are addicted to opioids. These babies may undergo withdrawal themselves and need special treatment.
- Children of all ages at risk for accidental ingestion or inhalation of toxic substances.
- Children living with an addicted parent, dealing with constant uncertainty and fear.
- Children who have taken over the role of family caregiver for younger siblings or for their addicted parents.
- Children who are removed from their homes and placed in foster or kinship care. Some of these children have unmet mental health care needs.
- Very young children exposed to toxic levels of stress that impair brain development.
No one knows how many of these vulnerable children there are in the U.S. because no one is counting. As a point of comparison, an advisory group to the British government estimated that there are between 250,000 and 350,000 children of drug abusers in the U.K. — about one for every drug user. The title of its report, Hidden Harm, applies equally well to American children. They remain hidden in families with addiction until a crisis erupts and law enforcement or child welfare agencies get involved.
Many of these children are taken in by grandparents, who may themselves be struggling with illness and poverty. According to U.S. census data, more than 2.4 million grandparents are currently raising grandchildren. Unless they become formal foster parents, subject to an agency’s monitoring, these relatives are not eligible for financial or other resources to help them deal with their own or the child’s emotional distress and basic needs.
When relatives are unable to take in these children, foster care is the next option. In 2016, about 274,000 children entered the foster care system, 22,000 more than in 2012. One-third of those youngsters were removed from their homes because at least one parent had a drug abuse issue.
Responding to the opioid crisis requires action on many fronts. Prevention, treatment, and control of prescription opioids and illegal substances are already on the agenda for adults. But children are rarely the focus of concerted planning and action.
Integrating child-centered policies into prevention and treatment programs is essential. We need targeted research that draws from the fields of addiction treatment, child development, family therapy, mental health, child welfare, law enforcement, and others to determine the best evidence-based solutions.
Among the many lessons we learned from the HIV/AIDS epidemic is that it affects more than just newborns or children entering foster or kinship care. Any child whose family life is disrupted by addiction or illness carries a heavy weight — sometimes because they are acting as caregivers to siblings and parents, and sometimes because their peers, teachers, and coaches know nothing about their home lives. Understanding what these young people need requires listening to them, including them in their parents’ treatment process, and planning interventions for their own mental health.
In many ways, HIV/AIDS changed our conceptions of family by incorporating nontraditional relationships based on commitment. That needs to be extended to the opioid epidemic. Children whose parents have overdosed, or died from overdoses, need support from grandparents and other relatives as well as from their educators, religious leaders, and community agencies.
Some legal precedents established during the HIV/AIDS epidemic should also come into play today, such as standby guardianships to give relatives or friends legal standing in case a parent is unable to take care of a child. And as in HIV/AIDS, grandparents and other relatives who take on responsibility for these children need financial and other kinds of support.
Perhaps the most powerful lesson from the HIV/AIDS epidemic is the emphasis on linking prevention and treatment to human rights. In the era of opioid overdoses, the rights of children to be protected, nurtured, and educated are fundamental to ensuring their futures.
We must start immediately. With each day that passes, more children lose their parents to addiction — physically or emotionally — and suffer severe mental trauma or become overwhelmed by anxiety. This too is part of the national disaster that we must work to reverse.
Carol Levine directs the Families and Health Care Project for United Hospital Fund, a non-profit based in New York. She was named a MacArthur Fellow in 1993 for her groundbreaking work on the legal, ethical, and public policy aspects of the AIDS epidemic.