October 6, 2022

The opioid crisis is creating shockwaves in communities throughout the country. Along with methamphetamine and alcohol use, opioid use is near the top of the list of public health and safety concerns today. One of the most concerning ripple effects is being felt in child welfare. While there are several factors that affect court decisions regarding child safety and placement, there are some specific concerns with opioid use today that make the current crisis different from spikes of illicit drug use in the past.

A Correlation Between Overdose Death Rates and Child Welfare Case Loads

Overdoses and deaths related to substance use have been steadily increasing for decades. In 2012, these rates showed a sharp increase, with overdose-related deaths totaling just under 200,000. But by 2016, that number was nearly 300,000. Considering the rise of overdose-related deaths in the previous six years was only about 20,000 (an alarming number), the dramatic increase of 110,000 over the next four years is disturbing, to say the least.

The fallout of this increase correlates with an increase in foster placement cases that started in 2012, the first time in decades that the foster care system reported an increase in its caseload. Although substance use can’t be named as the only cause of this increase—poverty is a strong predictor of both substance use and child welfare—it is widely considered the primary cause. And while many controlled substances play a role in the increased overdose death rates, opioids have become the most reported type of substance in these deaths.

What Makes the Opioid Crisis Different

Public health concerns related to opioids stem from more complicated effects than substance use crises of the past. Families affected by opioids don’t fit the mold associated with most other substances. Opioid-related overdose deaths are twice as prevalent for women than non-opioid overdoses and more than twice for non-Hispanic whites.

Also, opioid use is more multigenerational than in past drug-related crises. Treatment professionals and case workers have noted that both parents and grandparents in some families have reported opioid use. The impact on child welfare is substantial: without the same family support system present to care for the children of affected parents, foster placements have become a necessary, albeit less desirable, outcome.

Compounding Factors in Families Affected by Opioids

Substance abuse alone is a concern, specifically for the parent's health, but it is just one of many factors to consider in child welfare decisions. Families affected by opioids and substance use issues often suffer from several other long-term problems that compound recovery efforts and child safety.

The most concerning indicator for child welfare and treatment needs is polysubstance use, where individuals report using more than one substance simultaneously. In a recent study of child welfare cases and their connection to opioid use, polysubstance use was a common indicator in every sample site. Other common co-occurring issues with substance use include:

domestic violence
mental illness
long histories of traumatic experiences

The same study also saw a significant decrease in involvement within churches and other social institutions, weakening the social safety net present in past crises.

Treatment Needs and Challenges

Child welfare greatly depends on family reunification since a stable family structure is the most beneficial setting for children. But with steeply increasing caseloads for both caseworkers and treatment professionals, parents are becoming less and less likely to receive the necessary recovery support to keep their children. And current research and data point to the need for more than just physical support services.

Treatment professionals and caseworkers believe that merely addressing substance use will not be effective enough to achieve the child welfare outcomes we all desire.

Some of the most pressing challenges revolve around providing support for mental health and treating co-occurring issues. An essential treatment component should include programs that build parenting skills, child development services, domestic violence intervention services, and family therapy. Programs that build parenting skills alongside substance use treatment help re-establish the family unit in a more permanent manner.

Family-friendly treatment options are also a rising need for those affected by the opioid crisis. With facilities that allow children to stay with their parents during treatment, fewer families will require foster placement or alternative care plans. Yet, even though the need is well known among case workers, there is seldom more than one family-friendly treatment option in any given community. And almost no outpatient treatment plans are available that could potentially keep families together.

Major Challenges of Treatment

From the perspective of judicial rulings and case planning, families affected by the opioid crisis will likely encounter crucial challenges in receiving clinically proven treatment options due to some common misconceptions. And while these perceptions have been changing over the last decade, some stigmas surrounding various approaches to substance use treatment and recovery have yet to see popularity in court rulings.

Substance Use Assessment and Treatment Timeframe

In many cases, families do not receive appropriate support and treatment within the ASFA timeline for placement. Although arrangements are made eventually, many parents see their children placed in foster care before they have the opportunity to comply and enter into recovery and stability. In short, the lack of timely and appropriate treatment simply sets families up for failure.

Misconceptions Surrounding Medication-Aided Treatment (MAT)

Both methadone and buprenorphine can be used to aid in efforts to reach substance use abstinence. Though the process by which these medications are used is crucial to their success. When combined with appropriate counseling and treatment therapy support systems, MAT can double the rate of opioid abstinence in trials compared to no medication or placebo. And this statistic is well-known and well-documented among treatment professionals.

However, judges and caseworkers often see MAT as a trade-off addiction, exchanging one substance for another. And some treatment facilities even refuse to treat individuals still using methadone or buprenorphine, citing that they are not in “recovery” until clear of any substance use.

When it is used, medication-aided treatment often lacks the proper coordination with counseling and therapy or delays reunification during stabilization with methadone or buprenorphine. Judges also frequently expect a faster step-down timeline from these withdrawal substances than treatment professionals and clinical studies recommend. In all these cases, the effectiveness of MAT plans is lost or greatly diminished.

Haphazard Substance Use Assessments

In some situations, case workers don’t keep assessments consistent enough to be useful, and many assessment methods lack the information necessary to make accurate evaluations of substance use and child welfare concerns. For example, intermittent drug testing provides information about the presence of substances, but it doesn’t provide a complete picture of the effects of the substance use, the frequency of that use, and the home environment’s safety for children.

To overcome this obstacle, courts should require consistent drug testing supported by home visits, screening questions, and observational data. This more complete picture of the home environment and substance use provides a better understanding of child welfare. And a better understanding of child welfare allows caseworkers the opportunity to provide the best possible treatment options for families affected by the opioid crisis.

Family-Friendly Treatment Options in Short Supply

Family-friendly treatment facilities are rare even though the advantages of keeping families together during treatment and recovery are clear. Still, more intensive treatment options often require inpatient living, with no childcare options available during the extended treatment period.

Caseworkers want more facilities where families can stay together, childcare options are available, or outpatient treatment and accountability scenarios that make it easier to remain unified during the recovery process. Not only is this better for the patient, but it’s also more beneficial for the children than temporary or long-term foster care.

A Lack of Timely Treatment Options

Due to long waiting lists for publicly funded treatment options, caseworkers have started circumventing wait times by personally funding some crucial treatment services for their clients. The pattern is surprisingly prevalent, with caseworkers blaming an overloaded legal system for not providing parents with adequate and timely treatment. And Medicaid and insurance frequently leave gaps in mental health coverage, despite their crucial role in recovery efforts. This lack of much-needed treatments only further hinders recovery and reconciliation for families affected by the opioid crisis.

How the PharmChek® Sweat Patch Aids in Supporting Families Affected by Opioids

The increased caseload for child welfare caseworkers starts with several different factors. From data collection issues to availability of services, the U.S. is seeing increases in use, overdose reports, and child safety concerns in families affected by the epidemic rise in opioid use. So how does the PharmChek® Drugs of Abuse Sweat Patch help agencies, treatment professionals, and courts better support families affected by opioids? Through simplifying the drug testing process, reducing costs, and providing a complete picture of substance use.

Reducing Costs

With drug testing frequency ranging from about once per month to three times per week in child welfare cases, conventional drug testing methods are either too infrequent to provide adequate information or too frequent to be cost-effective. With PharmChek®, a single sweat patch can collect samples for up to 7–10 days, sometimes longer, reducing the cost typically associated with drug testing. With this increased detection window and continuous monitoring, caseworkers can collect more substance use data with a single test than would otherwise be possible, even with three conventional tests per week.

Simplifying the Process

Generally speaking, restrictive schedules or requirements placed on parents lead to less drug testing compliance. For families affected by opioids, frequent appointments and complicated scheduling result in skipped tests, negatively impacted assessments, determinations involving child permanency, or compliance with court mandates.

Since the PharmChek® Drugs of Abuse Sweat Patch requires only two short appointments—one for application and one for collection—case workers can expect a better compliance rate with mandated drug testing. Both parents and children, in these cases, benefit from simplified appointments that must accommodate childcare and work schedules. And with reduced strain comes improved child welfare.

A More Complete Picture

Abstinence from substance use is a key component of family reunification and stability. When the cost and scheduling concerns of frequent drug testing result in extended periods between testing, abstinence is harder to maintain. The PharmChek® Sweat Patch, with more than a week of continuous monitoring per application, provides a more comprehensive data point for substance use patterns. Alongside appropriate counseling and therapy support, as well as behavioral and environmental observations, substance use testing can be used to help guide case planning, additional support needs, and more beneficial child welfare decisions for families affected by opioids.