As the number of opioid overdoses continues to climb statewide, more children of parents who struggle with addiction are entering the state’s foster care system.
“It’s incredibly sad,” said Rob Thompson, deputy director of NC Child, a nonprofit child advocacy organization. “We know that when kids go into foster care, the outcomes in life are not as good as kids who don’t go into foster care.”
NC Child recently released a report that suggests the opioid crisis is driving up the number of children entering foster care. Last year, more than 2,400 children were in foster care due to parental substance misuse. That number is more than 88 percent higher than it was almost a decade ago. In that same time, the number of fatal opioid overdoses statewide has increased by about 94 percent, with 1,776 people dying from opioid overdoses last year, according to the North Carolina Medical Examiner’s office.
“If parents are experiencing this, then kids are experiencing this,” said Whitney Tucker, research director at NC Child and the report’s author. “We know now that the opioid epidemic is having a very definitive and negative impact on communities across the state. It stands to reason that there was a definitive negative impact on children in the state.”
Parents struggling with addiction are more likely to have their children taken away, Tucker said. “A lot of children who come from households where there’s parental substance misuse they deal with food insecurity,” Tucker said. “They are at higher risk of child abuse and neglect. Those children are more likely to live in homes with housing instability.”
This often pushes children into the foster care system, where they may endure additional trauma from being separated from their families. And when children enter foster care due to parental substance misuse, they’re more likely to stay longer than other children, Tucker said.
“Not only are they more likely to be placed in out-of-home care, but they’re more likely to stay there, which just compounds this adverse childhood experience,” Tucker said.
Thirty-nine percent of children in foster care statewide have parents who have a substance use disorder, according to the state’s health department. In many Eastern North Carolina counties, there’s a greater share of children in foster care due to parental substance misuse. In Wayne County, about 58 percent of children in foster care were placed in the system due to parental substance misuse.
In her work as a pediatrician for Wayne UNC Health Care, Dr. Katherine McDonald says she’s seen an increase in the number of pregnant mothers struggling with opioid addiction. Those mothers are typically prescribed Subutex or methadone, medicines used to reduce opioid withdrawal symptoms, McDonald said.
“We’ve seen an increase in the number of mothers who need to be on those medicines,” McDonald said. “When the babies are born, we watch the babies and monitor them really closely for what we call neonatal abstinence syndrome, which means the babies have become physiologically dependent on either the Subutex or the methadone.”
When health care providers become aware of a mother who’s using drugs or alcohol while pregnant, they refer her to the county’s department of social services, McDonald said.
“In some situations, these infants are able to stay with the mother if the mother was basically on a Subutex program or she’s in a methadone program. And she’s working the program and doing the things she’s supposed to be doing,” McDonald said. But after they give birth, many mothers who struggle with opioid addiction no longer have access to a free supply of these medicines, McDonald said. “I feel as if we set these mothers up to fail."
To reduce the number of children in foster care due to parental substance abuse, the NC Child report recommends expanding Medicaid coverage eligibility across the state.
"Parents cannot afford the treatment that they need to really beat addiction and reunite their failies," said Whitney Tucker, who wrote the NC Child report.
North Carolina is one of 18 states that hasn’t yet taken advantage of federal dollars to expand Medicaid through the Affordable Care Act. For parents who earn too much to qualify for Medicaid and too little to afford private health insurance, expanding Medicaid coverage could improve their access to substance abuse treatment services, Tucker said.
“Other states have had significantly positive outcomes with this, as they work to battle the opioid epidemic, Tucker said. “Kentucky saw a 700 percent increase in Medicaid beneficiaries using substance use treatment services after they expanded eligibility. And nationally, expanding Medicaid is estimated to reduce the unmet need for substance abuse treatment by 18 percent.”
A bipartisan bill in the General Assembly would expand access to Medicaid coverage to people whose incomes are at or below 133 percent of the federal poverty level. That's $33, 383 per year for a family of four. But state lawmakers are unlikely to pass that bill before the session ends, said Rob Thompson, deputy director of NC Child.
"We're hopeful that there will be a similar proposal in 2019," Thompson said. "We're hopeful that it moves next time."
If the state expands Medicaid coverage, other barriers to substance abuse treatment, such as a shortage of long-term rehab facilities and mental health services, would still exist, Thompson said.
"This isn't a silver bullet," he said. "There are people with health insurance who are still struggling with addiction. What makes this particular solution stand out is just that it's a tremendous opportunity that we're leaving on the table right now."