Parental Opioid Abuse: Barriers to Care, Policy, and Implications for Primary Care Pediatric Providers

Michelle K. Spehr, MSN, RN, CPNP; Jennifer Coddington, DNP, MSN, RN, CPNP; Azza H. Ahmed, DNSc, RN, IBCLC, CPNP; Elizabeth Jones, DNP, RN, CPNP

Disclosures

J Pediatr Health Care. 2017;31(6):695-702. 

In This Article

Abstract and Introduction

Abstract

Parental opioid use is affecting the physical, developmental, and mental health of the pediatric population nationwide and raises questions of safety when these children remain in the care of opioid-addicted parents. Pediatric providers face many barriers to identifying and caring for children beyond the neonatal period who have been affected by parental opioid abuse both in utero and in the home. These barriers include communication between providers and services, identification of intrauterine exposure, parental opioid abuse screening, and knowledge of child protective services involvement. In addition, understanding current state and national health policy regarding parental opioid abuse helps providers navigate these barriers. The purpose of this article is to identify barriers to care of children affected by parental opioid abuse both in utero and in the home, to discuss current health policy surrounding the issue, and to identify implications for the care of these children in the primary care pediatric setting.

Introduction

Prescription opioid and heroin abuse is a known, growing epidemic throughout the country (National Institute on Drug Abuse, 2015a, National Institute on Drug Abuse, 2015b). Less often discussed is the increasing role in which parental opioid abuse is affecting children beyond the neonatal period.

In 2012, over 20,000 infants in the United States were born with neonatal abstinence syndrome (NAS; Patrick, Davis, Lehmann, & Cooper, 2015). The number of infants diagnosed with NAS has increased fivefold since 2000 (Patrick et al., 2012). Many of the nation's children are being physically exposed to opioids in utero, which could potentially have lasting effects on child development. Additionally, children of all ages are being affected by opioid use through parental use in the home; however, this is often less examined and researched. It is currently unknown how many children are living in homes specifically affected by parental opioid or heroin abuse because there is no national data collection system (Child Welfare Information Gateway [CWIG], 2014). However, it has been estimated that as many as 2.1 million children live with at least one parent abusing illegal substances (Substance Abuse and Mental Health Services Administration, 2009).

Intrauterine and childhood opioid exposure in the home are a financial burden to the nation. In 2012, initial complications of NAS resulted in a cost of approximately $1.5 billion dollars to the U.S. health care system (National Institute on Drug Abuse, 2015a, National Institute on Drug Abuse, 2015b). This does not begin to address the unknown, long-term financial costs of parental opioid exposure on children including initial hospitalization, readmission, continued developmental therapy or mental therapy, and child protective services (CPS) involvement (França, Mustafa, & McManus, 2016).

Unfortunately, there are many barriers for pediatric providers in addressing parental opioid addiction. Federal and state governments have only begun to initiate legislation that could affect some of these barriers and standardize care of children affected by parental opioid use (U.S. Department of Health and Human Services [USHHS], 2009). Although there is an abundance of literature surrounding the impact of maternal opioid addiction on neonates, there is a lack of literature concerning how maternal and paternal opioid use affect older pediatric populations. It is imperative that pediatric providers understand current barriers and health policy related to parental opioid addiction as it pertains to the child beyond the neonatal period and their role in combating this national issue. The purpose of this article is to identify barriers to care of older children affected by parental opioid abuse both in utero and in the home, to discuss current health policy surrounding the issue, and to identify implications for the care of these children in the primary care pediatric setting.

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