The Ripple Effect: An In-Depth Look at The Hidden Impact of The Opioid Epidemic on Children

“My dad died of a combination of opiates and prescription drugs…The only thing I remember is my brother telling me it's not going to be okay, it's never going to be okay, but we're going to pretend it's going to be okay.”—Heroin’s Children: My Life Inside the Opioid Epidemic, Al Jazeera English 

"I never got any health care until I was 10. Never went to the dentist, never saw a pediatrician. Nothing. I considered myself as the parent and my mom as the kid."--Opioid Crisis: 14-Year-Old on Mother’s Addiction, NBC Nightly News 

NEW YORK, NEW YORK March 7, 2019—Opioid addiction is well-recognized as a national crisis, but the impact on children and adolescents whose parents or close family members are addicted has received little sustained attention. A far-reaching report released today by United Hospital Fund makes clear that the magnitude of the epidemic’s impact is much greater than realized--even if the opioid epidemic were stopped cold today, there would be damaging ripples far into the future.

While previous reports examined aspects of the impact on children, such as pregnant women who use drugs or the increased numbers of children who enter foster care, this is the first comprehensive look at the successive waves of loss and trauma experienced by newborns, young children, adolescents, and their families. It also looks at the needs of kinship caregivers, typically grandparents who often step in to care for these children. Potential remedies are proposed, and the report describes innovative programs around the nation that address these issues. 

Titled The Ripple Effect: The Impact of the Opioid Epidemic on Children and Families, the report draws on lessons learned from the HIV/AIDS and crack/cocaine epidemics, which, like the opioid crisis, were characterized by stigma and failures to provide needed services to children and families. And like those earlier crises, opioid addiction is leaving too many children in foster or kinship care, caring for younger siblings, and suffering from potentially long-term behavioral and physical health issues.

“Children in families affected by substance use are often hidden from view until there is an overdose, arrest, or other crisis,” said Carol Levine, co-author of the report and director of UHF’s Families and Health Care Project. “The good news is that existing capabilities in agencies and programs that support children and families can be leveraged, along with lessons from prior public health crises—the HIV/AIDS and crack cocaine epidemics in particular.” 

The Ripple Effect report was produced with the generous support of the Alfred P. Sloan Foundation and in collaboration with the Milbank Memorial Fund. It is based on extensive research, interviews, and a literature review by UHF staff, as well as a two-day meeting hosted by UHF in October 2018 that brought together some 40 national and local experts in child development, family policy, addiction treatment, and child welfare, and state and local government officials. 

The report lays out a blueprint for action aimed at public and private agencies and professionals. Four broad areas for action are identified, with detailed recommendations for each:  
•    Reduce stigma and misunderstanding of opioid use and treatment
•    Make investing in a response to the ripple effect a priority
•    Ensure that government and private agencies work as a team
•    Identify children at risk as early as possible

Promising programs across the nation are highlighted in the report, among them Handle with Care in West Virginia, Relatives as Parents Program in several states,  The Children and Recovering Mothers Collaborative in Vermont, and Supporting our Families Through Addiction and Recovery in Massachusetts.

“We’re not going to solve this problem by demonizing parents or pregnant women with substance use disorder,” said Suzanne Brundage, co-author of the report and director of UHF’s Children’s Health Initiative. “Instead we have to surround these vulnerable families with treatment resources and supports so their children can grow up in a secure and loving environment.” 

The report details the unique challenges faced by children living in households affected by substance use. Older children and teenagers may take on responsibilities ranging from grocery shopping to monitoring for overdoses. Some anecdotal reports describe young caregivers picking up naloxone kits at a dispensing outlet in case a parent overdoses. 

There has also been a dramatic increase in the number of children removed from their homes since the opioid epidemic took hold. After several years of declining numbers, children in foster care began to rise in 2012, and by 2017 approximately 440,000 children were in foster care. Another 2.7 million (4 percent of all children in the U.S.) are estimated to be living in informal kinship arrangements, staying with grandparents, aunts and uncles, or older siblings. 

Nevertheless, “there is reason for hope,” said UHF president Anthony Shih, MD, MPH. “We know the steps we need to take—we just need to commit the resources and mobilize public support to do it. This requires an ‘all hands on deck’ approach among many stakeholders, which will not only lead to meaningful improvements for children affected by the opioid epidemic, but serve as a model for addressing similar crises in the future.” 

“We have learned from past epidemics and public health crises that their effects extend far beyond the patient,” said Milbank Memorial Fund President Christopher F. Koller. “This study documents both those effects and what can be done to respond to them. We hope it will inspire coordinated, evidence-informed responses from officials at all levels of government across health, social services, law enforcement and other agencies and their partners."

The full report can be downloaded from UHF’s website here.

About United Hospital Fund
United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care. For more on our initiatives and programs please visit our website at and follow us on Twitter