As summer was ending on Long Island’s North Fork, six residents died of drug overdoses. The substance involved was cocaine laced with fentanyl, a synthetic opioid. Two others overdosed but survived. All were between the ages of 25 and 40, prime parenting years. One was a woman, and one was the father of a six-month-old baby.
Despite hopes a few years ago that the opioid epidemic was waning because of restrictions on opioid prescriptions, targeted public education, and the enhanced availability of naloxone (which rapidly reverses overdoses), it has instead expanded to include even more dangerous but cheaper street drugs. There is also evidence of a troubling racial disparity in opioid deaths: a new study shows that opioid overdose death rates are growing faster among Black Americans than white Americans in several states, including New York.
In the Long Island deaths, as in so many others, children too young to mourn will be affected by the loss of a parent as they grow up. In other cases, older children who are traumatized may themselves turn to drugs. All affected children and families must be included in funding and policy determinations. And the New York State Opioid Settlement Fund is an opportunity to do just that.
The Numbers Keep Growing
Provisional data reported by the Centers for Disease Control and Prevention (CDC) in July 2021 showed drug overdose deaths across the U.S. rose by close to 30 percent between 2019 and 2020. The 2020 estimate is 93,000 deaths, compared to 72,000 deaths in 2019. All demographic groups experienced increases, especially males, younger people, and communities of color.
CDC’s 2020 projections for New York are worse than for the nation as a whole: a 31.1 percent increase in drug overdose deaths in New York, excluding New York City, and a jump of 40.2 percent in New York City. This is happening statewide. In upstate Erie County, opioid-related deaths increased 57 percent from 2019 to 2020. And in Jamestown in Chautauqua County, overdoses in the first four months of 2021 surpassed all those in 2020.
Experts offer two principal explanations for this dramatic increase in overdose deaths. One is the steady growth of fentanyl use. According to New York City Health Commissioner Dr. David Chokshi, fentanyl was detected in 68 percent of drug overdose deaths in the city in 2019 compared with 60 percent in 2018. The second major explanation is the COVID-19 pandemic, which triggered increased levels of stress, social isolation, and even homelessness. For many of those in recovery programs in early 2020, the pandemic also meant a loss of access to treatment, although by summer several providers had successfully adopted telehealth strategies to reach their patients.
The Impact on Children and Families
A March 2019 UHF report, The Ripple Effect: The Impact of the Opioid Epidemic on Children and Families, provided a comprehensive look at the several groups most affected by opioid use disorders (OUD). These include infants born with neonatal abstinence syndrome and their mothers, children experiencing the loss or death of a parent, children who have become caregivers for parents, kinship caregivers and foster parents, and those who have become addicted themselves.
In November 2019, UHF, in partnership with the Boston Consulting Group, issued a follow-up chartbook to quantify the number of children affected by the opioid epidemic across the country. In 2017, an estimated 2.2 million children and adolescents had a parent with OUD or had OUD themselves. Even if then-current downward trends continued, the chartbook predicted that the number of children affected would nearly double by 2030, to 4.3 million.
The cumulative, lifetime cost of this “ripple effect” would be $400 billion. This includes additional spending in health care, special education, child welfare, and criminal justice stemming from the multiple impacts of parental OUD on a child’s physical, mental, and social and emotional health; it does not include productivity losses or missed opportunities.
Unfortunately, the promising downward trend of 2017 has now been upended, and it appears that UHF’s chartbook’s “worst case scenario” is more likely—namely that the total number of children affected could reach 5.3 million by 2030. The lifetime costs of helping them will be far more than $400 billion.
The COVID-19 pandemic, which has affected all school-age children, has had a particularly severe impact on children whose lives have been disrupted by opioid use in the family. Schools—the center of their daily lives—have not been able to provide in-person teaching and essential support services. In some areas, teachers and counselors report that it has been hard to maintain contact with at-risk children because they are living with relatives in a different area or are not attending school regularly. For these children and their families, the dual epidemics are a daily reality.
New York’s Opioid Settlement Fund
These statistics about the ravages of the epidemic are daunting, but there is a new opportunity to address them. New York State, along with several other states, has taken a major first step. On June 27, 2021, Attorney General Letitia James announced a settlement with Johnson & Johnson to end production and distribution of opioids and to pay the state $230 million over nine years, with substantial upfront payments.
In July New York also reached a $1 billion agreement with distributors Cardinal Health, McKesson, and AmerisourceBergen; and in August a bankruptcy court approved the $4.325 billion settlement of a multi-state lawsuit against the Sackler family and their company, Purdue Pharma. Under that settlement, New York State will receive at least $200 million over the next nine years. (Some states are planning to appeal because the Sackler family was excused from filing bankruptcy and liability.)
In June the state legislature unanimously approved, and then-Governor Cuomo signed, legislation establishing an Opioid Settlement Fund to distribute the proceeds of these and any future opioid settlements. The money expended from this fund will be used to supplement and not replace any other state funds that support drug treatment, recovery, and abatement efforts.
The legislation also establishes an advisory board in the Office of Addiction Services and Supports that will make recommendations to the legislature on how the money should be distributed. The law specifies that “every effort shall be made to ensure a balanced and diverse [advisory] board representing the geographic regions and racial and ethnic demographics of the state as well as those with lived experiences of a substance use disorder.” It is critical that the board’s membership include individuals experienced in working with families and running family-centered programs. Many organizations will compete for funds; people who understand the complexity of serving families and children should be at the table.
Basic Principles for Going Forward
In its March 2019 Ripple Effect report, UHF set out four basic principles for addressing the opioid epidemic’s impact on children:
- 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
- Reduce stigma and misunderstanding of opioid use and treatment, particularly among people interacting with pregnant women and parents
As the dollars begin to flow into the Opioid Settlement Fund and the new advisory board is appointed and begins its work, we hope these principles will guide their decisions. The report also highlighted examples of innovative programs that serve families and children as well as those with SUD.
Central to the success of these efforts will be the coordination of the responses to these children and families across health care, law enforcement, child welfare agencies, schools, and community-based programs. All children in these perilous times need support. Well-planned and evidence-based programs to serve families and children affected by the opioid epidemic can be models to serve those affected by other disasters.
Opportunity, it is said, knocks only once. This knock is loud and clear; let the kids open the door.
Carol Levine is a senior fellow at United Hospital Fund. Carol was formerly director of UHF’s Families and Health Care Project and is a co-author of the 2019 Ripple Effect report.
Lee Partridge is also a senior fellow at UHF. She was Medicaid Director for the District of Columbia and is a co-author of the Ripple Effect chartbook.
United Hospital Fund has a long history of bringing together diverse perspectives to address critical challenges in health care in New York. In the current crisis, it’s more important than ever to hear from all parts of the health care system. Today’s commentary from UHF senior fellows Carol Levine and Lee Partridge highlights an important opportunity to help New York children and families affected by the opioid crisis. – UHF President Tony Shih