As the opioid crisis swept across the United States, the number of kids entering the foster care system rose. From 2000 to 2017, there was a 147% increase in foster care entries due to parents' drug use, according to a study published Monday in the medical journal JAMA Pediatrics.
The study looked at the number of foster care entries in the nationwide Adoption and Foster Care Analysis and Reporting System. The study did not count the number of children -- an important distinction, as some children may have been entered in the database multiple times, the researchers noted.
This increase in foster care entries related to parental drug use was most prominent in the last five years studied, 2012 to 2017, when there were surges in opioid use and overdoses.
"There is so little [research] about how the epidemic has spilled over and affected children," said Angélica Meinhofer, lead author and instructor of health care policy and research at Weill Cornell Medical College. "This study attempts to quantify ... increases in foster care and parental drug use."
Researchers analyzed nearly 5 million foster care entries and looked at factors such as demographics, geographic area and reasons for home removal, including parent or caretaker drug use.
Parental drug use accounted for more than 1 million foster care entries, making up 23% of all entries recorded in the 17-year time span. Over time, the percentage of home removals related to parental drug use increased "dramatically and steadily" from almost 15% of removals in 2000 to 36% in 2017, the researchers found. In comparison to kids with other causes of home removal, kids removed from the home because of parental drug use were more likely to be less than 5 years old (60.2% vs. 39.7%), white (54.5% vs. 45.3%) and live in the South (44.7% vs. 30.8%).
However, these findings come with several caveats. The study didn't specify what kind of drugs the parents used, so the results can't be linked to particular drugs, such as opioids. While the researchers saw a trend related to parental drug use, they didn't examine the causes of growth in drug use. For example, there could have been changes in drug use policies that involved more foster care intervention or changes in how the drug use was documented in the database, according to Meinhofer.
Follow-up studies should look at the causes of increased drug use, which can "direct better policy" that can "address the needs of these children," Meinhofer said.
The study's results are based on "what a protective services social worker writes down and enters into a system based on the data they're able to gather," which may not be accurate, thorough or well-funded, according to Richard Ruth, an associate professor of clinical psychology at George Washington University who was not involved in the study.
Furthermore, the researchers only had information up until 2017, the year with the most recent data available from the Adoption and Foster Care Analysis and Reporting System.
Ruth has treated foster care children through a national volunteer counseling program.
"I don't see anything stopping this very unfortunate trend ... it's been escalating," Ruth said in regard to foster cases related to parental drug use.
"There needs to be a lot of different kinds of research, including qualitative research," Ruth said. "We need to know the parents of substance abuse in-depth -- what's their story, how did they get there, what did they try, what's worked?"