State-level variation in the relationship between child removals and opioid prescriptions

One of the most devastating impacts of the U.S. opioid crisis is the challenge it creates for dependent parents to care for their children, potentially leading to the child being removed from their home. However, existing studies of the link between child removals and opioid prescriptions have either focused on a single state or estimated a national average.

To estimate state-level associations between child removals and opioid prescriptions.

U.S. counties from 2010 to 2015.

We performed longitudinal regression analysis in which the rates for all removals and removals associated with parental drug abuse were employed as dependent variables. In addition to the opioid prescription rate, additional explanatory variables included child removal risk factors, county fixed effects, year fixed effects, and state-specific time trends. Interaction variables were used to estimate state-specific relationships.

We found substantial variation in the association between child removals and opioid prescriptions. Twenty-three states had a positive association, fifteen had a negative association, and twelve did not have a statistically significant association. A one-standard deviation increase in the prescription rate was associated with a 37% (p < .001) increase in the removal rate for parental drug abuse in Illinois, while in New Hampshire it was associated with a 28% (p < .001) decrease.

The substantial variation in state-level relationships between child removals and opioid prescriptions may reflect differences in the extent to which states have experienced the opioid crisis and indicate the need for interventions that account for those differences.