Association between medications for opioid use disorder and child removals

Buprenorphine and methadone are effective medication treatments for opioid use disorder (MOUD), but their population effects on child welfare are unclear. MOUD may help parents in recovery better care for their families and reduce the risk of children being removed from their homes.

The rate of child removals by state Child Protective Services was estimated as a function of per-capita purchases of methadone and buprenorphine for OUD using data for U.S. counties from 2010 to 2019. The estimates were estimated for all counties and, to account for baseline differences in OUD prevalence, were also stratified by quintiles of per-capita opioid analgesic purchases in 2010.

A one standard deviation increase in milligrams per capita of buprenorphine for OUD treatment predicted a decrease of 4.9% (p = .008) in the removal rate due to parental neglect. A significant association between the per capita amounts for buprenorphine for OUD or methadone and the all-cause removal rate was not observed. Stratifying by the baseline level of per-capita morphine milligram equivalents (MMEs) for pain management, the negative association between buprenorphine for OUD and removals due to parental neglect was present in the first (lowest) and third quintiles. For methadone, there were negative associations between removals due to neglect and removals due to parental drug use in the highest quintile of baseline MMEs for pain management.

Our findings suggest an important population-level benefit of MOUD that may vary according to the prevalence of OUD and the medication. Clinicians and policymakers should take steps to ensure that OUD treatment is accessible to parents who may benefit.