States Vary in Parental Opioid Use and Child Removal Rates Interview with:

Troy Quast, PhD Associate Professor in the University South Florida College of Public Health

Dr. Quast

Troy Quast, PhD
Associate Professor in the University
South Florida College of Public Healt What is the background for this study? What are the main findings?

Response: One of the cited repercussions of the opioid epidemic is its effect on families. However, there is considerable variation in opioid misuse across the county. This is the first nation-wide study to investigate the relationship between opioid prescription rates and child removals at the state level.

I found that there are significant differences across states in the relationship between opioid prescription and child removal rates associated with parental substance abuse. In twenty-three states, increases in opioid prescription rates were associated with increases in the child removal rate. For instance, in California a 10% increase in the county average prescription rate was associated with a 28% increase in the child removal rate. By contrast, in fifteen states the association was flipped, where increases in the opioid prescription rate were associated with decreases in the child removal rate. There was no statistically significant relationship in the remaining states. What should readers take away from your report?

Response: My results are somewhat surprising, as one would expect that higher levels of drug use would have been associated with more removals in all states. My analysis does not definitively identify the reasons for the differences across states, but there are a number of potential explanations. Differences in state criteria for removing children from their home may play a role. Also, states differ in their legal treatment of opioid prescriptions through prescription drug monitoring programs and legislation regarding pill mills.

A speculative explanation is that the differences could reflect the different stages of the opioid epidemic. For instance, in some states higher opioid prescription rates may reflect lower levels of illicit opioid consumption. Given the especially potentially drastic effects of illicit opioids on families, prescribed opioids may be relatively less likely to lead to a child removal. What recommendations do you have for future research as a result of this work?

 Response: I think the paper highlights the very complex nature of the opioid epidemic and the need to carefully consider the potential effects of policies to try to address it. I hope that researchers will empirically compare various interventions across a broad range of outcomes to assess which approaches are most effective. I also believe it is important to monitor children who have entered the foster system and attempt to identify ways in which we can mitigate the traumatic experience of being removed from their home.

No disclosures 


Troy Quast. State-level variation in the relationship between child removals and opioid prescriptions. Child Abuse & Neglect, 2018; DOI: 10.1016/j.chiabu.2018.10.001 

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Last Updated on November 7, 2018 by Marie Benz MD FAAD