Opioid overdoses linked to child abuse at neighborhood level

Neighborhoods with more opioid overdoses have higher rates of child welfare investigations and confirmed cases of child maltreatment, a new study in Ohio finds.

While other research has found this link at the county level, this study is one of the few to look at the crisis at the neighborhood level, said Bridget Freisthler, lead author of the study and professor of social work at The Ohio State University.

“When you look at the county level, it makes it very difficult for child welfare agencies and other groups to figure out where they need to devote resources and target interventions,” Freisthler said.

“If we can identify particular neighborhoods as potential hotspots of opioid-related child maltreatment, we can prepare community-based interventions.”

Freisthler conducted the research with Nichole Michaels of Nationwide Children’s Hospital in Columbus and Jennifer Price Wolf of the Pacific Institute for Research and Evaluation in Berkeley, California.

The study was published in the January 2022 issue of the Journal of Studies on Alcohol and Drugs.

The researchers studied 9,231 Census block groups in Ohio, which were used as a stand-in for neighborhoods. Those Census block groups covered nearly the entire state.

For each Census block group, the team collected 2015 data on the number of children referred for investigations of child abuse and neglect, as well as the number of substantiated cases of child maltreatment.

They also examined rates of naloxone administration for each Census block that same year. Naloxone is a prescription drug that emergency personnel use to treat people experiencing an opioid overdose.

Findings showed that higher rates of naloxone administration were related to a higher number of both referrals for child welfare investigations and confirmed cases of child maltreatment.

“There’s been an increase in child maltreatment in recent years after decades of decline and that trend is likely related, at least in part, to the opioid crisis,” Freisthler said.

The link between naloxone use and child maltreatment was particularly strong in rural Appalachian counties, which may be because of their high rates of poverty, she said.

The study found that neighborhoods with concentrated disadvantage – measured by levels of extreme poverty, among other problems – had particularly severe issues with child maltreatment.

“Appalachian counties already have depressed economies, which is a risk factor for child abuse and neglect by itself,” Freisthler said.

“If you add opiate use on top of that disadvantage, it only compounds those risks.”

The results suggest ways to help mitigate the crisis, she said.

Rapid response teams consisting of public health, social work, medicine, emergency medical services and nursing professionals could be deployed to neighborhoods experiencing high rates of overdoses in an effort to prevent additional social problems.

The main message is that the child welfare system needs to work with professionals involved in dealing with the opioid crisis to address these interconnected social problems, according to Freisthler.

“The opioid crisis is still with us, even though it may not be in the headlines as much,” she said.

“As long as we have that crisis, we’re going to have to deal with more potential cases of child maltreatment.”

The research was supported by grants from the federal Children’s Bureau, the Centers for Disease Control and Prevention, the Ohio Department of Job and Family Services and the Victims of Crime Act Fund.

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