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The consequences of an opioid use disorder (OUD) and the overdose epidemic span beyond the individual suffering with the disease, as the effects of addiction ripple across the social context in which they live. Individuals with OUD have parents, siblings, children, and extended family members. This chapter summarizes existing research on how OUD and the overdose epidemic has impacted those families’ members and children, in terms of short- and long-term sequelae. There is specific focus on parent/caregiver use of opioids and its impact on children under 18 years old including medical, psychosocial, and behavioral consequences. The chapter will begin by reviewing the incidence of OUD in parents and focus broadly on how OUD impacts parenting style, parent–child bonding, child maltreatment, trauma, family dissolution and removal of children from the home. The next section will discuss prevention and treatment services for families, the added burden of stigma experienced by parents with OUD and how policies are desperately needed to encourage cross-system collaboration. The chapter will conclude with a case report that illustrates much of the content covered in this chapter and a summary of evidence-based clinical recommendations.

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