Longitudinal changes in the county-level relationship between opioid prescriptions and child maltreatment reports, United States, 2009–2018.

Abstract

This article examines whether county opioid prescription rates were associated with county child maltreatment report (CMR) rates in the United States and whether this relationship changed over time. We linked multiple national data sets to assemble retail opioid prescription data, CMR data, rural-urban codes (to control for urbanicity), and census data (to control for other community characteristics, such as poverty rates) covering 2009-2018. Multilevel linear modeling analyzed the linked data. We found that the strength of the county-level relationship between opioid prescription rates and CMR rates increased almost linearly during the study period. The relationship was not significant in 2009-2011; it became significant in 2012 and grew stronger in the next 6 years. In 2012, there was one more CMR per 1,000 children in a county for every 14.3 more opioid prescriptions per 100 people. In 2018, the number of prescriptions related to this effect was 3.6. In other words, the county-level relationship between opioid prescriptions and CMRs was four times as strong in 2018 as it had been in 2012. This trend was also observed within all subgroups of child age and sex. By type, this trend was somewhat more pronounced for neglect, but somewhat less for sexual abuse. Our findings suggest a growing need for greater efforts to prevent child maltreatment in communities with high opioid prescription rates. Further research is warranted to reveal the underlying factors for this concerning trend. Public Policy Relevance StatementThis study confirms the county-level relationship between opioid prescription rates and CMR rates across the United States, providing empirical support for federal efforts to address CMR. The relationship intensified over the 2010s, highlighting the urgency of further research and efforts to better understand and reverse this trend. Policy and practice should factor in opioid prescription rates and implement better monitoring and prevention strategies, and holistic, strength-based approaches at the community level may be necessary to reduce opioid-related harms and child maltreatment incidents and reports.