Parental Opioid Abuse: Barriers to Care, Policy, and Implications for Primary Care Pediatric Providers

Abstract

Parental opioid use is affecting the physical, developmental, and mental health of the pediatric population nationwide and raises questions of safety when these children remain in the care of opioid-addicted parents. Pediatric providers face many barriers to identifying and caring for children beyond the neonatal period who have been affected by parental opioid abuse both in utero and in the home. These barriers include communication between providers and services, identification of intrauterine exposure, parental opioid abuse screening, and knowledge of child protective services involvement. In addition, understanding current state and national health policy regarding parental opioid abuse helps providers navigate these barriers. The purpose of this article is to identify barriers to care of children affected by parental opioid abuse both in utero and in the home, to discuss current health policy surrounding the issue, and to identify implications for the care of these children in the primary care pediatric setting.

Applying ambiguous loss theory to children of parents with an opioid use disorder

“…While a family experiencing a death of a loved one can usually anticipate social support, stigma can be a barrier to social support in families with a loved one who has a SUD. Subsequently, children of a parent with an OUD in particular are hindered from accessing the resources needed for healthy psychosocial development and achieving resiliency (Spehr, Coddington, Ahmed, & Jones, ). Unfortunately, stigma toward parents with an OUD also exists among healthcare professionals (Whittaker, Williams, Chandler et al, ).…”

“…The nature of these disorders dictates a loss of pleasure in certain facets of life which the individual once experienced enjoyment, including parenting (Neger & Prinz, ). There is abundant evidence that shows that when a parent has a SUD he or she commonly disengages and an overwhelming lack of parental supervision ensues (DiPirro, ; Fraser et al, ; Hogan, ; Spehr et al, ). Meanwhile, in one study with 98 mother–child dyads which focused on OUD and parenting effectiveness, results included the fact that parental control (limit‐setting with support of autonomy) contributed to a decrease in children's externalizing (acting‐out) behaviors and their maladjustment at school (Suchman et al, ).…”

“…They posited that parentification and abandonment of parental responsibilities occur because family members function in developmentally inappropriate roles. These children often encounter a disrupted home‐life concerning daily routines involving school preparation, meals, and bedtimes (Hogan, ; Spehr et al, ). They may take on tasks usually carried out by a parent, such as caring for their siblings, cooking, cleaning, grocery‐shopping, and general maintaining of structuring the household (McKeganey et al, ).…”

What aspects of their child's primary care do mothers value? A qualitative analysis of perspectives of women in treatment for opioid use disorder

“…Healthcare that is family-centred may be especially significant and meaningful for mothers with OUD for several reasons, and so it is not unexpected that participants of this study valued these aspects of care. First, mothers with OUD have previously reported feeling overwhelmed, guilty, judged and removed from the care of their infants (Cleveland & Bonugli, 2014;Cleveland & Gill, 2013) and frequently have unique vulnerabilities (Smith & Wilson, 2016;Spehr, Coddington, Ahmed, & Jones, 2017;Sutter, Gopman, & Leeman, 2017), including significant trauma histories (Short et al, 2017). Family-centred care may allow for a trauma-informed approach to care, increased trust with the healthcare system, and provide opportunities for discussions around issues relevant to families affected by maternal OUD.…”

Accelerating the Pace of Science: Improving Parenting Practices in Parents with Opioid Use Disorder

“…Moreover, specific to mothers with OUD, limited social support has been related to a greater risk for comorbid depression and opioid use, whereas greater social support has been related to improvements in parenting and parent-child bonding (Suchman et al, 2010). OUD has also been directly associated with a lack of a supportive partner, marked by high rates of interparental conflict when a partner is present and limited or non-existent parenting support when parents are no longer partnered (Spehr, Coddington, Ahmed, & Jones, 2017).…”