On October 26, 2017, President Donald J. Trump proclaimed the opioid epidemic a Nationwide Public Health Emergency. However, some may be unaware that Alabama already started to wage its own fight against opioid abuse and addiction. On August 15, 2017, Governor Kay Ivey established the Alabama Opioid Overdose and Addiction Council to explore the causes and develop a strategic plan to address the overuse and abuse of prescription and non-prescription opiates in the state which was released on January 24, 2018. Additionally, PBS premiered its special report Understanding the Opioid Epidemic on January 17, 2018. The spotlight on the opioid use and abuse has fallen clearly on the state of Alabama in the past 12 months. Alabamians have the highest opioid prescription usage rate in the country. So, what are the consequences and what can be done to stem the tide when enough prescription opioids were produced in 2013 to give every adult a 30-day supply?
According to the CDC, there were approximately 62 deaths per day involving prescription opioids in 2015 which represents an increase from 2014 (CDC, 2017). One third or over 92,000 children entered U.S foster care in FY2016 in part due to parental substance abuse. 2% of children entered foster care in FY2016 due to their own substance abuse. These figures account for multiple causes of child removal. Neglect accounts for over 60% of child removals in FY2016 and shares a similar catchment of removal issues as parental substance users (Children’s Bureau, 2017).
Parental alcohol or substance abuse is the fastest growing contributing factor for child removal in the United States from 2000-2015 (National Center on Substance Abuse and Child Welfare, n.d.). In Alabama, AFCARS data suggests 36.7% of children enter foster care as a result of parental substance abuse. An estimated 5% of children are born with prenatal exposure to illicit drugs which include opioids. Additionally, the greatest number of children entering care were less than one year old at the time of removal. When considering these factors together, one might conclude that substance abuse literally fractures safe living environments especially among the most vulnerable children in our population.
While it may be easy to focus efforts on treating parents for opioid abuse, providers must consider how modeling from parents influences the substance use of their children. According to a SAMSHA (2017) report, 11.8 million people age 12 and older misused opioids in the past year including almost 900,000 adolescents. Oxycodone, hydrocodone, and codeine represented the most commonly misused pain relievers (SAMSHA, 2017). Pain relief, relaxation, and euphoric effects were the most commonly reported reasons for opioid misuse. Lastly, individuals 12 and older report that they obtain their opioids through friends or relatives (53.0%) or from a doctor (35.4%) (SAMSHA, 2017). Parents must understand their impact as a role in modeling safe medication practices including assessing the reasons for one’s use and the necessity of medications in their household. Additionally, parents must understand their child’s social life in an increasingly social media-driven era.
Warning signs of opioid use can vary from physical symptoms (injection marks, confusion, slowed breathing, drowsiness, and constricted pupils), to emotional symptoms (elation or euphoria, changing moods), to environmental issues or drug-seeking behaviors (doctor shopping, excessive prescription bottles, financial issues, and social withdrawal), and withdrawal symptoms (fatigue, anxiety, insomnia, sweating, nausea, vomiting, etc.) (Patterson, n.d.). For a service provider assisting families, you should be aware of sudden drops in attendance of program participants, changes in living circumstances, shifts in behavior or mood, and reports of parenting issues from child clients. While substance abuse should be addressed, it often contributes to a variety of other social issues that affect the well-being of Alabama’s children. As mandated reporters, we have an obligation to consider these issues and report our suspicions of child, parent, or caregiver substance abuse.
There are treatment options available even for pregnant mothers. If you have concerns for an individual regarding their substance or you may need to seek help yourself, please contact the National Helpline at any time at 1-800-662-HELP (4357). Additionally, you can assist a client with a warm handoff to a treatment center by visiting SAMSHA’s opioid treatment program directory or buprenorphine treatment practitioner locator provided below:
Opioid Treatment Program Directory: https://dpt2.samhsa.gov/treatment/directory.aspx
Additionally, you can inform individuals and their families of the availability of naloxone in Alabama pharmacies to counteract opioid overdoses if administered in a timely manner. And in the coming months, please look out for the Alabama Opioid Task Force’s unveiling of two websites designed to offer support and treatment for individuals with opioid abuse issues:
Alabama Opioid Overdose and Addiction Council. (2017). State of Alabama Opioid Action Plan. [PDF format]. Retrieved from http://www.mh.alabama.gov
CDC, National Center for Health Statistics. (2017). Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA. Available at http://wonder.cdc.gov.
Children’s Bureau. (2017). The AFCARS Report. [PDF format]. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families: Washington, D.C. Retrieved from https://www.acf.hhs.gov/sites/default/files/cb/afcarsreport24.pdf
Combatting the National Drug Demand and Opioid Crisis. 82 Fed. Reg. 50305. (October 26, 2017). Retrieved from https://www.federalregister.gov/documents/2017/10/31/2017-23787/combatting-the-national-drug-demand-and-opioid-crisis
Grant, J. (2018). Understanding the Opioid Epidemic. [Television broadcast]. In. J. Grant (Producer). Toronto: WNED-TV.
National Center on Substance Abuse and Child Welfare. (n.d.). Child welfare and treatment statistics. Retrieved from https://ncsacw.samhsa.gov/resources/child-welfare-and-treatment-statistics.aspx
Patterson, E. (n.d.) Opiate abuse. Retrieved from https://drugabuse.com/library/opiate-abuse/
Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
Substance Abuse and Mental Health Services Administration. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH, Series H-48, HHS Publication No. (SMA) 14-4863. [PDF format]. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf
U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth, and Families, Children’s Bureau. (2000-2016). The Adoption and Foster Care Analysis and Reporting System (AFCARS) Data Set.