The opioid epidemic’s toll is wide-ranging and long-lasting, measured not only by lives lost but by families disrupted and communities strained. One dimension of the epidemic’s ripple effect that is critically important but not well understood is its impact on children. While there have been some dramatic and heart-wrenching media accounts of the struggles experienced by children of parents with opioid addiction—from foster care entry to disrupted learning to opioid withdrawal—essential questions remain: How many children are facing the consequences of the opioid epidemic? In what ways are they affected? And what is the societal cost? 

A new analysis by United Hospital Fund and Boston Consulting Group, The Ripple Effect: National and State Estimates of the U.S. Opioid Epidemic’s Impact on Children, offers national and state-level estimates that provide some answers. Among the findings: 

In 2017, an estimated 2.2 million children and adolescents had a parent with opioid use disorder (OUD) or had OUD themselves. This breaks down into the following categories: 

  • 1.4 million children living with a parent with OUD;
  • 325,000 children who have been removed from home and live in foster or kinship care due to opioids;
  • 240,000 children who have had a parent die due to opioids;
  • 10,000 children who have a parent in long-term imprisonment due to opioids; and
  • 170,000 children who have OUD themselves or have accidentally ingested opioids. 

The rate of children affected by the opioid epidemic in 2017 varied significantly from state to state. West Virginia had the highest rate (54 per 1,000 children) and California had the lowest (20 per 1,000). 

If current trends continue, an estimated 4.3 million children will have had OUD or a parent with OUD by 2030.

By 2030, the cumulative, lifetime cost of the “ripple effect” will be $400 billion. This includes additional spending in health care, special education, child welfare, and criminal justice stemming from the multiple impacts of parental opioid use disorder on a child’s physical, mental, and social-emotional health. It does not include productivity losses or missed opportunities. 

These numbers should make every policymaker sit up and take note. Childhood adversity—such as living in a household with a family member with substance use disorder or being separated from a parent—has been strongly linked to a wide range of negative outcomes. These include poor school performance, early emergence of chronic disease, and an increased likelihood of developing a substance use disorder (the latter of which contributes to intergenerational cycles of addiction). 

The good news is that policymakers can act now to avoid this harmful toll on children, as well as the nation’s purse. The key is focusing on the needs of parents and children simultaneously. States should dramatically scale up access to medications for opioid use disorder for parents (including pregnant women) while also employing strategies that promote resiliency in the face of child adversity. Such interventions include combining treatment for parents with family-based mental health services; increasing the availability of recovery-friendly pediatric and OB/GYN practices; and investing in evidence-based healthy youth development programs. 

It’s clear that there is no magic bullet: a single intervention won’t work. To tackle the threat the epidemic poses to the next generation, every state opioid response plan must include a comprehensive strategy focused on supporting families with substance use disorders and investing in the healthy development of their children. Likewise, all opioid-related legislation and settlements must include a plan for supporting children affected by the crisis. A vigorous response is needed to reduce harm to our nation’s youth from the long-lasting consequences of this public health emergency. 

Read the full report and access your state’s estimates.