First of all, what is an opioid? “Opioids are substances that, when reaching opioid receptors, have effects similar to those of morphine.” The term includes classical opiate drugs like morphine, as well as newer opioid medications like hydrocodone (Lortab, Vicodin, or Norco); oxycodone (Roxicodone or “roxy,” Percocet, or OxyContin); fentanyl; and carfentanil. The illegal drug heroin is also an opioid. Misuse of prescription opioids is common because they make users feel good (in other words, they produce euphoria).

Most people know that a parent’s opioid addiction poses risk to a child, but what does that risk entail? This post examines how parental opioid addiction can endanger a child.

The Opioid Epidemic Crisis

We’ve all heard about the “opioid epidemic.” The opioid crisis is multilayered and for purposes of this post, I am not going to get deeply into how it all began.

However, it’s generally accepted that

There are legitimate medical uses for prescription opioids.
Prescription opioids are highly addictive.
The pharmaceutical companies that patented/manufactured prescription opioids deliberately downplayed the addictive potential of these medications while providing incentives to encourage doctors to prescribe them.
Heroin is less expensive than illegally-obtained opioid pharmaceuticals.
Many Americans have unwittingly become addicted to opioids after a surgery or other event requiring pain relief, and then out of desperation have had to turn to street drugs to feed their addiction.
“Heroin” obtained on the street is often not actual heroin. It is frequently some combination of cheaper opioids like fentanyl or carfentanil, and filler substances. “Oxycodone” and “hydrocodone” pills obtained on the streets are often not really oxycodone or hydrocodone. They too are often fentanyl or carfentanil pressed carefully to look like a legitimate pharmaceutical pill.
Because heroin and pills obtained on the street are often not what they claim to be, the dose contained therein can be unpredictable. Overdose is common. The danger in overdose relates to suppression of breathing. Narcan, a medication that can help reverse an overdose, is becoming more available. However, the dose in some of these fake drugs is so high that multiple doses of Narcan may not be successful in overcoming the overdose, and then the victim can die.

What does this all have to do with parenting? Opioids are highly addictive because they act on the users opioid receptors, disinhibiting the dopamine system. Most people addicted to opioids live from one high to the next, and are always looking for their next fix. Although there are casual users of prescription opioids, the person who tempts fate with casual recreational use is playing with fire. Users often find that addiction and dependency creeps in before they realize it. Denial of addiction is common.

Parental Focus and Priorities

Opioid use disorder affects the parent’s focus on the child’s needs. Parents who are high or “nodding” (a dreamlike state in which the user slips in and out of consciousness) are not alert enough to be responsible for children, especially very small ones. Parents who are constantly on the hunt for drugs are not thinking as much as they normally would about getting their children to school, feeding them, or otherwise meeting their needs. This can lead to neglect or abuse. Further, children may sense that something is “wrong” with the addicted parent, which can lead to psychological discomfort, fear, and trauma for the child.

Addiction’s Effects on the Parent’s Life

In general, people in the throes of addiction have difficulty “adulting.“ They might struggle to show up to work; pay bills; or maintain necessities like housing, utilities, driver license, vehicle, and insurance. Their lives become disorganized and focused on obtaining more of the drug. If addiction becomes very serious, the user may find him or herself on the fringes of society, engaging in drug sales, robbery/burglary, prostitution, or other illegal activity to feed the habit. This puts the parent at increased risk of arrest and incarceration, which on its own usually causes a disruption in custody of the child (see “The Trauma of Removal” below).

The Dangers of Withdrawal

Parents who need a fix and can’t get it experience withdrawal symptoms that can be debilitating. Opioid withdrawal is sometimes described as “flu-like”: chills, vomiting, diarrhea, and body aches. Users in withdrawal are often agitated and irritable. Parenting is hard enough for a parent not suffering from withdrawal Users can and do lash out.

People, Places, and Things

Parental opioid addiction also potentially exposes children to unsafe people (drug dealers and other adults using drugs), places (drug dealers’ homes, the homes of other users, sometimes the streets or other places a parent may try to obtain - or commit illegal activity to obtain - more drugs), and things (drugs, paraphernalia, or even illnesses a parents IV drug use may invite).

The Risk of Overdose

Opioid addiction is unsustainable in the long run. Because of the way that opioids act on the brain, users develop tolerance to the drug and need more and more to experience the pleasant feelings it produces. This is dangerous because the larger the dose, the greater the risk of overdose and death due to suppression of breathing.

There have been many instances of parents passing out in vehicles after ODing, leaving children trapped in car seats, helpless until rescued. Babies have found themselves alone after the overdose death of a parent, unable to call for help in any meaningful way. Overdose is a real risk, and it is unpredictable because street opioids themselves are unpredictable. A parent can reduce risk by never using without another adult present and always having Narcan on hand, but that is no guarantee of safety. Even if a parent recovers from passing out, the child is still unsupervised during the period of unconsciousness. Anyone who has ever had a child between the ages of 2-10 knows why this is a bad idea.

The Trauma of Removal

Parents who abuse opioids usually do not retain custody of their children if their use is brought to the attention of the courts. Removal of a child from a loving parent who has a drug addiction is a traumatic experience for the child. It is necessary for the child’s safety, but it has a lasting effect on the child. The child may feel rejected, internalizing a belief (true or not) that the parent cares more about drugs than he or she cares about the child. Children who are not told the reason for the change in custody may feel even more rejected because it may seem to them that their parent(s) left for no reason at all.

This insecurity may cause lifelong trauma to the child, following him or her into adulthood. It may affect attachment to caregivers and the ability to form secure relationships later on in life. It may even raise the risk of a child becoming addicted as an adult.

That is not to say that children should not be removed from their opioid-addicted caregivers. Staying in the care of such a person has its own dangers.

The Trauma of Staying with an Addicted Parent

Recent studies have demonstrated that children of parents with Opioid Use Disorder experience many opportunities for adverse childhood experiences (ACEs). According to one analysis of many such studies, “[f]amilies struggling with opioid addiction often have severe poverty, legal issues, and domestic violence, along with parental medical and psychiatric issues.”

Infants born with Neonatal Abstinence Syndrome (NAS) are often more difficult to parent due to feeding problems and incessant crying. Pair that kind of baby with a parent struggling with addiction, and the potential for abuse or neglect is obvious.

Source: National Institute on Drug Abuse

The research tells us that children of opioid-dependent parents can show disorganized attachment to caregivers (difficulty with bonding), as well as increased likelihood of emotional and behavioral issues (ADHD, anxiety, depression, etc), poor academic performance, and problems with social interaction. They are less likely, of course, to get these issues addressed by professionals if their parents are only focused on their next high.

In addition to all of the above, a child in the physical possession of an addicted parent is at risk of watching the parent overdose or even die. I know a 10-year-old who watched a parent die at the age of 3 or 4. This child can still recall the event in devastating detail. I know another child who, at age 6, was coached by the parent on how to administer Narcan. That child, thankfully, is no longer in a situation where he or she will ever have to worry about a caregiver overdosing; but many children are not so lucky. The risk to a child in an opioid-addicted parent’s custody cannot be overstated.

If You Are a Parent Struggling with Addiction, Help Is Available

Funding is available to help people who want treatment and cannot afford it. If you are in Tennessee, the state runs a hotline called REDLINE that assists people in finding referrals to treatment programs.

Please ignore the excuses and fears in your head and just reach out for help - if not for yourself, then for your precious innocent children who did not ask to be born into a family struggling with addiction. It’s the best thing you can do to protect their future and preserve your ability to have a healthy relationship with them that lasts well into their adult years.

How Does a Parent’s Opioid Addiction Endanger a Child?