Public attention to the historic wave of opioid addiction gripping the U.S. has focused mostly on its effect on adults and the thousands who have died of overdoses. Missed by much of the spotlight, though, is a hidden epidemic: children who have fallen victim to opioids' wrath because a parent's drug use has left them in danger and thrust them into the foster care system.
A look at the issues surrounding children caught up in the opioid epidemic:
• Full coverage: Minnesota's opioid crisis
What is happening?
Abuse of painkillers, heroin, fentanyl and other opioids across the country has resulted in tens of thousands of children being removed from their homes and placed in the foster care system. New foster care cases involving parents who are using drugs have hit the highest point in more than three decades of record-keeping, accounting for 92,000 children entering the system in 2016, according to data by the U.S. Department of Health and Human Services. That's one-third of the 274,000 children who entered foster care in the U.S. last year. From 2012 to 2016, the country saw a 32 percent spike in drug-related foster care cases.
How is this any different than before?
Drugs have always been a major driver of children into the foster care system, but officials haven't seen something of this magnitude since the wave of crack cocaine use in the 1980s.
Today's opioid epidemic is the deadliest surge of drug use in the country's history. That fact alone leads many to believe it could also amount to the most significant impact the country's foster care system has ever seen.
Officials' assessment of the effect on children, though, has been less immediate than that of the deadliness of the epidemic or pressing law enforcement and health needs. The speed at which foster cases proceed through the court system and at which child welfare officials report data has contributed to that delay.
Was the system prepared for this?
The rise in foster children due to parental drug use reversed a trend toward fewer new foster care cases in the decade preceding 2012. State and local officials, in turn, have been left trying to accommodate the influx of children. That means recruiting new foster parents, asking existing ones to take on another child, and increasing capacity in emergency shelters, group homes and other places that house wards of state.
In some areas, staffing at child welfare agencies and in family and juvenile courts has been increased. The crisis also has officials weighing how to stem the tide by further increasing access to substance abuse treatment, and examining the way courts treat such cases.
What becomes of the kids' parents?
Opioid addiction is claiming astounding numbers of American lives. The Centers for Disease Control and Prevention estimated 15,000 people died of prescription opioid overdoses in the U.S. in 2015, another 13,000 died of heroin overdoses, and more than 9,500 were killed by fentanyl and other synthetic opioids. Children have been orphaned by those deaths. Many others who are struggling with addiction have faced losing permanent custody of their children.
Once a child enters foster care, federal law puts a timeline on how long parents have to comply with a court's orders that they get clean. Parental rights can be terminated for those whose children have been in foster care for 15 out of the previous 22 months. Some parents, unable or unwilling to get clean, voluntarily relinquish their rights and hand over their children to a relative or foster parent.
Who are these children?
Children of all ages have been caught up in the addiction of their parents, but on average, they are about three years younger than other foster children, according to an Associated Press analysis of statistics obtained from the National Data Archive on Child Abuse and Neglect.
Rampant opioid addiction has extended to pregnant women, resulting in infants born with exposure to the drugs and pulling down the average age of children who enter the system because of a parent's drug use.
About three-fourths of foster children who land in the system because of parental drug use are white.
Child welfare officials often look to other family members to place a youngster with, and grandparents around the country are raising children again late in life because of their own child's drug use. Opioid addiction has paralyzed two or more generations of a single family in some cases, though, complicating efforts to keep a child with blood relatives.
What happens to these babies?
Babies exposed to opioids by their mother's use during pregnancy are often born with a condition known as neonatal abstinence syndrome and can go through an agonizing withdrawal — reflected in a distinctive high-pitched cry, tremors in the arms and legs, and difficulty sleeping. Such babies are often born premature and underweight, and their mothers' drug use increases their risk for exposure to hepatitis and HIV.
Hospitals around the U.S. have begun testing newborns for drug exposure, and authorities are routinely involved when babies test positive. In many cases, they enter the foster care system in their very first days.