A prescription for fighting the opioid epidemic: Evidence-based policies and practices (Urban Institute)

By Arden Kreeger 

With opioid use soaring, people who have become addicted to these drugs are not the only ones who may need assistance: The children of parents struggling with addiction are also affected, and may be at a higher risk for child abuse and neglect. As policymakers and others attempt to address the opioid epidemic, it is important to strengthen evidence for programs that can tackle parental addiction while also protecting kids and keeping families together.

Legislation recently introduced in the House would establish a grant program for states and local governments to provide services for the prevention and treatment of opioid misuse and abuse. As Congress is poised to make a major investment in the epidemic, policymakers are considering how evidence and data can inform decisions about how to use potential new funding sources. New legislation is an opportunity to further test approaches and understand more about what works and what does not.

Two weeks ago, the House Ways and Means Human Resources Subcommittee held a hearing examining the effectiveness of programs designed to address parental substance abuse and protect children from harm, state efforts to use data to identify at-risk children, and the impact of the epidemic on the child welfare system. The hearing included testimonies on three interventions:Sobriety Treatment and Recovery Teams (START),  Family-Based Recovery (FBR), and the Women and Children Residential Services program in Texas. A witness from Eckerd Kids, a nonprofit that manages the country’s largest privately operated child welfare program, also testified on using data to protect children in the child welfare system.

Pay for success (PFS) is one way governments are thinking about building the evidence base around addiction treatment. The Connecticut Family Stability Project is the first PFS project to tackle substance abuse by scaling FBR, an in-home parent-child therapy and contingency management substance abuse treatment program that helps children develop optimally in drug-free, safe, and stable homes with their parent(s).

Prior to the project, analysis of non-experimental evidencesuggested FBR has positive outcomes for families, but the randomized control trial (RCT) used to measure outcomes in the PFS project will be the first rigorous evaluation of the intervention. It is too early to know any evaluation results, but by the end of the project in 2020, we will have valuable insight into the ways FBR might help communities struggling with substance abuse.

START, an integrated treatment intervention for families affected by both child abuse and neglect and parental substance abuse, is currently undergoing its first randomized evaluation in Louisville, KY. To date, START has undergone one matched comparison group design and onegroup pretest-post test study, both of which showed positive outcomes for parents achieving sobriety and maintaining custody of their children. The RCT will provide valuable evidence to expand our understanding of how START might contribute to positive outcomes for families and communities.

There is also evidence that prevention and treatment strategies such as better prescription practices, education initiatives in school and community settings, and medication can be effective for opioid use disorders. But in order to learn more about what works, and to make sure proven practices reach communities that need them, governments and social service providers alike should test and evaluate new strategies in the fight against the opioid epidemic.

As an organization, the Urban Institute does not take positions on issues. Scholars are independent and empowered to share their evidence-based views and recommendations shaped by research.