Parental Methamphetamine-Opioid Co-Use and Child Welfare Outcomes

Background and Purpose: For families involved with the child welfare system, parental substance use is associated with increased odds of adverse child welfare outcomes. Additionally, substance use patterns are important, with research showing that methamphetamine and opioid use are associated with increased likelihood of placement in out-of-home care and lower rates of reunification when compared to other substance use.

An emerging drug trend is the co-use of methamphetamine and opioids (i.e., use of both drugs simultaneously or temporally near one another). Previous research shows that methamphetamine-opioid co-use is associated with increased hospital days, housing instability, social service use, and criminal justice involvement relative to opioid use alone. No studies to date have assessed how methamphetamine-opioid co-use relates to child welfare outcomes, so we aimed to determine the relationship between this and other patterns of substance use and parent custody at child welfare case closure.

Methods: This was a retrospective cohort comparison with families who entered child welfare because of substance use in one Midwestern state between 2014 and 2019 (N = 1,025 parents from 690 families). The independent variable was methamphetamine-opioid co-use. The dependent variable was child placement at case closure (parents retained custody vs. all other outcomes). Control variables included parent age, race, county, social services received, mental health services received, and the number of addiction treatment services received. Bivariate comparisons were conducted using chi-square and t-tests, followed by a multiple logistic regression to identify correlates of child placement at case closure.

Results: The overall prevalence of methamphetamine-opioid co-use was 20.7%. Across the six-year study period, prevalence significantly increased from 15.1% in 2014 to 26.5% in 2019. County rates significantly differed, ranging from 15.8% to 27.7%. Co-use did not differ based on sex or age but was more common among White parents (22.7%) than parents who were Black (9.5%) or of other races (8.3%). Parents who used methamphetamine alone or co-used methamphetamine and opioids received more addiction treatment services, social services, and mental health services compared to parents who used opioids without methamphetamine or other drug types, but were less likely to complete their first addiction treatment. In the multiple logistic regression model identifying correlates of parent custody at case closure, parents who used opioids without methamphetamine (OR = 1.599; 95% CI 1.122-2.279) or used other substances (OR = 2.333; 95% CI 1.532-3.552) had higher odds of retaining custody than parents who co-used methamphetamine and opioids. Mental health treatment (OR = 1.725; 95% CI 1.618-2.546) and number of addiction treatment services (OR = .937; 95% CI .891-.984) were also significant.

Conclusions and Implications: Consistent with national surveillance data, this study of parents involved with the child welfare system because of substance use showed increased prevalence of methamphetamine-opioid co-use. Co-use of methamphetamine and opioids was associated with higher likelihood of adverse child welfare outcomes relative to opioid use alone, but not methamphetamine use alone. The expansion of evidence-based behavioral treatments for methamphetamine use, such as contingency management, is needed, as are approved pharmacological treatments.