By Michelle Ries

Opiate use is increasingly affecting children and families in North Carolina, and many stakeholders agree that primary prevention of trauma and adverse childhood experiences (ACEs), and the expanded infusion of trauma-informed practices into state efforts to address opiate use, are necessary tools for combating this problem.

Research has shown a link between trauma and ACEs and opioid addiction; while an estimated 75% of individuals with substance use disorders have experienced trauma, rates are even higher for individuals seeking treatment for opioid addiction. A 2016 study showed that people reporting five or more ACEs were three times more likely to misuse prescription opiates, and five times more likely to use injected drugs.[1] Strategies that focus on resiliency for children experiencing ACEs can help mitigate their impact and can help fight the opioid crisis facing our state.

Several states have initiated programs that focus on the prevention of childhood trauma as a key tool in addressing opiate use. In West Virginia, the Martinsburg Initiative aims to reduce opiate use by establishing community partnerships between schools, police, and other stakeholders. Participating stakeholders work to reduce trauma and ACEs through parenting classes, mentoring programs, mental health care, and other activities.[2] Generally, programs aimed at reducing childhood trauma and improving children’s well-being and mental health show significant cost savings; RAND estimates lifetime net benefits per child served at between $1,400 and $240,000, with the largest benefits associated with programs with longer-term follow up.[3]

While there is currently some debate over the direct impact of opiate use on the child welfare and foster care systems in North Carolina, the percent of children entering foster care with parental substance use as a factor in out-of-home placement has increased from 30.6% in state fiscal year 2009-10 to 41.7% in state fiscal year 2017-18. In addition, the number of hospitalizations associated with drug withdrawal in newborns in North Carolina rose from 125 in 2004 to 1,392 in 2017.[4]

Through the North Carolina Essentials for Childhood initiative, a public health framework for child maltreatment prevention, the NCIOM is facilitating a series of stakeholder discussions to identify feasible strategies that address risk and protective factors for trauma and ACEs, and the relationship to opioid misuse/overdose. Many potential strategies for preventing ACEs—including home visiting, parent training and social support programs, high-quality child care, and improved access to behavioral health care—were recommended by the 2015 Essentials for Childhood task force and may also prove valuable investments for the prevention of opioid use and related fatalities.

[1] Campaign for Trauma-Informed Policy and Practice, Trauma-Informed Approaches Need to be Part of a Comprehensive Strategy for Addressing the Opioid Epidemic. June 2017. http://www.acesconnection.com/fileSendAction/fcType/0/fcOid/468137553024138668/filePointer/468278290830069822/fodoid/468278290830069817/CTIPP_OPB_final-corrected.pdf

[2] The Martinsburg Initiative. http://www.martinsburgpd.org/downloads/TMI-1Page.pdf

[3] Karoly, L.A., et al. Early Childhood Interventions. RAND  Labor and Population. 2005. https://www.rand.org/content/dam/rand/pubs/monographs/2005/RAND_MG341.pdf

[4] NC Department of Health and Human Services. Impacts of Substance Use on Families. January 2019.