The relationship between foster care entries and high-dose opioid prescribing in California

Troy Quast, Melissa A. Bright, Chris Delcher

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


An important effect of the current opioid epidemic is on children whose parents are unable to provide appropriate care. We employ quarterly, county-level data for California for 2009–2016 to study the relationship between foster care entries and opioid misuse by their parents. Our linear regression analysis includes both county and time fixed effects and controls related to child removal risk. We improve on the limited existing research in the area by analyzing higher frequency data, examining a proximal measure of opioid abuse, and allowing for differential associations by urbanicity. We found a positive association between the rate of child removals and the rate of residents who were cumulatively prescribed a high dose of opioids (>90 morphine milligram equivalents (MMEs) per day) during the quarter. A one standard deviation in this rate is associated with a roughly 9% increase in the overall removal rate. We further found that the association between removals and high MMEs is especially pronounced in rural areas and largely not existent in urban areas. Our results provide a more precise estimate of the relationship between the potential for opioid misuse and child welfare.

Original languageEnglish
Pages (from-to)52-58
Number of pages7
JournalAddictive Behaviors
StatePublished - Jun 2019

Bibliographical note

Publisher Copyright:
© 2019


  • California
  • Foster care
  • Opioids
  • Urbanicity

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Clinical Psychology
  • Toxicology
  • Psychiatry and Mental health


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