Side Effects May Include Poor Parenting

According to the standard Grossman model, individuals’ consumption of medical care yields benefits in two dimensions. As a consumption benefit, improved health from consuming medical care yields greater utility, in and of itself. Improved health also yields investment benefits in the form of increased labor productivity and higher wages. At times, the health economics literature also acknowledges other spillover effects from medical care usage, including those to the family, but often these are difficult to measure.

In this paper, we examine how one form of medical care, the usage of prescription opioids to treat pain, affects adverse family outcomes such as engagement of child protective services, engagement with the foster care system, domestic violence, and tendency for children to run away from home. Ex-ante, it is unclear how opioid use should affect these outcomes. If some proportion of parents are suffering from conditions which result in chronic pain, the right dosage of opioids may yield therapeutic value, thereby enabling parents to more fully engage with their children and reduce the incidence of these adverse outcomes. Alternatively, if overprescribing and/or improper use is more common, increased opioid prescribing may lead to greater numbers of adverse outcomes. Our model is identified using an instrumental variables through the presence of high-volume prescribers and the implementation of must access PDMP programs, similar to Buchmueller and Carey (2018) and Harris et al. (2018). Using data from multiple sources, including the Prescription Drug Monitoring Programs of ten states, county level data from AFCARS (Adoption and Foster Care Analysis and Reporting System), NCANDS (National Child Abuse and Neglect Data System), and data from the Bureau of Justice Statistics, we find that higher levels of opioid prescribing are linked to greater engagement of foster care services, and increased numbers of complaints for child neglect, but not abuse. Similarly, in the UCR data, we find that areas with more prevalent opioid prescribing lead to increased arrests for runaways, but not for domestic violence. All of these result are consistent with the pharmacological depressant effect of opioids: increased prescribing leads to greater apathy/neglect, but not increased violence or aggression.