The opioid epidemic is one of the largest public health crises in a generation, and it takes place against a backdrop of deep and growing structural inequality in the nation’s social, economic, and political landscapes. To date, most of the response to the opioid epidemic has focused on people directly affected by problem drug use and addiction. Yet, about 8.7 million children ages 17 and younger live in households with at least one parent with a substance use disorder, and an estimated 623,000 parents with opioid use disorder live with children. A comprehensive approach to fighting the opioid epidemic must account for the unique needs of children and families, acknowledge the family caregiving roles and responsibilities of people who use drugs, and provide effective care and supports long before addiction emerges. Drawing on interviews with national experts in the field and site visits to two Appalachian communities significantly affected by the epidemic, we sought to identify how the opioid epidemic is affecting children in families touched by problem drug use, how parents or caregivers could be better supported, and how service providers and systems could be better positioned to support families affected by the crisis. It is important to note, however, that the communities we visited do not represent the wide range of communities and local contexts relevant to this nationwide epidemic. We also explore how systems and settings that support children and families are responding to the opioid crisis. These systems include early care and education, K–12 schools, primary and other health care settings for both children and parents, and, for parents, employment and training settings. We also investigate if and how safety net policies or practices have come into play
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