This research brief examines trends in opioid misuse and child welfare outcomes in New York State between 2006 and 2016. It finds that increases in opioid misuse and rates of child maltreatment were geographically concentrated, with many counties in Central NY and the Southern Tier experiencing high increases in both measures. Specifically, 17 counties saw above-median increases in both opioid emergency department admissions and reported child maltreatment rates, indicating particular vulnerability in these regions. In contrast, most counties downstate like in the Hudson Valley saw below-median increases in both measures.

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NEW YORK STATE BRIEF
January 2019
TrendsinOpioidMisuseandImplicationsforChildWelfarein
NewYorkState
The opioid epidemic has become a national
public health crisis; an estimated 2.1 million
people are currently living with an opioid use
disorder.i The epidemic has had devastating
effects on communities, with approximately
115 Americans dying every day from opioid
overdoses.ii Rates of overdoses have continued
to rise over the past two decades.iii From 1999
to 2016, the drug overdose death rate from
synthetic opioids (excluding methadone)
increased from 0.3 to 6.2 deaths per 100,000
population.iii
Many professionals in the child welfare field
believe that the increase in opioid misuse has
had adverse effects on the welfare of children
and may be linked to the recent growth in the
national rate of children entering foster care.
Between 2012 and 2016, the number of
children in foster care nationally rose by 10
percent, after more than a decade of sustained
declines.iv Rates of child maltreatment also
increased during this time period.v There may
be a connection to parental substance misuse,
as the percent of victims with a risk factor
designation of parental drug abuse increased
from 19.8% to 25.5% from 2012 to 2015.vi Both
trends are also geographically concentrated, as
counties with higher overdose death and drug
hospitalization rates also have higher caseload
rates.vii
The purpose of this research brief is to examine
whether and how these national trends have
affected New York families and children. We
provide an overview of county-level trends in
opioid misuse and child welfare caseloads and
examine the relationship between the two. We
identify counties that are particularly
vulnerable and may benefit from additional
resources to mitigate the impact of the opioid
epidemic on families and children.
New York State Trends and
County Variation
Opioid Misuse
Opioid misuse in New York State has risen
markedly over recent years, mirroring trends
observed at the national level. The state-wide
rate of overdoses from opioid pain relievers and
heroin increased 100% from 2010 to 2015--
from 5.4 to 10.8 deaths per 100,000
population.viii Similarly, outpatient emergency
department (ED) visits related to opioid use
increased by 73% from 2010 to 2014.ix
Within New York State, the severity of opioid
misuse varies considerably. Figure 1 maps
opioid ED admission rates per 100,000 in 2016
across New York counties.
The state-wide rate of overdoses from
opioid pain relievers and heroin increased
100% from 2010 to 2015--from 5.4 to 10.8
deaths per 100,000 population.

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While seven counties reported opioid ED
admission rates above 90 per 100,000, over 10
counties had rates below 27 per 100,000. The
visual representation of admission rates in
Figure 1 hints that higher levels of misuse are
concentrated in Central NY, Western NY and
the Southern Tier, with Onondaga, Cayuga,
Niagara, and Broome County comprising five
of the seven counties with ED admission rates
above 90 per 100,000. Moreover, Figure 1
reveals that, with the exception of Steuben
County, counties with the lowest rates of
misuse are located in NYC, Long Island, Hudson
Valley and North Country.
Foster Care Entry & Maltreatment
Foster care entry is one measure of child
welfare outcomes. Unlike national trends,
New York State as a whole has shown
improvement in this measure; from 2007 to
2016 there was a decline in the number of
foster care entries statewide.x Another
measure of child welfare is indicated rates of
maltreatment, and New York as a whole also
fared better than national trends on this
measure – statewide rates changed little over
this period.xi
Figure 1. 2016 Opioid ED Admission Rates per 100,000 population
Data Source: New York State Department of Health

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Not all counties mirror the statewide trends,
however. Figure 2 maps reported
maltreatment rates per 1,000 children in 2015
across New York counties. Similar to patterns
in opioid ED visits, counties reporting high
rates of reported maltreatment were heavily
concentrated in the Southern Tier and Central
NY. Out of the thirteen counties that fell within
the highest range of reported maltreatment
rates (between 124.12 and 157.24 per 1,000),
six were located in these two regions of the
state. Moreover, out of the counties reporting
the lowest rates of reported maltreatment
(between 21.73 and 54.72 per 1,000) all but
one were located in Hudson Valley, NYC and
Long Island.
Figures 1 and 2 show that in 2015 and 2016
respectively, many counties in the Southern
Tier and Central NY had high rates of both
opioid misuse and child maltreatment,
whereas most counties in Hudson Valley, NYC
and Long Island had lower rates for both
measures.
Data Source: New York State Office of Children and Family Services
Figure 2. 2015 Reported Maltreatment Rate per 1,000 Children
In 2015 and 2016, many counties in the
Southern Tier and Central NY had high
rates of both opioid misuse and child
maltreatment, whereas most counties in
Hudson Valley, NYC and Long Island had
lower rates for both measures.

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County Concentrations: Trends in Opioid Misuse
& Child Maltreatment
Figure 3 shows the association between
county changes in opioid misuse and
maltreatment rates between 2006 and
2015/2016. It divides counties into four
classifications based on low or high increases
in rates of opioid ED admissions and reported
maltreatment rates: High Opioid-High
Maltreatment, High Opioid-Low
Maltreatment, Low Opioid-High Maltreatment
and Low Opioid-Low Maltreatment. High/Low
classifications were based on above/below
median change in opioid ED admission rates
(median increase was 48 per 100,000) and
change in reported maltreatment rates
(median increase was 14).
The seventeen counties (Broome,
Cattaraugus, Cayuga, Chenango, Cortland,
Erie, Genesee, Herkimer, Niagara, Onondaga,
Oswego, Otsego, Rensselaer, Sullivan,
Tompkins, Wayne and Yates) falling into the
High-High category are of particular concern as
this indicates both high increases of opioid
misuse and child maltreatment. Thirteen of
these seventeen counties are located in
Western NY, the Finger Lakes, Central NY and
the Southern Tier. The majority of counties
with low increases in opioid ED admissions and
reported maltreatment (Low-Low) are located
in North County, the Capital District and the
Hudson Valley.
Data Sources: NYS Office of Children and Family Services,
NYS Department of Health
Figure 3. 2006-2015/2016 Increase in Opioid ED Admissions and Reported Maltreatment
Rates
Increases in opioid misuse and child
maltreatment from 2006 to 2015/2016
were geographically concentrated in
Western NY, the Finger Lakes, Central NY
and the Southern Tier.

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Appendix
Opioid ED Rate per 100,000 Reported Maltreatment Rate per 1,000
County 2006 2016 Change 2006 2015 Change
ALBANY 11 37 26 106 94 -12
ALLEGANY 5 67 62 98 110 12
BRONX 9 31 22 72 71 0
BROOME 6 98 92 93 142 49
CATTARAUGUS 9 72 63 113 148 35
CAYUGA 5 98 94 75 110 35
CHAUTAUQUA 10 48 39 116 136 20
CHEMUNG 6 55 49 124 131 7
CHENANGO 6 59 54 92 139 47
CLINTON 4 30 25 94 119 25
COLUMBIA 11 47 36 99 124 25
CORTLAND 9 89 80 106 127 21
DELAWARE 9 52 43 103 130 27
DUTCHESS 10 35 25 58 70 12
ERIE 16 120 103 66 96 31
ESSEX 8 26 18 102 100 -2
FRANKLIN 6 20 14 86 144 58
FULTON 5 39 34 121 133 12
GENESEE 15 80 65 78 97 20
GREENE 11 99 88 121 132 10
HAMILTON 0 66 102 36
HERKIMER 15 84 69 78 101 23
JEFFERSON 8 37 28 88 93 5
KINGS 7 20 13 46 39 -7
LEWIS 9 37 29 62 75 13
LIVINGSTON 7 54 47 79 89 9
MADISON 6 74 68 95 103 8
MONROE 10 62 52 52 62 10
MONTGOMERY 11 54 44 103 122 19
NASSAU 4 26 22 29 32 2
NEW YORK 9 14 6 48 40 -8
NIAGARA 13 107 93 88 108 20
ONEIDA 11 80 69 99 105 7
ONONDAGA 14 103 89 68 84 16
ONTARIO 10 59 49 73 84 11
ORANGE 16 67 51 41 52 11
ORLEANS 11 84 73 100 97 -2

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Opioid ED Rate per 100,000 Reported Maltreatment Rate per 1,000
OSWEGO 6 65 59 89 157 69
OTSEGO 11 59 48 76 103 26
PUTNAM 6 39 33 25 28 2
QUEENS 4 14 10 36 34 -3
RENSSELAER 8 58 50 90 110 21
RICHMOND 6 53 48 42 43 1
ROCKLAND 5 11 6 21 22 0
SARATOGA 6 50 44 47 55 7
SCHENECTADY 7 78 70 106 113 7
SCHOHARIE 8 54 46 88 97 10
SCHUYLER 14 39 24 83 107 24
SENECA 14 66 53 140 130 -10
ST. LAWRENCE 8 43 35 89 108 19
STEUBEN 14 26 12 105 102 -3
SUFFOLK 9 73 64 40 44 4
SULLIVAN 16 102 85 99 117 18
TIOGA 4 38 35 78 99 20
TOMPKINS 6 55 50 73 101 29
ULSTER 12 59 48 72 88 16
WARREN 4 42 38 82 105 23
WASHINGTON 4 29 25 110 142 32
WAYNE 4 63 60 71 89 18
WESTCHESTER 7 18 11 34 37 4
WYOMING 11 56 45 59 80 20
YATES 13 88 74 77 92 15

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i
U.S. Department of Health and Human Services. (2018). What is the U.S. opioid epidemic? Retrieved from:
https://www.hhs.gov/opioids/about-the-epidemic/indez.html
ii
Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS). (2017). Understanding
the epidemic. Retrieved from: https://www.cdc.gov/drugoverdose/epidemic/index.html
iii
Hedegaard, H., Warner, M., & Miniño, A. M. (2017). Drug overdose deaths in the United States, 1999-2016.
Washington, DC: National Center for Health Statistics.
iv
Radel, L., Baldwin, M., Crouse, G., Ghertner, R., & Waters, A. (2018). Substance use, the opioid epidemic, and the child
welfare system: Key findings from a mixed methods study. Office of the Assistant Secretary for Planning and Evaluation.
v
https://www.childtrends.org/indicators/child-maltreatment
vi
Child Welfare Information Gateway. (2016). Child maltreatment 2014: Summary of key findings. Washington, DC: U.S.
Department of Health and Human Services, Children’s Bureau
vii
Ghertner, R., Waters, A., Radel, L., & Crouse, G. (2018). The role of substance use in child welfare caseloads. Children
and Youth Services Review, 90, 83-93.
viii
New York State Department of Health. (2017). Opioid-related data in New York state. Retrieved from:
https://www.health.ny.gov/statistics/opioid/
ix
New York State Department of Health. (2015). Opioid poisoning, overdose and prevention: 2015 report to the
Governor and NYS Legislature. Retrieved from:
https://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/docs/annual_report2015.pdf
x
New York State Kids Well-Being Indicators (KWIC). (2017) Retrieved from: http://www.nyskwic.org/
xi
New York State Kids Well-Being Indicators (KWIC). (2017) Retrieved from: http://www.nyskwic.org/