Abstract
The opioid crisis occurring within rural communities of America is inflicting a devastating effect on individuals, their families, and children. This amplifies a gap in the available support for families in rural communities. The national, state, and local responses to the needs have been inconsistent and uncoordinated, demanding a critical and appropriate frontline response from those who spend the most time with the youngest and most vulnerable. This chapter describes the urgency of this crisis with information about the effects of opioid and substance abuse disorder on maternal-fetal health and young children. It identifies the role of early childhood professionals as frontline responders to support children and families affected by trauma associated with opioid and substance abuse disorder.
TopIntroduction
Sean, three years old, arrives at school late, too late to get breakfast. He was up early, but he couldn’t get his mom out of bed. She’d had a late night; he knows this because he was woken in the middle of the night by the sound of her yelling at her boyfriend. He checked to see if his little sister was awake. Sometimes she was able to sleep through the chaos. She was fine, so he covered his head with his pillow and hummed himself back to sleep. In the morning, his mother just wouldn’t wake up. He helped his sister sit in front of the tv, found his mother’s phone, and called his grandmother. She drove over and picked Sean and his sister up, and dropped Sean off at school. Because this was a frequent experience, his Head Start teacher, Mrs. Campbell, had saved some breakfast for him. He was grateful for this, as dinner the night before had been a slice of cheese and two crackers. He wanted to learn. He tried hard to concentrate on what the teacher was saying, but he was worried about his mom. Why wouldn’t she wake up? Would she remember to pick him up from school? Would Grandma take care of his sister? Being safe in school is only a temporary refuge for Sean.
According to the National Institute on Drug Abuse (2019d), an opioid is defined as, “a class of drugs that includes the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.” The abuse of these drugs has caused increasing issues at both a social and economic level, where the approximate economic burden is $78.5 billion in the United States (NIDA, 2019d). In 2017, more than 70,200 Americans died of drug overdose, with 68% of these opioid overdoses, including death from prescription medication, heroine, and the powerful synthetic drug, fetanyl (Center for Disease Control and Prevention (CDC), 2019). To provide a broader picture, more than 700,000 Americans died from opioid overdose between the years of 1999 and 2017 representing a six time increase in 18 years. This increase is the result of three distinct waves:
- 1.
1990’s: an increase in prescribing of opioids
- 2.
Beginning in 2010: an increase in overdoses involving heroin
- 3.
Beginning in 2013: a significant increase in deaths involving illicitly manufactured opioids such as fetanyl and combinations of fetanyl with heroin and cocaine
This final wave, in which we still find ourselves, has demonstrated the most dramatic of increases.
While much of the contemporary media attention has focused on the issues of opioid addiction in urban areas, the rise of opioid abuse in rural communities has increased dramatically in recent years. In October 2017, the Centers for Disease Control and Prevention indicated that deaths from drug overdose in rural communities was escalating at rates faster than in urban areas. Rural areas, as defined in the Growing up in Rural America Report, are nonmetropolitan and include open countryside and towns with fewer than 2,500 people as well as urban clusters with populations ranging from 2,500 to 49,000 people that are not part of a larger metro area (Save the Children, 2018).
Surveys have found that over 74% of farmers, ranchers and work hands have been directly impacted by opioid abuse (i.e., they know someone, have a family member, have taken an opioid themselves, or are currently dealing with or have dealt with opioid addiction) (National Farmers Union, 2017). As indicated by these data, there is an opioid crisis occurring within rural communities of America, a crisis that is having a devastating effect on individuals, their families and children. While statistics on deaths surrounding Opioid Use Disorder (OUD) are dramatic, the domino effects of this crisis affect the education and community for those tangential and most vulnerable of our population: young children. The trauma these infants, toddlers and preschoolers experience often has long-term and devastating effects on their psycho-social development and educational trajectory.
Key Terms in this Chapter
Early Childhood: The distinct period between birth and eight years old during which children grow and develop at a rapid pace and the brain is especially susceptible to environmental factors.
Family-Centered: An approach that considers the family system as a critical component in developing relationships with a child.
Early Childhood Educator: A professional who has the knowledge and skills and preparation to work with children birth to age 8 and their families to create positive learning environments and rich learning experiences.
Neonatal Abstinence Syndrome (NAS): Conditions that occur when a fetus is exposed to opioids in utero and the newborn often experiences the side effects of withdrawal (e.g., tremors, diarrhea, sleep difficulties, and irritability).
Adverse Childhood Experience (ACE): Abuse, neglect, and traumatic events that happen before a child turns 18 and are associated with chronic health conditions, decreased quality of life, deficient educational outcomes and potential early death.
Preschool: General category of learning environments for children, typically 3-5 years old.
Bronfenbrenner’s Ecological Systems Model: A framework conceptualized by psychologist Dr. Urie Bronfenbrenner emphasizing the quality, context and inter-connectedness of a child’s environment as impactful on a growth and development.
Home Visiting: An intentional curriculum in which trained early childhood professionals take the curriculum to the child and provide services in the child’s home as well as work with the child’s family. Home visiting often allows for early childhood educators to forge a deeper relationship with a family.
Head Start: Comprehensive federal program providing health, nutrition and educational services for children birth to five years old whose families are classified as “in poverty” according to federal guidelines.