Opioid misuse and family structure: Changes and continuities in the role of marriage and children over two decades.

Abstract

The opioid crisis is widely felt in the United States. Scholarly attention to the crisis focuses on macro-level processes and largely neglects meso-level explanations such as family structure for opioid use behaviors. We hypothesize that married adults and adults with coresident children are at lower risk of misusing prescription pain relievers (PPR), using heroin, and using needles to inject heroin relative to adults from other family structures. We used National Survey on Drug Use and Health data from 2002-2018 to test our hypotheses with multivariable logistic regression. We found that married adults have a lower predicted probability of each opioid use behavior relative to nonmarried adults across the study period. We also found that the presence of children is associated with reductions in all three outcomes especially for never married adults. Individuals from all family structures are vulnerable to the opioid crisis, but never married adults without coresident children ("disconnected adults") are especially susceptible to temporal fluctuations and drive the temporal trends in PPR misuse and heroin use. These findings suggest that ongoing demographic trends where disconnected adults are a growing population may result in future rises in opioid use disorders and mortality because of divestment from U.S. social safety nets. Future research should examine the role of U.S. policies that make disconnected adults especially vulnerable to developing opioid use disorders.