Naomi Schaefer Riley is a senior fellow at the American Enterprise Institute.
GLP-1 drugs like Ozempic and Wegovy are often called miraculous for their ability to promote weight loss, reduce the risk of diabetes, and even lower the likelihood of dementia. But what if they can help combat drug and alcohol addiction by tempering cravings and ultimately prevent parents from losing their children to foster care?
GLP-1s have been shown to reduce cravings for alcohol, opioids, cocaine, and methamphetamines. The Allegheny County Department of Human Services in Pennsylvania is now hoping to partner with philanthropic foundations to pay individuals with substance use disorder at high risk of going to jail to take one of these drugs in order to mitigate their drug abuse. More than a third of people eligible for the project have also had a “screened in” referral to child welfare, meaning someone reported them for allegedly abusing or neglecting a child in their care and the department thought it was plausible enough to launch an investigation.
Across the country, the drug crisis is fueling child abuse and neglect. Pediatric poisonings, children deprived of food or medical care because their parents are high, and kids who are exposed to dangerous individuals so their parents can access drugs are some of the most common factors in the more than 2,000 child maltreatment fatalities that occur each year. Up to 90 percent of families involved with the child welfare system are affected by substance use disorders.
In response to this reality, the Trump administration recently announced that states could put the Title IV-E money that flows to the states for child welfare toward drug treatment programs for parents. But offering programs is not enough to get parents to stop using drugs, as many jurisdictions are finding out the hard way. A 2021 law in Washington state offered parents voluntary drug treatment and mental health services. More than two-thirds of the families refused.
Washington, D.C., and Illinois, meanwhile, have recently launched programs to give parents in the child welfare system unrestricted cash. Advocates of this solution generally argue that such families suffer primarily from a lack of financial resources and that — even if they do have drug problems — they are largely caused by poverty. But handing cash to those with substance use disorder may not improve their parenting and (by funding their drug use) may actually make things worse.
As a precursor to the GLP-1 project, Allegheny County recently launched a program (funded by the philanthropy Arnold Ventures, which is also reviewing a proposal for the GLP-1 study) to pay up to 500 people to stay off drugs and alcohol using more traditional medications. In return for incentives starting at $2 per day and other payments, participants who have experienced involuntary hospitalization because of mental illness and/or substance use disorder or who are at risk of hospitalization are offered long-lasting medications to improve their condition. These include injections of Sublocade and Vivitrol to treat opiate and alcohol addiction. About a third of this group also had a “screened in” child welfare referral.
“Child welfare can’t be naive,” Alex Jutca, interim director of the Allegheny County Department of Human Services, told me. “I read cases where we are a little bit too credulous about what’s going on in these homes. If you have a parent in the throes of addiction and they’re not willing to take steps to fix it. … Even if they are willing, it’s still red alert.”
Removing children may be warranted and may even help, but he also argues that “what we do with these folks with respect to support is wildly inadequate.” Sending people “text messages every two weeks” to remind them about treatment programs or rehab is not an adequate response. “We can’t think about these things episodically.”
Contingency management — in which people are paid small amounts to stay clean — has a promising record. Allegheny is “applying well-developed scientific literature” in a real-world context, said Stephen Higgins, director of the Vermont Center on Behavior and Health. And long-acting medication — whether a weekly injection of Wegovy or a monthly injection of Sublocade — is a better idea than daily methadone administration because, as Higgins explained, “in populations with problems where adherence is a problem, the fewer times you need to get them to adhere the better the chances of success.” A recent experiment comparing outcomes of people released from jails in Maine found that those who went on long-acting medication were more likely to remain drug-free and were less likely to die from an overdose in the year following release.
Jutca is hopeful about GLP-1s. Because this class of drugs has wide-ranging health benefits and few side effects compared to other medically assisted treatments for addiction, people may be more incentivized to participate. And unlike methadone, GLP-1s are not controlled substances. There is no risk of overdose, so they don’t require the same levels of supervision for use.
Higgins tells me he is hopeful about the Allegheny project’s impacts on child welfare. “These psychiatric conditions and drug addiction wreak havoc in families. Getting people to take these meds will keep families together.”