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Prenatal Opioid Exposure and Special Education Needs: A Sibling Study

Ira J. Chasnoff , Margaret Lloyd Sieger

Objective: To determine if prenatal opioid exposure places children at increased risk for using school-based special education services.

Method: Using a sibling-based quasi-experimental design via retrospective survey methods, an anonymous survey was distributed to a convenience sample of 2,860 parents/guardians of children with documented prenatal opioid exposure. Data for 720 children from 262 families were collected. The primary outcome was child utilization of special education, 504 plan or school-based behavior services, accounting for biological and environmental determinants via the sibling design, as well as 16 confounders including child age, race, biological sex, other substance exposures, birth weight, gestational age, per capita income, city and receipt of early intervention services.

Results: 482 opioid-exposed children were compared to 125 biological and 113 non-biological siblings. Opioid-exposed children had a 2.1 times increased incidence of specialized school-based services use compared to their non-exposed biological siblings (IRR=2.110, 95% CI=1.360-3.273, p<.01) and a 4.1 times increased incidence of service use compared to non-biological siblings (IRR=4.107, 95% CI=2.249-7.499, p<.001), controlling for covariates.

Conclusion: Prenatal opioid exposure is significantly associated with increased use of specialized school-based educational services in children 3 to 18 years of age compared to biological and non-biological siblings without opioid exposure.