Inheriting Risk: Theory and Evidence on Parental Substance Use, Child Outcomes, and PDMP Mandates

• In Event: Regulating Risk: State Policy and Health Outcomes Across Substance Use and Reproductive Care

Abstract

This paper examines whether strict mandatory access Prescription Drug Monitoring Programs (PDMPs) affect primary caregivers’ mental health and children’s mental health and educational outcomes, and whether effects differ by household substance-use risk. We develop a theoretical model of parental health management under present bias, where PDMP constraints can reduce impulsive opioid use but may induce harmful substitutions and household stress. Using 2016–2023 National Survey of Children’s Health data linked to state-level PDMP adoption, we estimate two-way fixed-effects and staggered adoption event-study models. Household substance-use risk is large: any adult tobacco use, indoor smoking, or a caregiver alcohol or drug problem raises poor or fair caregiver mental health by 24, 21, and 36 percentage points (pp) and elevates child anxiety, low school engagement, and grade repetition. PDMPs reduce caregiver distress by 2.1 pp and low engagement by 1.1 pp. Treatment-effect heterogeneity by household risk shows mandates widen academic failure in high risk homes: grade repetition increases by 1.6 pp (tobacco), 2.4 pp (indoor smoking), and 1.5 pp (caregiver substance problem), and behavior problems rise by 2.6 pp when a caregiver reports substance problems—concentrated among boys, younger children, and poorer families. Event studies confirm parallel pre-trends and reveal persistent post-mandate increases in grade repetition. Findings imply PDMPs deliver modest caregiver benefits but can magnify educational disparities. Strict mandatory access PDMPs yield modest average gains, improved caregiver mental well-being and slightly better school engagement. In homes with tobacco exposure, indoor smoking, or caregiver substance problems, mandates coincide with worsening academic progression and, when substance problems are present, there are more behavioral difficulties. The policy takeaway is straightforward: PDMPs are necessary but insufficient. Pairing monitoring with accessible non-opioid pain care, medications for opioid use disorder, and smoking-cessation support, and proactively routing academic and pediatric services to high-risk families can preserve public-health gains while protecting children.

Author

• Archi Arnob, University of Kansas
  Presenting Author