Association between prenatal opioid exposure and health, education, and foster care between ages 0 and 18.

The opioid crisis has emerged as a critical public health challenge, yet the long-term outcomes of children exposed before birth remain underexamined. Prior studies have focused on acute neonatal outcomes or adult opioid misuse, leaving the broader developmental outcomes largely unexplored. Here, we show that children in British Columbia with prenatal opioid exposure-identified through comprehensive linked administrative data-face significant and enduring deficits in health, education, and social well-being that extend into adolescence. These findings reveal associations that go beyond clinically diagnosed neonatal abstinence syndrome, highlighting the importance of addressing even lower levels of prenatal exposure. Propensity score matching qualitatively corroborates these findings. By examining multiple levels of prenatal exposure and linking them to a wide array of child outcomes, our work underscores the urgent need for enhanced prenatal screening, targeted interventions, and integrated policymaking to break the intergenerational cycle of opioid-related harm.