When I was a senior children's services manager toward the end of the 90s I had to deal with the unexpected death of John, a young boy in his teens. He had found some methadone at home, drank it and it killed him. This was legally prescribed methadone, given to his mother's partner. Despite the family being known to social services we had no knowledge of his mother's new partner and his substance misuse, and his drug treatment agency had no idea he was living in a family with children. The complexities of this family situation led to the death of a child and raised questions about protecting children.
Talking to colleagues from around the country I found that this was far from an isolated incident. The growth in the use of hard drugs, combined with the increase in treatments for addicts based in the community, meant an increased likelihood that children might take medication that ordinarily was not held in family homes. In 2003 the Advisory Council on the Misuse of Drugs published Hidden Harm, which did lead to a greater focus on the needs of the children of problem drug users. Over the following years treatment services developed more awareness about the issue, but children still died from taking an adult's prescription medicine.
Medications in drug treatment - tackling the risks to children highlights growing concern in this area. Published by Adfam, a charity working with families affected by substance misuse, it reports that still not all agencies ensure that the risks to children are minimised, particularly with the storage of methadone and other Opioid Substitution Treatment (OST) medicines in the home. Over 60,000 adults receive these medicines at any one time, and around 50% are estimated to be parents.
Between 2003 and 2013 there were 20 Serious Case Reviews involving children affected by Opioid medicine - 17 of them in the last five years. Shockingly 5 of these reviews were about children who had been given methadone deliberately by a parent. They give some indication of the level of risk, but there are incidents which have not met the requisite threshold and consequently no review has been undertaken, so the number of near misses is not known.
The aim of Opioid Substitution Treatment is to reduce the dependence on opioids over time; the user can eventually overcome their addiction. They help them begin their recovery journey without illegal drugs, away from crime, and with the support of treatment services. It is a widespread practice, supported by the Government's Drug Strategy.
The conclusion of the Adfam research is that the risk to children posed by these Opioid Substitution Treatment medications is not being adequately managed. Despite the numbers of Serious Case Reviews, and the similarity of their conclusions, there is nothing to show that lessons are being learned at a national level, and often not at a local level. The report recommends that every two years Serious Case Reviews dealing with incidents of children taking drugs in this way should be studied with common strands being collated and disseminated.
Around 60% of child protection cases are estimated to involve substance or alcohol misuse, so it seems common sense that a representative from a drug treatment agency should be present on all Local Safeguarding Children's Boards. This would better coordinate treatment, help and support at a local level.
Better training on the dangers of these medicines to children is needed for drug services, pharmacies and local GPs. Research found an unwillingness to believe that children might be given them deliberately. Ensuring staff and service users learn about and understand the risks to children is crucial.
Safeguarding children has to become a primary factor in making and reviewing decisions about Opioid Substitution Treatment, including which drug to prescribe and whether to permit take-home doses. Safe storage boxes should be provided to all drug treatment clients if they ever take any of their prescription home. There should be consistent checks on storage arrangements, and ongoing provision of information about the dangers of children taking drugs.
At the moment the number of children who die or suffer serious harm as a result of taking adult's prescribed medication is thankfully small. But the likelihood of a child dying if they do take these drugs is very high. This means that the risk for children who live with parents who misuse drugs should be properly assessed; their protection must determine plans to help the adult and not put them at further risk.
To view the Adfam report visit: http://www.adfam.org.uk/professionals/latest_information_and_events/news/459