What Can we do to Stop Children Dying After Ingesting Medications Used to Treat Drug Addiction?
What can we do to stop children dying after ingesting medications used to treat drug addiction?
Rachael Evans of Adfam
Over the past thirteen years, hundreds of children in the UK have died or been seriously harmed after ingesting medications prescribed to their parents to treat opioid dependence.
The mainstream media has picked up on some of these cases, like the tragic death of Fenton Hogan in 2013, whose mum gave him methadone ‘to help him sleep.’ But these reports do not get to the root of the problem, preferring to instead demonise ‘drug addicted’ parents, rather than look at what went wrong and what could have been done to prevent this tragedy – and others like it.
When Adfam started looking into this problem, the huge gap in knowledge around the risks to children posed by opioid substitute therapy (OST) medications (usually methadone or buprenorphine) became immediately obvious. We didn’t know how many people with parental responsibility or contact with children were allowed to take home these medications, let alone how many children had come to harm after ingesting these drugs – nor did we know anything about the circumstances in which children were coming to ingest them. After two research reports, we now have a better idea of the prevalence and scope of child ingestions of OST, but so much more still needs to be done. One child dying is one too many – these deaths are preventable.
Between 2003 and 2013, at least 110 children and teenagers died from the toxic effects of OST medications in the UK, with methadone being responsible for 107 of these.
Of the 73 deaths in England and Wales, only seven resulted in serious case reviews – an investigation by the local authority into the harm or death of a child where abuse or neglect is suspected. In the same time, at least 328 children in England were hospitalised with methadone poisoning.
That methadone can be dangerous is, of course, not news: it is responsible for a growing number of adult deaths, reaching 394 in 2014. Safety measures have already been put in place by manufacturers in the form of childproof bottles, lockable storage boxes, safety information and supervised consumption regimes – so, how is this still happening?
Many of the reviews explain similar sequences of events – methadone left lying around the house or stored in baby beakers, or parents trying to placate their children with it – and make similar recommendations for practice, like restrictions on take-home medication. History has repeated itself from Bradford to Bridgend, without any platform of proactive, national learning. The risks to children posed by OST medications are not sufficiently managed in practice, and we can’t wait for every local authority to experience one of these incidents before something changes; indeed, some areas have had multiple cases, showing that improved practice has not always followed an ingestion incident.
Perhaps one of the most surprising findings is that whilst many of the children swallowed the drug accidentally, some were given them by their parents in a misguided attempt to soothe or help them sleep.
These parents are not trying to harm their children, they simply don’t know or understand how dangerous and toxic these drugs are to children, even in tiny amounts.
Better education of parents and professionals of the dangers of OST to children is an obvious necessity, as is the provision of safe storage boxes to parents, but, in addition, professionals must address the possibility of intentional administration with parents in no uncertain terms.
Some professionals are shocked at the suggestion their clients might be giving their children these drugs, and assume they know what the dangers are, so don’t need to discuss it. This is a mistake. The number of deaths and incidents unequivocally show that this is an issue that must be tackled directly. OST is proven to reduce dependence on street heroin, and by doing so it saves lives, improves health and wellbeing and cuts crime. The rightful place of these medications in addiction treatment is not at issue, but it’s imperative that the risks they pose to children are better addressed and future incidents prevented.
So what needs to change? Although there is no magic bullet – no one measure can eliminate risk – there are some relatively simple steps which could make a real difference.
Firstly, all incidents involving a child’s ingestion of these medications must be fully investigated and recorded; and analysed centrally by government, with learning shared with local services. The wide range of professionals who come into contact with parents and carers prescribed OST medications must all be trained about their potential harm to children, and services must work together and share information more effectively to minimise risk.
The lessons from previous tragic cases have not been heeded, and children are still dying. The vast majority of parents prescribed these medications will use them safely and appropriately – but the number of children now identified as having been harmed lends the issue even greater urgency. Some areas have taken positive steps: for example, by employing specialist family workers in drug treatment agencies which work with pregnant women and families to help the service to maintain a family-focus, and ensure that safeguarding is a prime consideration when treating parents for opioid dependence. Inter-agency joint protocols between drug services and health visiting teams will also ensure that vital information is shared, and allows for joint home visits to be conducted. The better agencies involved with the family work together, the lesser the risk – this is a consistent finding of serious case review panels looking into these cases.
Adfam has delivered training to multi-disciplinary teams across the country to help them develop a blueprint for best practice on the issue – as well as providing an opportunity to get everyone in the room, to link up and encourage improved future communication amongst local agencies – and will be offering this training to more local authorities in the coming months. If you want to know more about this email: .