An increasing number of children are accidentally poisoning themselves with drugs within their reach — and the youngest kids continue to be at the highest risk.

Drug ingestions have emerged as a leading cause of injury for kids, the Allegheny County Department of Human Services found in a new report. The analysis looked at fatality and near fatality cases where abuse or neglect is suspected. These drug-related incidents, largely unintentional, comprised one-third of incidents in 2022 and rose to nearly one-half in 2023.

While only affecting a small number of kids — an average of 23 per year or less than 1% of all children in the county — the findings still reflect a troubling trend, said Director of Human Services Erin Dalton.

The number of drug poisonings has been rising year over year since 2019 and caused most of the county’s child fatalities and near fatalities in neglect or abuse cases since 2022, surpassing physical violence like blunt force or head trauma.

“What we see in child welfare is really often just a mirror of society,” Ms. Dalton said. “We see a lot of very dangerous drugs on the street and being used. For children in particular, even in trace amounts, it can lead to some really concerning outcomes.”

The report reflects the prevalence and lethality of opioids in particular.

In nearly all ingestion cases, at least one of the substances the children took was an opioid. And almost 90% involved fentanyl, a potent synthetic opioid that can be lethal even in doses as little as 2 milligrams. It’s often mixed with other drugs without the user knowing.

That could be one reason, the county suspects, that these poisonings are on the rise.

“As the drugs get stronger, it’s just even more of a challenge,” Ms. Dalton. “Children get into everything, and you’re taught that as a new parent, no matter who you are, to baby-proof your house.

“When these drugs are just so incredibly potent, it’s even trace amounts on tables and things like that that can be dangerous to children.”

Angela Liddle, president and CEO of the Pennsylvania Family Support Alliance, emphasizes that the problem is not unique to Allegheny County.

Nationally, the percentage of all child poisoning deaths due to medications has nearly doubled since the late 1970s. Among young children, nearly all medication-related poisoning visits to emergency departments are caused by ingesting medication while unsupervised.

The pandemic exacerbated the problem — since March 2020, drug-related hospitalizations in children under 5 increased by more than 20% nationwide.

Many cases come down to lack of caretaker supervision, and it’s very young kids — who need the most supervision — who end up in danger. Most of the victims in Allegheny County were children under 3.

Ms. Liddle doesn’t want people to make swift judgements about the parents or caregivers involved.

“When people have substance-use disorder, their rational thinking is really impaired,” she said. “Where maybe some of these parents would normally be very careful with the care of their kids, but you add in the addiction issue, and things look very different in the blink of an eye.”

Only 20% of families involved in the ingestion-related critical incidents had active child welfare involvement at the time, although three quarters had a history of involvement. To Ms. Liddle, this may indicate the caregivers gained the stability they needed to have their case closed by protective services and then relapsed.

“They might have gone through treatment services and thought they were doing fine,” she said. “The road to recovery is not usually just linear.”

Research shows that stress points often trigger a relapse, Ms. Liddle said. That can be mental health issues or economic-related challenges, like housing or food insecurity. In the child welfare system, “very often, we confuse poverty and neglect,” she said.

Seeking support, treatment

The report notes many families sought treatment at some point prior to the child’s poisoning.

Sixty-six percent of caretakers involved in ingestion cases had received publicly funded substance-use disorder services prior to the critical incident. Yet, interactions with those services went down to 43% within a year of the incident and to 36% within a month.

Around 40% of caregivers had used medication for opioid-use disorder before the drug poisoning. But there also was a steady decrease in use leading up to the accident, dropping to 31% within a year and 13% within a month.

Ms. Liddle said those numbers underscore the importance of consistent, accessible support for families.

Sojourner House in Garfield offers inpatient treatment to help mothers break the cycle of substance-use disorder while rebuilding relationships with their children. It’s one of the first treatment programs in the country that admitted mothers with kids.

Typically, a caregiver needs to find child care for weeks to months at a time to get help. Or, parents may be worried that accessing services would put them at risk of losing their kids.

That’s why De’netta Benjamin-Miller, executive director of Sojourner House, assures moms that the program is there to advocate for them and their kids. By allowing the family unit to stay together during treatment, moms can heal without worry. In cases when child welfare services are involved, they can help them take steps toward regaining custody and can host supervised visits.

“Substance-use disorder and trauma, there’s a high correlation there,” she said. “No one wakes up and says, ‘You know what, today, I think I’ll choose to be addicted to an opioid and neglect my children.’

“Substance-use disorder is a real disease. It’s biological and psychological and it’s social. It’s really important to keep that in mind when we’re thinking about people wanting to be healthy parents, but still may be in the recovery process.”

The program also works to help parents prepare for life in recovery outside the Sojourner House facility, teaching safe habits like securing drugs in lockboxes and high spaces so curious children can’t get to them.

The nonprofit teaches moms about access and administering life-saving interventions like Naloxone, and good Samaritan laws that protect people from criminal charges when seeking help in overdose situations.

Ms. Benjamin-Miller sees parents at Sojourner House who want what’s best for their kids. “No parent wants to see their child die from an overdose or have serious health issues from an overdose,” she said.

Ms. Dalton said DHS had been actively working, before the report’s publication, to address the growing trend of accidental drug ingestions in Allegheny County.

The county has expanded access to Naloxone, lockboxes and fentanyl test strips for caseworkers to provide to their clients, she said. The county, through its opioid settlement funds, has also increased access to MOUD, telemedicine prescribing and incentives for abstinence from opioids. Sojourner House received $168,000 from these funds to conduct community intervention work, such as outreach fairs.

DHS’ child welfare office partnered with the PA Organization for Women in Early Recovery to conduct assessments and educate its staff on substance-abuse disorder and related issues.

Child welfare cases are never simple and county caseworkers themselves aren’t experts on addiction, said Betsy Caroff, interim deputy director at the county’s Office of Children, Youth and Families.

“It’s not black and white,” Ms. Caroff said. “If you’re on an opioid, we do not instantly remove [the children]. We have to look at what is going on with this family. What are the natural supports? How vulnerable is this child? How can we really think about balancing children’s safety with keeping families together?”

The county launched a marketing campaign earlier this year to warn the community about the dangers of opioid ingestions and the safety of administering Naloxone to children, said Julia Reuben, assistant deputy director of system design and implementation at DHS.

“If you look at our data, thankfully the majority of kids who had these ingestions went on to live,” she said. “That’s because EMS carries Naloxone, individuals and homes have Naloxone. We have some resources of places you can get it. It is a life-saving measure and we want to make sure that everyone’s aware of that.”

Resources are available on Allegheny County’s website on substance use services, free Naloxone, MOUD providers and safe storage.

From Pittsburgh Post-Gazette, August 12, 2024