Last month, Albuquerque police launched an investigation into how they handled the case of a seven-month-old baby who died in 2022 of asphyxiation. The death was ruled accidental—the child fell between a couch and a windowsill—even though he also had methamphetamines in his system. Three other children in the home also tested positive within a few days, but authorities did not remove them—that is, until almost a year later, when police conducted a welfare check at the home, prompted by a daycare worker who reported that another child in the home had arrived smelling of marijuana twice in a week. Only then was the baby’s mother, Victoria Romero, arrested on, among other charges, child abuse resulting in death.
As the decriminalization and legalization of drug possession becomes more widespread, and as drug use becomes more culturally acceptable, authorities are less sure how to handle cases of parents using drugs around small children. And because police are not investigating reports of illegal drug use, they are less likely to encounter situations where children are living with addicted parents.
Whether it’s from exposure to drugs in the womb, children finding drugs or paraphernalia in the home, or parents neglecting infants and toddlers because they are high, substance abuse is driving our country’s child-welfare crisis. At least 40 percent of kids in foster care are removed from their homes because of parental substance abuse, but most experts say that the true proportion is closer to 80 percent.
We are not addressing this problem. To begin with, states have faced growing pressure to stop testing mothers and infants for drugs at the time of birth. Even when drug testing does occur, authorities often do not use that information effectively. Connecticut reports substance-exposed babies “blindly”—that is, without any identifying information. This allows the state to keep a tally of how many children are affected, but authorities have no way of following up to make sure that the child is actually safe.
Instead of referring families to child protective services, social-services agencies instead offer many women “plans of safe care.” But these services are entirely voluntary. As a recent report from New Mexico noted, “data show that a high percentage of families are declining services when referred.” Indeed, a survey found that of those for whom such a plan was created,“ 41.8% of families did not know what a Plan of Care was or had no one talk to them about it in the hospital. In addition, 57.1% of families completing the survey either were not contacted by a care coordinator or refused services.”
The substance-abuse numbers are also startling. More than half of those referred for substance-abuse counseling declined. Similarly, most declined medically assisted treatment for substance abuse. (Possibly the only statistic more depressing was that fewer than 5 percent of people referred for domestic-abuse counseling decided to accept.)
Many of the families with children born exposed to a substance already have a history with child welfare, including almost a third with a substantiated case of abuse or neglect. New Mexico has one of the highest rates of repeat maltreatment rates in the country: 14 percent of children who are victims of abuse or neglect are subject to another incident of substantiated abuse or neglect within a year. Authorities are not only missing signs of serious trouble but also failing to ensure that adults get the help they need so as not to hurt children again.
New Mexico authorities say that “prevention and early intervention” are the keys to fixing this problem. But if they are not taking parental substance abuse seriously and holding adults accountable for engaging in rehabilitation, how are they going to improve early intervention? Increasingly, our public policy seems to have embraced the idea that drug use is a legitimate adult choice—who are we to judge? We will offer help, but parents who repeatedly engage in this unsafe behavior will face no accountability.
Substance abuse around children is dangerous. A recent paper by the journal Pediatrics found 731 poisoning-related fatalities for children ages five and under between 2005 and 2018. In 2005, a quarter of those involved opioids, but by 2018, fully half were opioid-involved. Many hospitals still don’t test for fentanyl, which is quickly becoming a danger for small children. As one homeless-outreach professional in Portland, Oregon, recently told me, when parents nod off and toddlers find a paper with traces of fentanyl and put it in their mouths, the results can be fatal.
We should treat substance abuse while parenting the same way we treat substance abuse while driving or operating heavy machinery or practicing medicine. In all these cases, lawmakers have drawn a bright line. Even in localities where drug use is legal, parenting young children while intoxicated should not be.
Photo by Erin Clark for The Boston Globe via Getty Images