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Medications in Drug Treatment: Tackling the Risks to Children

Since the publication of Hidden Harm by the Advisory Council on the Misuse of Drugs in 2003, the needs of children of problem drug users have received much greater attention in policy and practice, both in drug treatment and in the wider children and families agenda. Agencies have significantly improved their practice in terms of recognising and responding to children affected by parental substance use, and there is a greater emphasis on child protection in clinical guidelines.

However, whilst the general or overall impacts of parental substance use are now widely recognised, there are some gaps in knowledge and learning on specific risks, such as those posed by the use and storage of Opioid Substitution Treatment (OST) medicines in the home. This review explores these particular risks to children whose parents or carers are in receipt of OST, and gives recommendations on what can be done to improve practice and policy responses.

OST is a medical intervention whereby long-acting and less euphoric opioid medications (primarily methadone or buprenorphine) are prescribed in replacement of illegal opioid drugs (heroin). The aim of OST is to reduce opioid dependence over time so that the user can eventually overcome
their addiction, whilst allowing them to 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 2010 Drug Strategy, which states that ‘substitute prescribing [has] a role to play in the treatment of heroin dependence, both in stabilising drug use and supporting detoxification’. Evidence shows that it is an effective treatment across a number of measures including continued engagement in treatment and reductions in crime, the transmission of blood-borne viruses, and risk of death. Service users and professionals alike have also asserted that it can be a positive facilitator for a normal family life.

Whilst the National Institute for Health and Care Excellence (NICE) and the Department of Health have acknowledged the possible dangers to children and safety measures are recognised as important, there is still limited policy and practice guidance available on the front line.

Findings from a study of Serious Case Reviews (SCRs) from the last decade revealed a significant number of cases of where children had died or been
hospitalised after ingesting OST drugs, and further research is merited. Adfam’s focus on the impact of substance misuse on the family means that we are keen to highlight the learning and recommendations that emerge from these tragic events in order to minimise risks to other children in the future.