OST: more needs to be done to protect children

The safeguarding of children is not being sufficiently prioritised by professionals making decisions about drug treatment medications, says a new report from Adfam. Improved training is needed for treatment services, pharmacies, GPs and social workers to highlight the potential dangers, says Medications in drug treatment: tackling the risks to children.

The report looks at 20 serious case reviews from the last ten years involving the ingestion of treatment medications by children, and says that ‘too many children are being put at risk’ by insufficient safeguards. The 20 case reviews involved the ingestion of medication by 23 children, 17 of whom died. Their average age was two.

While some of the children died as a result of medications being stored inappropriately, there is also a ‘rare but real’ use of methadone as a pacifier for small children, says the document. Methadone was the cause of 15 of the deaths, and buprenorphine the cause of one. However, the review findings are ‘not contributing to national learning on managing risk’, says Adfam.

‘Tragedies occur, and we can never eliminate risks completely,’ says the report. ‘But in conducting this research our thinking has always been: on a systemic level, are we doing all that we can to make sure these incidents don’t keep happening? And based on our findings, the answer, so far, is no.’

Alongside improved analysis of the serious case reviews, the report calls for better national data collection on the number of parents allowed to take home OST medication and the number of children admitted to hospital as a result of ingesting them.

Around 60,000 people caring for children currently receive drug treatment prescriptions, and not all cases of ingestion reach serious case review level, Adfam points out, meaning the true extent of the risk remains unknown. Many of the case reviews found that professionals ‘missed or minimised’ risk factors during the families’ contact with services and took an ‘overly optimistic’ view of progress on the part of parents, many of whom were able to ‘manipulate or deceive services into believing they were making positive changes’.

The research uncovered a ‘variety of unsafe storage practices’, including keeping methadone in children’s beakers or on bedside tables, as well as not disposing of containers properly. The report wants to see agreed safety plans and the provision of free lockable storage boxes for parents who take medication home, and a ‘re-emphasising’ of the importance of safeguarding children in line with existing NICE guidance. Treatment agencies should also be represented on local safeguarding children boards, it stresses.

‘Just one of these cases would be one case too many, but this research shows that they have happened with depressing regularity over the last decade,’ said Adfam chief executive Vivienne Evans. ‘The cases are frequent and similar enough that we should be much louder and more honest about the risks of methadone to children. We need a more proactive and nationally coordinated plan to tackle these risks, rather than waiting for every area in the country to experience a tragedy before anyone takes action.

‘Medications and recovery aren’t mutually exclusive and we’re very supportive of substitution treatment,’ she continued. ‘However, safeguarding should be first and foremost in professionals’ minds when working with parents who use drugs and alcohol, and the report suggests this isn’t always the case.’

Report at www.adfam.org.uk

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