Key Points

• Due to infrequent and inconsistent testing, there is no reliable count of how many infants
  are exposed to substances in utero, yet recent data on drug use and child fatalities signal an
  unmitigated crisis.
• Efforts to limit responsibility of Child Protective Services (CPS) for substance-exposed
  infants, including laws to prevent doctors from conducting toxicology screenings when
  there is reasonable suspicion the infant was exposed, severely diminish the likelihood that
  the parent and child will receive necessary care.
• Plans of Safe Care, voluntary offers of services seen as a more compassionate alternative to CPS
  involvement, are not backed by any evidence of their actual efficacy in keeping children safe.

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Introduction

The stark human and societal cost of the drug epidemic is undeniable, directly taking over 100,000 lives each year since 2021.¹ Due to infrequent and inconsistent testing,² there is no reliable count of how many children are exposed to substances in utero, but, even before the current drug epidemic began, researchers estimated that 400,000–480,000 children born each year were prenatally exposed to drugs or alcohol.³ Because the estimated number of adults meeting criteria for substance use disorder increased from 22 million in 2010⁴ to 46 million in 2021,⁵ prenatal exposure has likely increased as well. Recent data on drug and alcohol use among pregnant women,⁶ pediatric poisonings,⁷ Narcan administrations to infants,⁸ and child fatalities⁹ all signal an unmitigated crisis. To date, however, the US response has centered on parents and other adults experiencing addiction with inadequate attention to the needs of the infants and young children in their care.

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Notes

1. National Institute on Drug Abuse, “Drug Overdose Death Rates,” June 30, 2023, https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates; and Centers for Disease Control and Prevention, “Provisional Drug Overdose Death Counts,” March 13, 2024, https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.
2. Rates of toxicology testing are typically below 5 percent. Discretion in testing by medical professionals results in disproportionate testing of low-income and racial minority mothers. See Samuel Cohen et al., “Disparities in Maternal-Infant Drug Testing, Social Work Assessment and Custody at 5 Hospitals,” Academic Pediatrics 23, no. 6 (August 2023): 1268–75, https://pubmed.ncbi.nlm.nih.gov/36754165; and Sebastian Schoneich et al., “Incidence of Newborn Drug Testing and Variations by Birthing Parent Race and Ethnicity Before and After Recreational Cannabis Legalization,” JAMA Network Open 6, no. 3 (2023): e232058, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802124.
3. Rachel N. Lipari and Struther L. Van Horn, “Children Living with Parents Who Have a Substance Use Disorder,” US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavior Health Statistics and Quality, August 24, 2017, https://www.samhsa.gov/data/sites/default/files/report_3223/ShortReport-3223.html.
4. US Department of Health and Human Services, Substance Abuse and Mental Health Administration, Center for Behavior Health Statistics and Quality, “Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings,” September 2011, https://www.samhsa.gov/data/sites/default/files/NSDUHNationalFindingsResults2010-web/2k10ResultsRev/NSDUHresultsRev2010.htm.
5. US Department of Health and Human Services, “SAMHSA Announces National Survey on Drug Use and Health (NSDUH) Results Detailing Mental Illness and Substance Use Levels in 2021,” press release, January 4, 2023, https://www.hhs.gov/ about/news/2023/01/04/samhsa-announces-national-survey-drug-use-health-results-detailing-mental-illness-substance-uselevels-2021.html.
6. US Department of Health and Human Services, Substance Abuse and Mental Health Administration, 2020 National Survey on Drug Use and Health: Women, July 2022, https://www.samhsa.gov/data/sites/default/files/reports/slides-2020-nsduh/2020NSDUHWomenSlides072522.pdf; and Lucinda J. England et al., “Alcohol Use and Co-Use of Other Substances Among Pregnant Females Aged 12–44 Years—United States, 2015–2018,” Morbidity and Mortality Weekly Report 69, no. 31 (August 7, 2020): 1009–14, https://www.cdc.gov/mmwr/volumes/69/wr/mm6931a1.htm.
7. Julie R. Gaither, Veronika Shabanova, and John M. Leventhal, “US National Trends in Pediatric Deaths from Prescription and Illicit Opioids, 1999–2016,” JAMA Network Open 1, no. 8 (2018): e186558, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2719580.
8. John Cardinale, “Bernalillo County Court Records Show Babies Are Overdosing,” KOAT Action News, June 15, 2023, https://www.koat.com/article/bernalillo-county-court-records-show-babies-are-overdosing/44214139.
9. Deb Erdley, “Tiny Lives at Risk: ‘Frightening Rate’ of Children Dying Due to Parents’ Drug Abuse,” Trib Total Media, December 17, 2023, https://triblive.com/local/regional/frightening-rate-of-children-dying-due-to-parents-drug-abuse.