A 9-year-old boy in Washington lives in a tent with his fentanyl-addicted parents. He waits outside in the bushes while his mother exchanges sex for money and drugs. He doesn’t attend school or see a doctor. He appears underweight and ill.
Repeated offers of assistance — including housing — from social workers are refused by his parents. Now what?
The state’s answer is clear: the child protection system (CPS) will do nothing to protect this child because homelessness and drug use are “not neglect.”
Chronic drug use is increasingly seen as something that can be managed alongside caring for children, even medically fragile newborns. Parents in Oregon are encouraged to ask for naloxone (Narcan) without fear of stigma so that they can revive their children if their drug supply is inadvertently ingested. Lock boxes are recommended or distributed by CPS and other public agencies, often under the pretext of preventing accidental ingestions of prescription fentanyl, legal cannabis or other medications. America’s Poison Centers reminds adults who use fentanyl that naloxone can be safely used on children.
At a recent national forum, a former New Mexico state legislator described how CPS safety plans often ask parents to please dispose of their foils and clean their spoons before their children return home from school or child care. Parents in Arizona, Connecticut, Illinois, New Mexico, New York and Texas (to name just a few) are led — consistent with CAPTA-funded federal trainings and guidance — to believe that despite their addiction, they are capable of implementing “safety plans” alongside continued use of their drug of choice.
In a growing number of jurisdictions, CPS agencies tell doctors they do not have to report a parent or newborn’s positive drug test, while telling other community members that an active substance use disorder is not a basis for investigating whether a child has been harmed or endangered.
Parent advocates who argue that “drug tests are not parenting tests” seem to have convinced child welfare leaders across the political spectrum that, even though it is illegal to drive a car while intoxicated, parenting under the influence should not evoke similar concerns. Even the federally funded National Center on Substance Abuse and Child Welfare discourages the use of drug testing to inform whether it is safe to retain young children in the home: “The punitive use of drug testing can inhibit recovery and prove harmful to families,” noting also that “drug tests can perpetuate stigma about substance use disorders.”
These practices fall under the umbrella of harm reduction. Harm reduction is a normative framework that “centers the lived and living experience of people who use drugs” and focuses on “minimizing the negative consequences associated with substance use without requiring abstinence.” Influential groups such as the Drug Policy Alliance describe harm reduction as “simply common-sense safety,” no different than “seatbelts, bike helmets, sunscreen, or flu shots.” The Harm Reduction Coalition describes a “movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”
Under this framework, we are obligated to assume that people who use drugs “know their own bodies” and “are capable of making rational choices”; the assertion that drug use poses a danger to children or that treatment must be mandated is stigmatizing and therefore counterproductive.
These harm reduction strategies focus on reducing harms to adults who use drugs, not on safeguarding children who may be endangered by parental substance use.
Prioritizing expressed preferences of the parent to continue their drug use over the long-term health and safety of both parents and children has foreseeable consequences. In 2023 in Westchester County, New York, an early term, jittery, cocaine-positive newborn was deemed “unaffected” by substance exposure and released to her parents. Despite several subsequent calls to CPS about the parents using heroin and other drugs while caring for the child, the subsequent birth of a drug-exposed sibling, and parents’ nonparticipation in voluntary services, agency lawyers prevented caseworkers from petitioning for court intervention because there was “no impact” on the child.
The infant girl died of drug ingestion shortly after caseworkers requested to petition the court and were denied — for the third time. The parents were charged with manslaughter.
Some may argue that the cases of the 9-year old in Washington and this Westchester infant reflect aberrations in practice, and that taking these failures seriously will inevitably lead to unnecessary removals. Yet, statements from agency personnel rationalizing their decisions not to intervene reveal a consistent logic.
Prior advocacy sought — reasonably — to ensure that CPS approached addiction as a chronic disease in need of treatment rather than a character flaw. Now, the message is that parents’ untreated addiction is not the business of CPS. Empowered with pieces of paper listing possible services, and legally unenforceable safety plans, parents are left to figure it out on their own. Even recent federal efforts to expand access to medication-assisted treatment may be read as a signal that getting parents to begin medication is enough — and that CPS need not remain involved — despite high rates of discontinuation, relapse, overdose and concurrent use of other illicit drugs.
No one is suggesting that a single positive drug test or instance of drug use should automatically trigger the removal of children from the home. But we must abandon the delusion that parents who are drug-addicted will enter treatment voluntarily before serious harm falls to them or their children, or have the capacity to make their addiction safe and inconsequential while parenting. Such beliefs are contradicted by the neuroscience of addiction, the massive death count of the opioid epidemic, and piles of research and personal accounts documenting what happens to children reared by parents with active drug addictions.
Let’s be honest. The same people defending this hands-off approach would be terrified to have their own children spend five seconds in a tent full of fentanyl and strange men soliciting sex — much less live there indefinitely. This is a classic example of luxury beliefs — the privileged gain status by espousing tolerance of harmful environments and behaviors, while they and their loved ones remain fully insulated from the consequences. In the understandable desire to avoid being punitive about the struggles of drug addiction, we have perhaps forgotten that there are worse things than parents being coerced into drug treatment or experiencing a temporary separation from their child. As Pennsylvania child protection advocate Cathleen Palm observed, “There is nothing more punishing than a dead baby and a prosecuted mom.”
Originally published in The Imprint