Cancer is not the biggest threat to my pediatric patients. It is their parents’ addictions.

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Cancer is not the biggest threat to my pediatric patients. We can cure cancer. Almost 90% of children diagnosed with cancer will survive.

The biggest threat to my patients is their parents’ addictions.

Parental addiction affects one-third of my patients. One-third.

The adult drug overdose death rate is 7 times childhood cancer deaths. New Hampshire, where I practice, has the nation’s second highest drug overdose death rate at 15 times childhood cancer deaths. Substance abuse is skyrocketing. Many are parents.

The Food and Drug Administration recently announced expanded opioid prescriber training to reduce addiction. My patients can’t open their child-resistant prescription bottles. This won’t help them.

Treating addicted parents would reduce the biggest threat to my patients.

An addicted parent often vows sobriety when their child is newly diagnosed with cancer. They sincerely want the healthiest environment for their child. But they will fail without help.

Parents are scared. Family and finances are strained. Add addiction and a child’s oxycodone prescription to this stress. It is a recipe for failure.

Children with addicted parents suffer more pain at home than other children. Addicted parents may take their child’s medications. Worried doctors prescribe less opioids. Sometimes addicted parents fear their child will become addicted and refuse to give their child pain medications.

A child with an addicted parent is more likely to miss chemotherapy appointments and home medications, be malnourished, and have poor hygiene, food and housing insecurity which compromise survival. They are more likely to die at home because of unnoticed signs and symptoms of life-threatening illness or because of accidental opioid exposure. A 6 year old New Hampshire boy would have died this month if not revived with Narcan, the opioid antidote.

Why we don’t involve child protective services? We do. I testified for a child who routinely came to clinic hungry and dirty. His parents were always high and wifty, or withdrawing and jittery.

Unfortunately, support for protective services is skeletonized. Agencies are understaffed, overwhelmed and forced to triage.

The child for whom I testified, came to appointments because we arranged transportation. He was never abused. He was an accidental bystander to neglect, not the direct target. There are no resources for interventions unless a child is in immediate danger. The parents retained custody.

Later, an unrelated adult overdosed in that family’s home and my patient entered foster care. His parents tried recovery. But failure is common, especially without intensive treatment. Fentanyl is easier to find than rehab and clean urine can be purchased cheaply on the internet. Their continued use remained undetected and a reunification hearing was scheduled.

The parents’ pro bono attorney obtained and shared a concerned letter I sent to the judge. His parents then came to my office to call me a liar. Days before the hearing, his parents were found unconscious with empty syringes. The father died. The mother survived.

This child is not alone.

Stories like the 6 year old boy whose overdose was reversed by Narcan will become more common. Powerful opioids such as carfentanil have emerged. A 13 month old and her grandmother in Ohio died from carfentanil exposure earlier this month. An aerosolized particle is enough to cause overdose.

Separating children from their addicted parents without providing effective treatment is short-sighted and more damaging. Despite their addictions, parents and their children love each other. The psychological scars from breaking those bonds result in other lifelong problems. Developing emotional resiliency is fundamental to becoming a contributing member of society. My patient is instead drowning in anger, abandonment, grief, and insecurity.

The majority of addicted parents cannot independently afford treatment. Through Medicaid expansion, some can access inpatient treatment, intensive day therapy, pharmacological support, and continued outpatient monitoring and counseling, then maintain long-term sobriety. But like community-based services for children, comprehensive drug-treatment is in short supply and in desperate need for funding. Now that the GOP has voted to proceed with health care reform to repeal aspects of the Affordable Care Act, I am concerned that fewer parents will have access to treatment.

Children are the ultimate victims here and their futures become collateral damage to parental addiction. We cannot see the full return of our investment in curing a child’s cancer if they cannot develop emotionally into productive citizens.

Children do not have their own public voice, especially those children whose lives are disrupted by parental addiction. We must speak for them. They need healthy parents. We need to find ways to help them.

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