Experts warn rising pediatric fentanyl harms, urge screening and family-centered responses

Nancy Young, project director of the National Center on Substance Abuse and Child Welfare, opened a webinar on children affected by parental substance use with a national prevalence estimate: "21 million children lived with a parent who misused substances in the past year," she said, citing the National Survey on Drug Use and Health.

Dr. Savonich, a co-presenter, described how those population figures translate into child-safety risk: "Fentanyl related deaths among children under five increased by 590% between 2018 and 2021," he said, and reported that child opioid poisonings quadrupled from 2019 to 2023. He said most child overdose deaths (about 93%) were accidental and that 64% occurred at home.

The presenters framed the problem around three distinct groups—prenatally exposed infants, children living with a parent who uses, and adolescents who begin using themselves—and said each requires different prevention and treatment strategies. Young noted child welfare systems see only a subset of affected children: while national estimates show roughly 16% of children lived with a parent who misused substances in the past year, "child welfare is not involved with nearly that number annually," she said.

Speakers emphasized stigma, access and workforce challenges as structural barriers. Young defined three forms of stigma—public, institutional and self-stigma—and said stigma reduces families’ willingness to seek care. Workforce concerns included trauma exposure and turnover, and presenters cautioned that fear about fentanyl exposure among staff is common but often misplaced: "Touching fentanyl is unlikely to cause overdose because fentanyl cannot be absorbed through intact skin in amounts that would cause harm," Dr. Savonich said, adding that ingestion and inhalation are the primary exposure risks.

Presenters reviewed specific toxicological and safety issues. They warned that xylazine, a veterinary tranquilizer now mixed with fentanyl in some markets, does not respond to naloxone alone and that supportive measures (including CPR) are needed when xylazine is involved. They also highlighted pediatric poisonings tied to edible cannabis products and urged safe storage and disposal of prescription medications as everyday prevention steps.

On practice and policy, the webinar recommended universal screening with validated tools and stronger handoffs to treatment: presenters described a six-question screen (referred to in the webinar as UNCOPE/UNOPE-like tools) as an example and urged jurisdictions to align on a screening instrument that fits local practice. They also cautioned against using drug testing punitively; testing is a point-in-time measure and can deter honesty and engagement if used as documentation rather than a pathway to help.

Practical home-safety measures singled out included lock boxes for medications and paraphernalia, routine naloxone access and training for caregivers, and reinforcement of safe-sleep practices for infants. The webinar framed safety assessment around three elements—immediate safety threats, risk factors for future harm, and parental protective capacities—and stressed age-appropriate approaches when talking with children. Presenters highlighted the "seven C's" framework for conversations with children (for example, reassuring a child that they did not cause a parent's substance use).

Speakers closed by urging cross-system collaboration—child welfare, courts, health care and treatment providers—to share case planning, training and resources. They pointed attendees to the National Center on Substance Abuse and Child Welfare’s website for tools and training materials and reminded participants the presentation was sponsored by the Department of Health and Human Services, the Administration for Children and Families, and co-funded by the Substance Abuse and Mental Health Services Administration.

The webinar ended with presenters encouraging jurisdictions to review local data, adopt standardized screening and prevention practices, and prioritize family-centered responses that reduce stigma while protecting children.