Each day in Virginia, more than 2 people die from a drug overdose. In the 15 years between 2000 and 2014, the Office of the Chief Medical Examiner noted that drug overdose deaths increased by 137%, from 424 to 992 victims. Now outpacing deaths from motor vehicle collisions, drug overdoses reflect our newest public health crisis.
The State Child Fatality Review Team – a brave group of professional women and men who gather several times a year to examine the specifics of child deaths in order to find solutions to these preventable deaths – has spent the past 2 years reviewing child cases of overdose to understand how this crisis is impacting Virginia’s children and their families. Looking at the 41 deaths of children from poisoning between 2009 and 2013, the Team noted two distinct groups of children, each with their own set of risks: teenagers and infants/young children.
Teenagers who die from poisoning are most often the victims of accidental overdoses while misusing prescription medication, notably narcotics. A smaller number die by suicide. They are overwhelmingly white and between the ages of 13 and 17. Even at very young ages, teens report a history of substance use and misuse, suffer mental health problems, receive substance abuse treatment, and grow up in homes with substance using and misusing parents. Keys to an effective response for these teens and their families include services that recognize and treat substance misuse in adolescents within the context of family relationships, and building Virginia’s capacity to serve those addicted to prescription medications and illicit drugs.
The picture of risk varies among the 15 infants and young children, where supervision by parents and caregivers is critical to their safety. While a majority of deaths were caused by taking prescription medications belonging to someone else, some children died after swallowing simple household products such as a battery, massage oil, or toothpaste. Some died after accidentally chewing or swallowing a poison, some were murdered when given a lethal dose of medication to get them to sleep or to calm them, and others had no clear circumstances to determine how they died. And like teenagers, most lived with substance using and misusing adults. For these young and vulnerable children, attentive care and supervision by parents and other caregivers is crucial, including their diligence in safely storing medications and other toxic substances in the home.
The Team ended their review with the recognition that children’s overdose deaths reflect a small portion of deaths overall. But the loss of each of these young lives provides a window into a most pressing public health problem, one where the vulnerability of children and the needs of their caretakers are exposed, and the urgency of an effective response to addiction is paramount.
Once finalized in the summer of 2016, the Team’s final report on this review can be found here: http://www.vdh.virginia.gov/medExam/childfatality-reports.htm.
Virginia Powell, Ph.D. is a Program Manager in the Virginia Department of Health in the Office of the Chief Medical Examiner, in a department devoted to understanding injury and violence patterns through fatality review and surveillance projects. Dr. Powell coordinated Virginia’s state child fatality review team; assisted in the development of a protocol for use by local domestic violence review teams; and was instrumental in the development of Virginia’s maternal death review team. She is principal investigator for the Virginia Violent Death Reporting System, a CDC funded initiative which is part of the National Violent Death Reporting System. In Virginia, fatality review is at its core a public health effort designed to understand how and why people die and to educate others about those injuries and deaths in order to assist policy makers, advocates and planners in reducing violence.
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