Advisory Council on the Misuse of Drugs
Hidden Harm: responding to the needs of children [2003]

Six key messages from the Inquiry:

• We estimate there are between 250,000 and 350,000 children of problem drug users in the UK – about one for every problem drug user.
• Parental problem drug use can and does cause serious harm to children at every age from conception to adulthood.
• Reducing the harm to children from parental problem drug use should become a main objective of policy and practice.
• Effective treatment of the parent can have major benefits for the child.
• By working together, services can take many practical steps to protect and improve the health and well-being of affected children.
• The number of affected children is only likely to decrease when the number of problem drug users decreases.

The Advisory Council on the Misuse of Drugs has a statutory duty to advise the Government on drugs of misuse and the health and social problems these may cause. Its Prevention Working Group carries out in-depth Inquiries into aspects of drug misuse that are causing particular concern, with the aim of producing reports that will be helpful to policy makers, service providers and others. In 2000, the Council thus decided to launch an Inquiry that would have the children of problem drug users as its centre of attention. Its terms of reference were to:

  • estimate the number of children so affected in the UK;

  • examine the immediate and long-term consequences of parental drug use for these children from conception through to adolescence;

  • consider the current involvement of relevant health, social care, education, criminal justice and other services;

  • identify the best policy and practice here and abroad; and

  • make policy and practice recommendations.

... the Working Group accepts that not all drug use is incompatible with being a good parent. Our Inquiry has thus focused squarely on parental problem drug use and its actual and potential effect on children. By problem drug use we mean drug use with serious negative consequences of a physical, psychological, social and interpersonal, financial or legal nature for users and those around them. Such drug use will usually be heavy, with features of dependence. In the United Kingdom at present this typically involves use of one or more of the following: heroin and other opiates, benzodiazepines, cocaine or amphetamines.

The Working Group is well aware that problem drinking by parents can have serious consequences for their children and that there are probably at least as many children thus affected as by problem drug use. Parental smoking is also harming the health of many hundreds of thousands of children in this country. However, it was decided that it was beyond the scope of the Inquiry to do justice to these two major topics. Our main focus is therefore on problem drug use, with the impact of alcohol or tobacco being considered as additional factors. Nevertheless, many of the recommendations we make for protecting and supporting the children of problem drug users will also be applicable to the children of problem drinkers.

We have written this report with the aim of illuminating an aspect of the harm caused by drug use that until now has remained largely hidden. By highlighting both the size and seriousness of the problem, we hope we can stimulate vigorous efforts by both policy makers and service providers to address the needs of some of this country’s most vulnerable children.

Maternal drug use during pregnancy can seriously affect fetal growth, but assessing the impact is usually impossible, with multiple drugs being taken in various doses against a background of other unfavourable circumstances. There is serious concern about the effect of cocaine on fetal development. Heroin and other opiates, cocaine and benzodiazepines can all cause severe neonatal withdrawal symptoms. The damaging effects of tobacco and alcohol are well established, and cannabis is not risk free.