Children’s Center staff pioneer drug exposure testing

Medical Examiner Christine Smith Presents at National Conference

Children’s Center Medical Examiner Christine Smith recently presented at a national child abuse conference about her groundbreaking research into the overlap of illegal drug use and child abuse.

Smith presented her findings at the American Professional Society on the Abuse of Children’s (APSAC) 21^st Annual Colloquium in Las Vegas. Smith, who is a family nurse practitioner, has been working at the Center since 2009. This is the first time a representative from Children’s Center has presented at the APSAC Colloquium.

As Clackamas County’s sole agency providing medical assessments, forensic interviews and family support services to children who are suspected victims of child abuse and neglect, Children’s Center plays a vital role in ending the trauma of abuse for local children.

Illicit drug use in Oregon exceeds the national per capita average. According to the Lane County Sheriff’s Office, Oregon is ranked 4^th in the U.S. for reported rates of illicit drug use by those twelve years and older.

Smith began researching the prevalence of illegal drug exposure and ingestion in children in 2010. Smith recalls one particular Children’s Center case that made her more aware of the need for testing children’s exposure to drugs.

The case involved a three-year-old boy, who was referred to Children’s Center with concerns that he had been exposed to marijuana in the home. When his test results came back, they showed he had ingested ecstasy. “What we think is happening with these kids is not necessarily the reality they’re living with,” said Smith. “We’re finding that it can be much different and sometimes worse than we expect.”

Since then, Smith and Children’s Center Medical Director Dr. Sue Skinner have pioneered drug testing in Oregon for Clackamas County children. Currently, Children’s Center is the only Child Abuse Intervention Center in the state that is drug testing on a consistent basis. “We’ve really pushed the limits on making sure all kids are tested when appropriate,” Smith said.

Approximately 25% of children referred to the Center between July 2011 and June 2012 had concerns of drug endangerment in the home, which is a form of child neglect. The majority of concerns of drug exposure are for nonverbal children – infants, toddlers, and developmentally delayed children.

Children’s Center drug exposure tests are conducted at a lab requiring a 100 milligram sample of the child’s hair to test for nine illegal substances: amphetamines, cannabinoids, cocaine, opiates, phencyclidine, benzodiazepines, barbituates, methadone, and propoxyphene. This hair sample is tested for repeated exposure over the past three months. It also reveals whether the drug exposure was environmental or if drugs were ingested by the child or both.

Out of 124 valid hair tests conducted between July 2011 and June 2012, 51% came back with positive results for at least one drug. Of the positive results, the most common drugs were methamphetamine (81%), marijuana (27%), and opiates (21%).

These drug endangered children are more likely to have experienced a traumatic event, and are at greater risk of sexual abuse and physical abuse. “People on meth are unpredictable, so kids in these homes have an increased risk of sexual and physical abuse,” said Smith. “A lot of the kids we’re seeing for drug endangerment we’re also evaluating for other types of abuse.”

As a result, criminal cases were pursued more than twice as often in the positive hair test group compared with those in the negative hair test group.

Risk factors for drug endangered children include:

}  Drug use in parents has both physical & psychological effects on children

}  Parental substance abuse is widespread, takes many forms

}  Drug endangered children are frequently neglected

}  Drug endangered children are at higher risk for many types of abuse