It is the dark backdrop of two of the stateâ€™s most prominent cases of child abuse: a powerful addiction to opioids that renders adults unable to function as parents.
In Auburn, a 2-year-old who was taken from a mother because of her heroin addiction died of heat stroke in a foster home.
In Boston, another 2-year-old whose body was found on Deer Island was allegedly the victim of her motherâ€™s boyfriend, a heroin addict.
Those on the front lines â€” doctors, judges, drug counselors â€” say they are seeing more and more cases like this, of opioid-addicted parents so focused on their next score that they neglect or abuse the children in their care.
But the state Department of Children and Families says it has no way to document what to many seems obvious: that the opioid crisis that killed 1,256 Massachusetts residents last year is one of the factors driving an increase in the stateâ€™s child protection caseload, which has soared to record levels.
The department says its outmoded computer system is simply not capable of tracking such basic information, even though child welfare professionals warn that drug abuse is one of the leading indicators that children are at risk of harm.
â€œI canâ€™t pull that data currently,â€ said Marylou Sudders, the state secretary of health and human services, who added that DCF will upgrade its computer system to allow it to track all drug-related cases.
â€˜There is no question the substance use issue has been a huge problem.â€™ – RHONDA MANN, Executive Office of Health and Human Services
Linda Carlisle, who served until last week as acting head of the Office of the Child Advocate, said it is crucial that DCF know which of the 47,000 children it monitors have parents addicted to opioids.
â€œThatâ€™s something that really has to be addressed,â€ she said. â€œThereâ€™s no way you can get a sense of the numbers or the scope of the problem without that.â€
Yet there is growing evidence that the problem is increasing.
Statewide, the number of children removed from their homes by DCF has jumped 28 percent over the last three years, from 2,655 to 3,383, according to court records.
â€œWe have seen a very significant increase in the number of child abuse and neglect cases, and it is clear that parental opioid addiction is a contributing factor,â€ said Carol A. Erskine, the first justice of the Worcester Juvenile Court. â€œAnd there doesnâ€™t appear to be any indication that those numbers are going to diminish anytime soon.â€
At UMass Memorial Childrenâ€™s Medical Center in Worcester, 119 children were admitted after serious physical abuse this year, up from 59 in 2012, while the number of children treated for less serious injuries because of abuse has grown to 336, from 199 in 2012.
A â€œsignificant numberâ€ of those cases involved children whose parents were addicted to opioids, said Dr. Heather C. Forkey, chief of the hospitalâ€™s child protection program.
â€œWhen youâ€™re living with a caregiver who is impaired, they are not able to meet your needs as a child,â€ she said. â€œMany kids are at significant risk, and while weâ€™d like to leave them at home, DCF â€” and we as a society â€” are having trouble doing that safely.â€
DCF also received reports of 3,215 infants who were born exposed to drugs between March 2014 and July 2015, according to the department, which started tracking those cases last year.
â€œThere is no question the substance use issue has been a huge problem,â€ said Rhonda Mann, a spokeswoman for the Executive Office of Health and Human Services.
â€œWhile we donâ€™t collect hard data other than those regarding substance-exposed newborns, this is a growing concern for our social workers and managers,â€ Mann said.
Doctors point out that children whose parents abuse them and are addicted to opioids are more likely to become addicts and abuse their own children when they grow up.
Yet many parents are reluctant to seek treatment because they are worried that DCF will take away their children, said Dr. Sarah Wakeman, a specialist in substance abuse treatment at Massachusetts General Hospital.
â€œRight now, thereâ€™s an incentive not to talk about the fact you have an addiction because youâ€™re worried youâ€™ll be punished and lose your kids,â€ Wakeman said. â€œSo we need to create a system where people want to come forward and talk about it so they can get the treatment they need.â€
Erskine said the lack of readily available detox programs means that even parents who want to kick their addiction and reunite with their children are unable to, so their children are languishing for longer periods in foster care.
â€œMy view has been that social workers are working very diligently and very hard to get parents into services, but the resources are just not there,â€ she said.
Doctors said that in addition to suffering from physical abuse, children who live with opioid-addicted parents experience emotional trauma that can have long-lasting effects.
That is the case for one 10-year-old girl whose parents were addicted to heroin and has been raised for the last two years by her grandmother on the South Shore.
The grandmother, who asked that her name not be used, said her granddaughter suffers from night terrors, low self-esteem, and feelings of abandonment after being taken from a home where she was not getting enough food and clothing and was often left alone or locked in her room.
â€œItâ€™s an epidemic, and we need some big, systemic approach to make sure the kids are being taken care of,â€ the grandmother said.
DCF said it will begin training its workers to better understand opioid addiction.
Dr. Ruth Potee, an addiction specialist at Valley Medical Group in Greenfield, recently led a training session, telling DCF employees that opioid-
addicted parents who neglect their children are suffering from a disease, not a moral failing.
â€œIf this part of your brain is screaming at you, then itâ€™s all you can think about,â€ she said. â€œItâ€™s hard for kids to crowd into that space, so I see more and more often that kids are very appropriately taken away by DCF.â€Michael Levenson can be reached at firstname.lastname@example.org.