As Oregon reverses years of progress on child fatalities and Washington reviews find most cases involved families already known to CPS, a new report from Professor Sarah Font calls for federal guidance under CAPTA.
Phoenix, AZ — A new policy report from Professor Sarah Font of Washington University in St. Louis, published by the Center for the Rights of Abused Children, draws on state fatality reviews and public records to expose the high risk of injury, poisoning, and death that parental abuse of fentanyl, heroin, meth, cocaine, opioids, and other substances poses to infants and young children.
The spread of synthetic opioids has resulted in real and significant danger. Fentanyl-related deaths nationally were more than 38 times higher in 2021 than in 2013. Today, opioids are the leading substance involved in fatal poisoning among children five and under. Between 2016 and 2023, young children’s exposure to fentanyl, heroin, and other synthetic opioids rose 512%.
More recent state fatality reviews and public records show the crisis deepening in states like Washington, Oregon, and Minnesota. The consequences are visible in the data:
Washington: In the first quarter of 2025, 14 of 16 reviewed child fatalities and near-fatalities involved substance use — and 11 of those families had six or more prior reports to CPS.
Oregon: 21 child deaths with past-year CPS contact in the first eight months of 2025 — reversing years of decline — and 90% involved parents with substance abuse histories.
Given the lethality and ubiquity of high-potency synthetic opioids and other substances, Font recommends that state and federal authorities revise policies to recognize that the presence of these substances in a home with young children can be an imminent threat to life that may warrant a protective response. The report is explicit that CPS should retain discretion to screen out low-risk cases where no substance-related impairment is evident. It targets specific and potentially lethal circumstances — such as a young child left in the care of an adult incapacitated by substance use.
The report urges HHS to issue guidance establishing a baseline federal standard for when parental substance use constitutes “imminent risk of serious harm” under CAPTA — consistent with how other federal agencies already treat these risks. DOT recognizes that chemical impairment itself makes it unsafe to operate a vehicle. DOJ treats drugs near schools, and drugs manufactured in homes where children live, as serious offenses. HHS should clarify how those same risks apply to the care of infants and young children at home.
“No reasonable parent would leave their baby with someone impaired by fentanyl or heroin,” said Darcy Olsen, Founder and CEO of the Center for the Rights of Abused Children. “Federal law already recognizes that risk on the road and near schools. It’s time to recognize the same risk in the presence of young children.”
The full report, When Parental Substance Use Endangers Children: Defining Imminent Risk for Child Protection Systems, authored by Sarah Font, PhD, MSW, of Washington University in St. Louis, is available here. Author interviews available on request.