The opioid crisis has helped spark a 56 percent increase in child protection cases since 2012 in Massachusetts.
Part of a MassLive special report on the the impact of the opioid crisis on children in Massachusetts.
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Franklin-Hampshire Juvenile Court Judge James Collins has seen the ugly, heart-breaking impact of the state's opioid crisis first-hand from the bench. And he's seen how it has ravaged families and hurt the smallest and most vulnerable among us.
There was the child who found the body of their parent after a fatal overdose. The case in Greenfield, where state troopers found a mother passed out in her car with her toddler in the back seat, a used syringe in the child's French fry carton. The babies transferred from the birth ward to detox, born with heroin or cocaine in their systems.
The juvenile court system is on the front lines of Massachusetts' opioid crisis. And according to statistics provided by court officials, addiction is increasingly wreaking havoc with Massachusetts families, helping spark a 56 percent increase in child protection cases since 2012.
Those cases, the last legal resort of the state Department of Children and Families, can lead to the permanent loss of parental rights if parents fail to create safe living conditions for their children.
Collins says addiction is the cause of 30 to 40 percent of child protection orders - and has increased strain on an already overburdened system. Cases have also increased due to more aggressive enforcement by DCF, following a series of tragic cases that led to questions about the agency's effectiveness.
'The devastating effects of substance abuse are really hitting our families and communities and children hard," Collins said.
Collins himself is an example of how juvenile courts are struggling to cope with waves of cases linked to opioid addition.
Collins is 70 years old, past the state's mandatory retirement age for judges, and formally left his position on Aug. 1. But he was immediately brought back to work full time to help the court cope with its growing caseload.
'We're trying to fight the effects of the opioid epidemic with the same resources we had several years ago," Collins said.
The effects of the opioid epidemic can also be seen in the growing numbers of children in foster care across the state. Thirty percent of neglect and abuse cases across the state were linked to substance abuse, according to DCF.
When DCF files a care and protection case, a judge makes an ex-parte decision - without the parents' input - as to whether the child should be placed in emergency state custody.
Parents then have the right to a hearing within 72 hours, and are denied guardianship if the state proves by a preponderance of the evidence that the child would be at immediate risk of harm or neglect if returned to parental custody.
The state then has between 15 and 18 months to establish a permanent living situation for the child. That can mean a return to the parents, if conditions improve; an agreement with parents to give up the child to adoption or alternative guardianship; or a trial to revoke parental rights.
Statistics provided by the Hampshire Franklin Juvenile Court show a stark increase in such cases, as the opioid epidemic spread across Massachusetts.
In fiscal 2012, there were 2,459 care and protection cases. That number rose to 3,855 in fiscal 2016.
Every county in the state has seen an increase, though some ares have been hit particularly hard. In Essex County, cases increases 73 percent. In Barnstable, that figure was 92 percent.
The highest numbers of cases, as might be expected, were filed in the counties with the state's three most populous cities - Boston, Worcester and Springfield. Worcester county had the highest number in 2016, with 695 care and protection cases. Hampden County had 552, and Suffolk had 518; none of the three counties had more than 425 cases in 2012.
Some of the rise is attributable to an increased focus on enforcement, after a series of tragedies - the deaths of 5-year-old Jeremiah Oliver, 4-week-old Aliana Lavigne, and 2-week-old Bailey Irish - placed DCF under tough scrutiny in 2014.
But opioids have also had a major impact, Collins said - both in the number of cases and how they are resolved.
Before the opioid epidemic, about two-thirds of care and protection orders ended with the reunification of families after parents addressed the state's concerns, Collins said.
Now, that number is about 50 percent. Only four in 10 cases involving opioid use now end in reunification, which has led to more families being kept apart, according to Collins.
"I think that the heroin, opioid, and opiate prescription drug epidemic and the suffering that accompanies it is reducing markedly that success rate," Collins said.
These cases can unveil the grim costs that addiction is leveling on children. Collins said he has reviewed reports of children born dependent on opioids due to maternal drug abuse.
"The child is born positive for heroin, cocaine, whatever the substance," Collins said. "The child has to go into a detox for weeks or longer and anybody who says that heavy substance abuse doesn't have an impact, they should listen to what we judges and clerks and staff listen to, which is the screams of a newborn trying to detox from cocaine or heroin."
(The prognosis for infants born dependent is positive with proper care and treatment, Dr. Rachana Singh of Baystate Medical Center's neonatal ICU told MassLive. And children can be born dependent even if their mother is in treatment.)
But Collins also said there were reasons for optimism. While many addicts relapse, Collins said he has seen numerous successes among parents he has ordered into treatment. And he has been heartened by cases of grandparents stepping up to raise children when parents are unable to do so.
"There's a lot of good news in terms of what's happening," Collins said. "I always tell people that there's light at the end of the tunnel. There's hope. I want them to be successful."
See how much child removal cases have spiked in your county