As opioid deaths surge, hundreds of children under the state’s watch witnessed an overdose last year

They wake up to discover their mother or father sprawled out in a bathroom. Some find parents unresponsive in the bedroom, syringes protruding from their arms. Others watch as an EMT desperately tries to save them.

As opioids tightened their grip again on Massachusetts last year, reports of children witnessing an overdose proliferated within the Department of Children and Families and other state agencies, illustrating the sometimes overlooked fallout from the addiction crisis.

Of the nearly 500 children receiving state services who were seriously injured, died, or witnessed a deadly or near-fatal incident last year, roughly 200 saw a relative or someone in their home overdose.

Children witnessing an overdose was by far the most frequent “critical incident” reported in fiscal year 2020, and marked a nearly three-fold increase from the year prior, when 77 saw an overdose. Officials in the Office of the Child Advocate attributed the increase, in part, to better reporting by DCF offices.

The data, released this week by the Office of the Child Advocate, provide a snapshot within a wider and growing problem. After years of progress, opioid deaths are again on the rise in Massachusetts, reaching 2,104 last year — 5 percent more than 2019 and even slightly more than the previous peak, in 2016.

That the rise in deaths means more children may be witnessing overdoses is not surprising, particularly as the COVID-19 pandemic came to dominate daily life, isolating families and adding to their stress, according to officials and addiction specialists.

But the statistics also underscore how substance use continues to challenge the state’s already stretched child welfare system — and in sometimes deeply disturbing ways. Children 7 and under, for example, accounted for more than half of those who witnessed an overdose, according to the Office of the Child Advocate’s report.

“I can’t imagine how traumatic it is watching an EMT try to revive your parent,” said Maria Mossaides, the agency’s director who said she often spends her nights reviewing the incident reports DCF and other state agencies are required to provide to her office.

“The cases that always strike me is the child who wakes up in the morning, expecting their parent to be there making breakfast, and they wander the apartment or the house and they find them,” she said. “Sometimes they’re in the bathroom unresponsive. Sometimes they’re in their bed. There are instances in which children find adults with needles still in their arms.”

In some cases, it was the last time the children saw their adults. Of the 210 incidents where a child witnessed an overdose, about 30 cases were fatal, according to the report.

“We should be all very alarmed that this is taking place,” said Dr. Scott Hadland, a pediatrician and addiction specialist at the Grayken Center for Addiction at Boston Medical Center.

Hadland said some of his young patients described trying to rescue a parent from an overdose, and ”almost invariably,” he said, they have some level of post-traumatic stress disorder. “That can have long lasting effects on you, and puts you at risk of numerous mental health conditions,” he said.

Substance use has long complicated child welfare, here and around the country.

DCF data showed in 2016 that it was the No. 1 factor in child abuse and neglect cases in Massachusetts, and officials at the agency said Friday it’s historically one of the leading factors, along with domestic violence and mental illness, that drive families to DCF’s attention.

The agency in recent years has hired more substance abuse specialists, which now number 18 and help consult on cases with social workers.

Still, there are challenges on multiple fronts, including numbers that indicate overdoses among children and young adults also increased last year.

Twenty-one children experienced an overdose — including one who overdosed twice and two who died — a jump from 15 reported overdoses in fiscal year 2019. Another 10 attempted suicide by overdose last year, data show.

Dr. Sharon Levy, director of the Adolescent Substance Use & Addiction Program at Boston Children’s Hospital, said the increases mirror a surge doctors have seen more generally during the pandemic. Three years ago, she said, her program would receive 10 calls a week from people asking about the program. Last week alone, it received 50, she said.

“Now, it’s unusual for a week to go by without a new patient seeking treatment,” Levy said. “In the past year, there’s no question it’s rising again.”

There were other concerning spikes among children receiving state services. Cases of children being seriously injured or killed through physical abuse jumped from six in 2019 to 21 last year, two of which were fatalities. Overall, fatalities, on the other hand, dropped slightly, from 61 to 58.

Children harmed in critical incidents also rose overall last year, more than doubling from 237 to 497, though Mossaides’ office said that was driven “largely, if not exclusively,” by the increased reporting of emotional injuries, which state officials began tracking only about three years ago.

Nearly 450 children under DCF’s watch were cited in the reports, accounting for the vast majority harmed in critical incidents. State officials stressed that they made up less than 1 percent of the 75,000-plus children in the DCF system.

“The report makes clear that pressures on employment, isolation, and financial struggles increased stress levels for residents, especially for parents,” said Andrea Grossman, a DCF spokeswoman. “DCF remains committed to its mission of ensuring the well-being of the Commonwealth’s most vulnerable children and families.”

Officials acknowledged gaps in the reporting.

While DCF and other state agencies have tracked critical incidents for years, they’ve never reported race or ethnicity data with them. That makes it impossible to say how many Black or Latino children, for example, make up those witnessing or experiencing overdoses at a time when they account for a disproportionate share of all children within the child welfare system.

Mossaides said her office intends to start including that data starting in fiscal year 2022.

The opioid crisis has hit people of color disproportionately hard. The death rate per 100,000 Black men surged the most last year, up 69 percent. In contrast, the statewide increase per 100,000 was a modest 5.2 percent. And while their increase wasn’t as steep, Hispanic men continued to have the highest rates of overdose deaths in the state.

State Senator Adam Gomez, a Springfield Democrat and Senate chairman of the Committee on Children, Families and Persons with Disabilities, said it’s incumbent on officials to put a racial equity lens on child welfare and other systems.

“You’re going to see an alarming rate of probably Black and brown children who were in homes and were neglected or seen substance abuse or domestic violence,” said Gomez. “These are things I’m looking forward to understanding why.”

Felice J. Freyer of the Globe staff contributed to this report.

Matt Stout can be reached at matt.stout@globe.com. Follow him @mattpstout.