Abstract: Child Protection System Involvement and Risk of Pediatric Overdose Mortality: A Population-Based Case-Control Study (Society for Social Work and Research 30th Annual Conference Anniversary)

Schedule:

Sunday, January 18, 2026

Independence BR B, ML 4 (Marriott Marquis Washington DC)

* noted as presenting author

Lindsey Palmer, PhD, Assistant Professor, University of Utah, Salt Lake City, UT

John Prindle, PhD, Research Faculty, University of Southern California, Los Angeles, CA

Andrea Eastman, PhD, Co-Director of the Transition-Age Youth Research and Evaluation Hub, University of California, Berkeley, Berkeley, CA

Emily Putnam-Hornstein, PhD, John A. Tate Distinguished Professor for Children in Need, University of North Carolina at Chapel Hill, Chapel Hill, NC

Background & Purpose:

Pediatric drug overdoses are a growing public health crisis, with more than 700 children and adolescents dying annually from unintentional drug poisoning in the United States. Certain subpopulations, including children with a history of maltreatment, may be at heightened risk. This population-based case-control study examines the association between child protection system (CPS) involvement and overdose mortality during childhood and adolescence.

Methods:

We used linked administrative data from birth, death, and child protection records to follow a cohort of children born in California between 2000 and 2005 through age 19. Cases were defined as adolescents who died from an unintentional drug overdose, as indicated by ICD-coded deaths. Each case was matched to four living controls based on age and sex. CPS exposure was categorized as: no CPS history, report of alleged maltreatment (unsubstantiated), substantiated maltreatment, and foster care placement. Crude lifetime overdose mortality rates were calculated, and conditional logistic regression was used to estimate adjusted odds ratios.

Results:

Findings show that approximately 70% of children and adolescents who died from an unintentional overdose had a history of CPS involvement. Children with a history of foster care had the highest risk of overdose mortality. Notably, even children with only unsubstantiated reports of maltreatment were at over four times greater risk of overdose compared to those with no CPS contact.

Conclusion & Implications:

These results indicate that elevated overdose risk is not confined to youth with substantiated maltreatment or foster care histories but extends to the broader population of children reported to CPS—who comprise nearly one-third of U.S. children. Findings underscore the urgent need to better understand and address the needs of children involved with CPS, even in the absence of substantiated maltreatment.