Drug misuse is common, and users of illicit drugs tend to be young. Many have children. A serious drug misuse problem in the parents can be devastating for the lives of their children.1Addiction to opiates, most commonly heroin, is one of the forms of drug misuse that is potentially most damaging to the child's home environment. Recent figures produced by the European Commission suggest that about 0.2–0.3% of European adults fulfil diagnostic criteria for heroin addiction at any given time,2 and higher rates exist in inner city areas. Department of Health figures suggest that heroin use is the form of drug misuse most commonly presented to treatment services in the United Kingdom.3

The financial pressure of obtaining large sums of money (typically £10–100 a day) to buy heroin can lock a person into a daily cycle of seeking out, buying, and using heroin, which can lead to poverty, criminal activity, and imprisonment.4 Chaotic lifestyles may preclude attention being given to basics such as nutrition and attending appointments, and may lead to the presence of unsafe persons in the home, unsuitable carers, and frequent parental absences. Dependent heroin users are also at greatly increased risk of death from overdose, infectious diseases, and other causes.4Addiction to stimulants such as amphetamines and crack cocaine may also produce adverse home circumstances, although anonymous testing of pregnant women suggests that there does not yet appear to be the misuse of these drugs in epidemic proportions in the United Kingdom that is reported in the United States.5

It is difficult to obtain clear figures about the scale of parental drug use and the numbers of children affected. Each NHS region has a regional drug misuse database containing details of all new drug users presenting for treatment and those …