In August 1935, Tu Tsung-ming (杜聰明), known as the father of Taiwanese medicine, published a case study report in the Journal of the Formosan Medical Association on the subject of “opium addicts who have been taking opium since birth.”
It comes as a shock to discover that the despicable act of using sedatives to control children has allegedly again taken place, nearly a century later, in New Taipei City, despite the nation’s modern and comprehensive healthcare, public health and education systems. Furthermore, this incident does not involve only a single family or individual childcare worker, but is reportedly a crime committed collectively by an entire preschool.
According to news reports, some parents of children attending the preschool started complaining to the New Taipei City Government in the middle of April, but the city government did not take action until the middle of last month, and it was not until this month that the case was exposed in the mass media. The news reports mentioned typical withdrawal symptoms, indicating that the children might have become addicted to sedatives.
Consider the medicinal properties of the drugs that have been detected. Barbiturates and benzodiazepines are two classes of central nervous system tranquilizers that mainly act on gamma-aminobutyric acid, or GABA, receptors, whose function is to produce inhibitory signals. These drugs have sedative, hypnotic, anti-anxiety and anti-epileptic effects.
Because overdoses of barbiturates can lead to death from severe respiratory depression, they have mostly been replaced by benzodiazepines in clinical practice. They are still used only as second-line drugs for certain children or severe epilepsy. For children, these two types of drugs require medical specialists to accurately calculate safe doses according to the patient’s symptoms, age, body weight, liver and kidney function, and so on.
These two classes of drugs are potentially addictive, so using them without expert medical guidance could lead to drug dependence and demands for increased dosage. For young children, whose brains are still developing, long-term improper use might also cause developmental delays and learning disorders. In such cases, when children go home from school and stay away on weekends and holidays, it means they suddenly stop receiving the drug, which could cause withdrawal symptoms, such as rebound insomnia, irritability and convulsions, which are even more dangerous.
There needs to be a thorough investigation of the perpetrators of this incident, including those operating behind the scenes. The presence of symptoms of poisoning and drug addiction indicates that this has been going on for some time and that the drugs might well have been used routinely rather than occasionally, making it a very serious problem from a medical point of view.
The willful administration of potentially lethal and disabling drugs by non-professionals is an even more vicious and ignorant behavior. A case like this involves multiple serious criminal offenses such as child abuse, drug abuse, illegal acquisition of controlled substances, and dealing and distribution of narcotics. That being so, there should be a thorough investigation as to how and why this crime was conceived, who made the decision to implement them and who carried them out. Still more importantly, how did the perpetrators obtain the drugs and is someone secretly pulling the strings to make a profit? It is very important to determine the flow of drugs and money.
The competent authorities of the central government should intervene to assist with public information and prevention. At a time when Taiwan’s declining birthrate has become a national security crisis, child protection is a policy area in which risks cannot be taken. The media’s exposure of this incident of drugging in a New Taipei City preschool has caused widespread anxiety among young parents and older family members across the nation. Now that it has attracted national attention, and given that the New Taipei City Government is clearly limited in its ability to handle the issue, the competent authorities of the central government should intervene and assist the local authorities by providing clear and consistent information and guidelines.
The Ministry of Health and Welfare should cooperate with professional associations such as the Taiwan Child Neurology Society and the Taiwanese Society of Child and Adolescent Psychiatry to publish regulations on the use of and the dangers of these sedatives, as well as how to identify their side effects, and provide related channels for medical treatment and testing. They should also guide local social policy departments to assist in monitoring and reporting from the perspective of child protection.
The Ministry of Education, for its part, should teach parents, schoolchildren and teachers across the country how to detect and identify improper use of drugs and inappropriate disciplining of children. It should also review the inspection and auditing of institutions catering to young children.
From the perspective of management of narcotics and misuse of drugs, the authorities should also consider whether to collect routine and nationwide anonymized monitoring statistics to help the authorities formulate management policies.
Liu Ching-kuan is a chair professor at National Sun Yat-sen University’s College of Medicine.
Translated by Julian Clegg
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