While researchers found that codeine prescriptions
for children in U.S. emergency rooms decreased slightly from 2001 to
2010, between about 559,000 and 877,000 kids were still receiving
the drug in that setting each year.
"My colleague and I felt like this was an important question to look
at to get a sense of how often it's being used in the U.S. and to
heighten awareness of the issue," Dr. Sunitha Kaiser told Reuters
Kaiser is the study's lead author from the University of California,
Codeine is an opioid that has historically been used to treat pain
and coughs in children. The drug, when broken down to morphine in
the body, changes how pain is perceived by the brain. It also
dampens the urge to cough.
Codeine also slows breathing. Depending on their ethnicity, up to a
third of people are known to break down the drug much faster than
usual, which could lead to an overdose.
Over a dozen reports of children dying from normal doses of codeine
have been reported among those so-called ultra-rapid metabolizers,
Kaiser and her colleagues write in the journal Pediatrics.
Dr. Alan Woolf, who co-wrote a commentary accompanying the new
study, added that some people's bodies may not break the drug down
enough for it to be effective. It can also be abused.
A number of organizations, including the American Academy of
Pediatrics (AAP) and American College of Chest Physicians (ACCP),
recommend against codeine use for coughs or upper respiratory
infections in children.
The Canadian Ministry of Health and the European Medicines Agency
prohibit its use in anyone younger than 12 years old.
For the new study, the researchers used data representing 189
million ER visits by children and teens between the ages of three
and 17 years old. The visits took place between 2001 and 2010.
The proportion of kids getting codeine during their ER visit or
being sent home with a prescription for the opioid decreased from
about 4 percent to 3 percent over the 10 years.
"But ultimately when we looked at the actual number of prescriptions
that were given during the visits, it was still hundreds of
thousands per year," Kaiser said.
She and her colleagues found that the decrease was mostly among the
The researchers also looked at whether the guidelines issued by the
AAP and ACCP in 2006 against codeine for coughs and upper
respiratory infections were tied to a decrease in prescriptions.
They were not.
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Kaiser's team did find that the likelihood of writing codeine
prescriptions during ER visits varied by the location of the ER.
Non-Hispanic black children were also less likely to receive a
prescription than non-Hispanic white kids.
"We don't know the reasons behind those differences," Kaiser
said, adding that knowing why some doctors are less likely to
prescribe codeine in certain areas or to certain patients may be
useful in bringing down the rates of use.
In his commentary, Woolf and his colleague wrote that in 2011 more
than 1.7 million codeine prescriptions were written in the U.S. for
use in children 17 years old and younger.
Woolf, a pediatrician at Boston Children's Hospital, told Reuters
Health that parents could ask doctors if there is an alternative
treatment without codeine.
"Far be it from me to contradict their pediatricians and doctors,
but at least open the dialogue," he said, adding that doctor
education is also important.
For example, doctors can be told about the other common side effects
of codeine. Those include allergic reactions and constipation.
"At Boston's Children Hospital, we've taken it off the formulary so
you can no longer easily prescribe it," he said.
Kaiser said it's important for doctors outside ERs to bring down the
number of codeine prescriptions, too.
"We looked at ER prescriptions because it is a really common place
for kids to be seen for pain, coughs and colds," she said. "But it's
just as important that we reduce codeine in other settings as well."
Source: Pediatrics, online April 21, 2014.
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