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 Researchers examined records for almost 363,000 children who had
tonsillectomies and adenoidectomies from 2010 to 2015. The U.S. Food
and Drug Administration (FDA) issued a black box warning against use
of codeine in kids because of the risk of overdoses and deaths.
Following the FDA warning, codeine prescribing related to these two
surgeries decreased significantly, by roughly 13 percentage points.
But by the end of 2015, nearly three years after the black box
warning, about 5% of kids were still getting codeine prescriptions
after these procedures.
“This is an unacceptable gamble given that there are better
alternatives,” said lead study author Dr. Kao-Ping Chua,
pediatrician at University of Michigan C.S. Mott Children’s
Hospital.
Many kids don’t have severe pain after getting their tonsils out and
can manage any discomfort with medicines like ibuprofen or
acetaminophen, Chua said. If they need something stronger,
alternatives to codeine include oxycodone and hydrocodone.
“Codeine prescribing in children for any reason should be a zero
event,” Chua said by email.
Last year, the American Academy of Pediatrics recommended against
any use of codeine for children.
Codeine used to be one of the most commonly prescribed painkillers
for kids after tonsillectomy and adenoidectomy in part because it
was perceived as safer than higher potency opioids like hydrocodone
and oxycodone, researchers note online November 16 in Pediatrics.
But between 1969 and 2012, the FDA received 13 reports of kids who
died or overdosed after taking codeine, including eight who had
recently undergone these surgeries.
Many of these overdoses happened in kids with genetic differences
that made their bodies rapidly convert codeine into morphine in the
liver, leading to dangerously high levels of morphine in the blood
that could cause suppression of breathing or even death.
For the study, researchers examined health insurance records for
kids up to 18 years old who had private coverage to see how often
they got at least one prescription for codeine or other opioids
within seven days of surgery. They also looked at how often
prescriptions were filled.
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At the start of the study, about 31% of the kids filled at least one
prescription for codeine within 7 days of surgery - and about 32% of
kids got at least one prescription filled for an alternative opioid.
As of January 2010, codeine products made up 47% of prescriptions
filled, while the rest were hydrocodone and oxycodone. By the end of
the study period, codeine accounted for just 9% of prescriptions and
the majority were for hydrocodone.
The study wasn’t a controlled experiment designed to prove whether
or how shifts in recommendations about codeine influenced
prescriptions after surgery. It’s also possible that results for
kids with private health insurance might not represent what happened
for children with other types of benefits or no insurance.
Still, the results suggest that pediatric codeine prescriptions
persist in spite of the risks, said Dr. Constance Houck, a
researcher at Boston Children’s Hospital and Harvard Medical School
who wasn’t involved in the study.
“Parents should know that there are other medications to treat pain
such as acetaminophen, ibuprofen or numbing medications,” Houck said
by email.
“If an opioid is prescribed, it should be one that does not have to
be broken down in the body in order to provide pain relief,” Houck
added. “Oxycodone and hydrocodone are two pain medicines that are
available in liquid form that can be used instead of codeine.”
SOURCE: http://bit.ly/2jyxGIt
Pediatrics 2017.
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