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Codeine prescribed for kids despite warnings

New study findings show that despite safety warnings from the AAP, codeine is still being prescribed for children in the ER.
New study findings show that despite safety warnings from the AAP, codeine is still being prescribed for children in the ER.
Carsten Koall/Getty Images

A new report by researchers from the University of California-San Francisco (UCSF) Benioff Children’s Hospital raises red flags about the use of codeine as a pain killer and cough suppressant in children. Published in the April 21 online journal Pediatrics, the study findings showed that emergency room physicians continue to prescribe codeine despite safety warnings issued by the American Academy of Pediatrics (AAP) in 1997 and 2006.

Codeine is a narcotic that gets converted to morphine by the liver. Because of variables in the way children process the drug, about a third get no symptom relief from taking it, while up to one in 12 kids can accumulate toxic amounts that cause breathing to slow and possible death.

To determine to what extent codeine is being prescribed for children in U.S. emergency rooms, the UCSF researchers, led by Sunitha Kaiser, MD, an associate pediatrics professor at the university, studied information from the National Center for Health Statistics. Kaiser and her team analyzed data gathered on children ages 3 to 17 from 2001 to 2010.

The investigators’ findings showed that although codeine prescriptions dropped from 3.7 percent to 2.9 percent during the 10-year period they studied, a substantial number of children were still being prescribed the drug. According to a UCSF news release, 559,000 to 877,000 prescriptions for codeine are written for children each year.

In addition, the study showed that codeine prescriptions were high in children ages 8 to 12 and in regions outside the Northeast. Findings also indicated that the number of prescriptions for codeine were lower for non-Hispanic black children or those with Medicaid.

“We have hundreds of thousands of children still getting codeine, even though there are better and safer alternatives available,” Kaiser told HealthDay.

According to Kaiser, ibuprofen is equal to or better than codeine for treating injury pain and hydrocodone is also a safer, more effective opiate alternative. Dark honey has been shown to be better than over-the-counter cough suppressants, and the AAP recommends it, but only for children over the age of 1 year.

Several U.S. hospitals have found a simple and effective way to reduce codeine prescriptions -- they have removed the drug from their formularies. “That’s an incredibly effective means, because physicians tend to reach for the drugs that are most easily available through their formulary,” said Kaiser.

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