Children Given Codeine in ER, Despite Death Risks: Study

More than half a million children are given codeine for pain and respiratory problems every year, despite national guidelines warning against use of the drug among kids due to the risk of severe side effects, including death.

According to a study published this month in the medical journal Pediatrics, hundreds of thousands of children are prescribed codeine every year, suggest that many doctors are ignoring the potential dangers the drug poses to young patients.

Researchers from the University of California, San Francisco conducted a cross-sectional analysis of emergency room visits involving patients between the ages of 3 and 17 between 2001 and 2010.

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The study examined data from 189 million emergency room visits, using data from the National Hospital Ambulatory Medical Care Survey.

Overall, prescriptions for codeine decreased during that period from four percent to about three percent during the 10 year period. However, researchers found that between 600,000 to 900,000 children were receiving the potent drug each year, with more than 1.7 million codeine prescriptions were written in the U.S. for children 17 and younger in 2011

Codeine prescriptions were much higher among kids ages 8 to 12 and among medical providers outside the Northeast. Prescriptions rates were much lower for non-Hispanic black children or children with Medicaid.

Sunitha Kaiser, lead author of the study, noted the decrease in codeine prescriptions was among the youngest patients and the likelihood of being prescribed the drug varied by the location of the emergency room.

Codeine is an opioid drug prescribed to children for upper respiratory infection (URI), cough or pain. The drug breaks down to morphine in the body, which changes how pain is perceived by the brain and can also slow down breathing. Some users may breakdown codeine much faster than usual, potentially leading to an overdose. For others, the drug may not be broken down enough for it to be effective.

More than 25 million emergency room visits involving kids occur each year. Many of those visits are for injuries and respiratory problems, increasing the risk that doctors may prescribe them codeine, unaware of the risks.

Last year, the FDA issued a strong warning concerning codeine and its likelihood to cause life-threatening complications and death in children given the drug after undergoing certain surgeries.

The warning followed an announcement in 2012, which indicated that the FDA was investigating the drug after several children taking the drug for pain following tonsil or adenoid surgery died. The FDA found children offered codeine after those surgeries have a higher likelihood of experiencing severe side effects. As a result the FDA required a black box warning for the opioid drug.

The American Academy of Pediatrics (AAP) and American College of Chest Physicians (ACCP) also recommends against prescribing codeine for coughs or URI in children. The Canadian Ministry of Health and European Medicines Agency prohibits the use of the drug in kids younger than 12.

Despite national guidelines which recommend against the use of codeine in children, many still receive the drug every year.

Officials warn parents who may be worried about potential side effects ask for alternative medications without codeine. Researchers call for more effective interventions and prescribing practices of the drug to prevent codeine use in children.


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