By Andrew M. Seaman
NEW YORK (Reuters Health) - Despite recommendations against the use of codeine in children, a new study found many emergency room doctors still give the potentially dangerous opioid to kids, such as for pain and coughs.
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 Health.
Kaiser is the study's lead author from the University of California, San Francisco.
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 youngest patients.
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.
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: http://bit.ly/uFc4g2 Pediatrics, online April 21, 2014.