Codeine Still Prescribed to Children in U.S. Emergency Rooms Despite Health Risks

First Posted: Apr 21, 2014 03:26 AM EDT

A latest study says that emergency room doctors overlook the harmful effects of codeine in pediatric cases and continue to prescribe the painkiller.

Researchers at the University of California, San Francisco Benioff Children's Hospital, found that codeine is still prescribed to children in the U.S. emergency rooms, despite the availability of alternatives. Researchers suggest the need to alter prescription behavior and promote the use of safe alternatives that include ibuprofen or hydrocodone.

"Despite strong evidence against the use of codeine in children, the drug continues to be prescribed to large numbers of them each year," Sunitha Kaiser, MD, UCSF assistant clinical professor of pediatrics at UCSF Benioff Children's Hospital San Francisco, said in a statement. "It can be prescribed in any clinical setting, so it is important to decrease codeine prescription to children in other settings such as clinics and hospitals, in addition to emergency rooms."

Codeine is an opioid pain medicine that is prescribed for children to treat moderate to mild pain.  It is also prescribed for mild cough. Belonging to the class of medications called narcotic analgesics, it is one of the most widely used drugs.  But this drug causes respiratory problems and in some cases death.

Due to increase in fatality cases and other life threatening conditions caused due to codeine, several national and international organizations urged a ban on the drug. In 1997, the American Academy of Pediatrics issued a guideline that was again reaffirmed in 2006, clearly warning to stop using the drug in children due to the growing health concerns and also lack of documented effectiveness in children suffering with cold and cough.  Apart from this, the American College of Chest Physicians 2006 also issued guideline for treatment of pediatric cough against the usage of drug.

The current study researchers found that the rate of codeine prescription dropped from 3.7 percent to 2.9 during the 10 year period of the research (2001-2010).  Yet, quiet a big population of the U.S. children was still given the drug i.e. 559,000 to 877,000 prescriptions a year. The researchers however, did not notice any decline in codeine prescription linked to 2006 professional recommendations.

The findings reveal that the drug was mostly prescribed to children of ages 8 to 12 and in regions outside Northeast. The prescription  drug was low for non-Hispanic black children or those with Medicaid.

"Further research is needed to determine the reasons for these lower rates so we can reduce codeine prescriptions to all children," Kaiser said.  "Many children are at risk of not getting any benefit from codeine, and we know there are safer, more effective alternatives available. A small portion of children are at risk of fatal toxicity from codeine, mainly in situations that make them more vulnerable to the effects of high drug levels such as after a tonsillectomy."

The study was documented in Pediatrics. 

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