Hundreds of thousands of children given codeine despite dangers


A new analysis shows doctors continue to prescribe codeine to children, despite mounting evidence that it may not be effective, and could be deadly for some children.

Hundreds of thousands of kids are still being prescribed codeine every year, most often for coughs and colds and to treat injury pain, the study found.

The drug has been linked to at least 10 deaths and three overdoses in recent years in kids from toddlers to age 9, NBC News reports.

Shan Yin, a pediatric emergency room physician and medical director of the Drug and Poison Information Center at Cincinnati Children's Hospital Medical Center, who was not involved in the new study, told USA Today:

"In emergency rooms we see a lot of children with cough caused by viral illnesses and often there's some expectation by parents that we do something," Yin says. "I've personally never given codeine for cough, but I wouldn't be surprised that prescribers have done that."

Dr. Alan D. Woolf, professor of pediatrics at Harvard Medical School wrote an editorial accompanying the startling new research, saying “there are good reasons why we should encourage all pediatric clinicians to give up their codeine-prescribing habit.”

Using data from the nationally representative National Hospital and Ambulatory Medical Care Survey, USA Today reports, researchers analyzed the equivalent of 189,028,628 emergency room visits for patients ages 3 to 17 between 2001 and 2010 and found:

– 577,270 prescriptions for codeine written in 2010, down from 644,394 in 2001.
– Codeine was prescribed in 2.9 percent of visits in 2010, down from 3.7 percent of visits in 2001 .
– Children ages 8 to 12 and 13 to 17 were more likely to be prescribed codeine than were younger kids, ages 3 to 7. Although there was no statistically significant change in prescribing rates for older children, the percentage of prescriptions for the youngest age group decreased from 3.8 percent to 3 percent during the 10-year study period.

The study notes that guidelines from the American Academy of Pediatrics, issued in 1997 and reaffirmed in 2006, warn about codeine's potential dangers and lack of documented effectiveness in children who have coughs or upper respiratory infections.

"There's been growing evidence that codeine is metabolized very differently in different children, with a small portion of them being at risk for potentially fatal side effects," says pediatrician Sunitha Kaiser, an assistant clinical professor at the University of California-San Francisco, and lead author of the study published online Monday in Pediatrics.

And 1 in 3 children "metabolize it in a way that they get no effect at all" when it's taken to relieve pain or to shorten or reduce the severity of cough and cold, says Kaiser. "The expense and time of going to get it may not even be worthwhile for a large proportion of children," she says.

NBC explains more about codeine:

Codeine is a so-called “pro-drug” that must be converted by the liver into morphine to work. About a third of people, including children, have genes that make them poor metabolizers, which means the drug doesn’t relieve symptoms like cough and pain. More concerning are the 8 percent of people who are ultra-rapid metabolizers, which means their bodies convert more than five to 30 times more of the drug than normal, possibly leading to fatal overdoses.

That adds up to 250,000 children in the U.S. each year who could be exposed to a drug that doesn’t work and another 57,000 a year who could risk overdose or death, Kaiser found.

The American Academy of Pediatrics began warning about codeine in 1997 and again in 2006. In 2012 and 2013, the federal Food and Drug Administration issued a black-box alert warning against using codeine in kids after surgery to correct sleep apnea because three children died and one suffered life-threatening respiratory arrest. Since 1999, 10 kids have died and three have overdosed on codeine, the FDA said.

In addition, the World Health Organization has ditched the drug from its recommended painkillers for kids and health agencies in Europe and Canada restricted codeine use to people older than 12.

Find more information about children's health from UnitedHealthcare.

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