April 21, 2014
Codeine Prescriptions To Children In The ER Continue Despite Dangers
Lawrence LeBlond for redOrbit.com - Your Universe Online
Codeine, or 3-methylmorphine, is an opioid that is used to treat mild to moderate pain and to suppress cough. While it is widely prescribed to adults, it is of great concern that US emergency rooms continue to prescribe it to children, despite its potentially harmful effects.
A report published in the May issue of the journal Pediatrics, offers some solutions to this dangerous practice. Solutions include provider prescription behaviors to promote the use of better alternatives to codeine, such as ibuprofen and hydrocodone.
"Despite strong evidence against the use of codeine in children, the drug continues to be prescribed to large numbers of them each year," lead author Sunitha Kaiser, MD, UCSF assistant clinical professor of pediatrics at UCSF Benioff Children's Hospital San Francisco, noted 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."
There is much variability in how children process codeine. A third of all children receive no symptom relief from taking the drug and one in 12 can accumulate toxic amounts of the opioid, leading to breathing difficulties and possible death.
The use of codeine in children is highly unadvised by national and international organizations.
The American Academy of Pediatrics (AAP) issued guidelines in 1997 (reaffirmed in 2006) that warn of the dangers and lack of documented effectiveness of codeine use in children with cough and cold. As well, the American College of Chest Physicians issued a guideline in 2006, advising against the reliance of the drug for pediatric cough.
Previously, there was no information on to what extent codeine was being prescribed to children in ERs around the country. For the most part, it is generally prescribed for everything from a painful injury to cough due to cold in children.
To determine just how often codeine is prescribed in US emergency rooms, Kaiser and her colleagues used the National Hospital and Ambulatory Medical Care Survey from the National Center for Health Statistics. The study looked at codeine prescriptions to children ages three to 17 who visited the ER between 2001 and 2010.
The team found the rates of codeine prescriptions decreased from 3.7 percent to 2.9 percent during the 10-year period. However, they found that too many children are still being prescribed the drug, from 559,000 to 877,000 codeine prescriptions per year – averaging out to nearly 2,000 codeine prescriptions per day.
The team also found no decline in codeine prescriptions associated with the 2006 guideline.
Based on their findings, the authors said codeine prescriptions were higher in children between the ages of eight and 12 and in regions outside the Northeast, and lower in non-Hispanic 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," Kaiser added. "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."
Instead of codeine, Kaiser thinks ERs should be prescribing ibuprofen, which is equal to or better for treating injury pain. As well, she maintains that hydrocodone is a much safer and more effective alternative to codeine. Also, dark honey has been shown to be better at suppressing cough than most over-the-counter medicines, and the AAP recommends it for children over 12 months of age.