Despite dangers, docs continue to prescribe kids codeine
Codeine is commonly prescribed for children with coughs and colds, although it's not recommended, a new study finds.
April 21st, 2014
04:24 PM ET

Despite dangers, docs continue to prescribe kids codeine

Every year, there are up to 870,000 prescriptions of codeine written for children in emergency rooms in the United States.

And that's a huge danger, because the narcotic can have particularly powerful effects on children. So powerful that the American Academy of Pediatrics issued guidelines against its use in 1997. Yet, despite those guidelines, a new study in the journal Pediatrics has found that little has changed in codeine prescribing habits.

Study author Dr. Sunitha Kaiser and her colleagues evaluated the National Hospital and Ambulatory Medical Care Survey database for emergency room visits of children between the ages of 3 and 17  from 2010 through 2010. They found found that in the nine years evaluated, the percentage of codeine prescriptions dropped very little - from 3.7%  to 2.9%.

Codeine can be a particular threat to children, because they can metabolize it very differently than adults. Up to a third of all children don't process it efficiently, so that they need more than a standard dose. Another 8% of children metabolize it too quickly, meaning a standard dose can result in a fatal overdose.

"Codeine is notorious for rashes, hives, vomiting in kids, and constipation. You can be allergic to it," says Dr. Alan Woolf, director of the Pediatric Environmental Health Center at Boston Children's Hospital. Woolf wrote an accompanying editorial titled "Why Can't We Retire Codeine?" in the same issue of Pediatrics.

Kaiser and her colleagues found that children between the ages of 8 and 12 were most likely to be prescribed the drug. While coughs and colds were commonly cited as a reason for codeine, the AAP's guidelines specifically state "no well-controlled scientific studies were found that support the efficacy and safety of narcotics (including codeine)."

"Codeine's been around a long time. You know, just like many other drugs, there's complacency about it. Because it has such name value, people assume it's safe. ... And I don't think a lot of practitioners, and a lot of (the) public, makes the connection between codeine and narcotic," says Woolf.

In fact, codeine's use is so prevalent that, according to the Food and Drug Administration, over 1.7 million prescriptions for codeine or codeine based products were filled for children under 18 in 2011.

Woolf suggests asking your doctor for codeine alternatives, when presented with a codeine option. The AAP endorses using products with dark honey as a cough suppressant. Even when trying to manage pain, Woolf says there are much safer options for children.

So how to get doctors to stop prescribing codeine? "Education is part of the answer," Woolf suggests, along with "getting other hospital therapy committees to consider whether they need codeine in their formularies," and making stricter regulation on codeine prescribed through Medicaid. "Maybe a combination of all those things may help."

soundoff (41 Responses)
  1. Bob

    Oh My Lanta

    April 22, 2014 at 08:10 | Report abuse | Reply
  2. Rodger

    What's up with the war on opiates. Used properly and under a doctor's care they are necessary for the treatment and care of many medical problems. Particularly pain and cough. I took them when I was a child for cough and it worked great. Sometimes things don't respond to over the counter remedies.

    April 22, 2014 at 09:19 | Report abuse | Reply
    • CEC

      codeine is not an opioid

      April 22, 2014 at 21:45 | Report abuse |
    • JayT

      CEC – better read up on opiates/opioids obviously.

      April 22, 2014 at 22:15 | Report abuse |
  3. Rodger

    And just for the record, all drugs have a down side. Not just opiates. For example, teens occasionaly take large doses of Robitussin cough syrup. That's because dextramethorphan, the active ingredient, causes your brain cells to overheat and causes a high similar to being drunk. In those people who abuse this on a routine basis, their brains end up with holes in them where the brain cells have died from the overheating.

    April 22, 2014 at 09:31 | Report abuse | Reply
  4. Diane Daguera

    I'd like to know who FUNDED this study. I sense that it was funded, either openly or behind the scenes, by an insurance company or HMO or similar organization that is trying to legitimize cutting costs at the expense of patient well-being and comfort..

    All medications have potential to have interactions. That is why patients, and/or those charged with their care are cautioned to watch for side effects, and seek medical care if they occur. In the case of codeine, serious complications are not common. That being said, codeine has proven GENERALLY safe, and is quite effective in different preparations in relieving pain and cough for over 100 years (talk about studies!). Eliminating and/or restricting access to an effective medication that has been observed and used for over 100 yeras, due to the potential side effects to a small minority of possible patients seems a bit draconian.

    Now on a personal level, I just have to speak up. Having grown up in a family where we tried home remedies prior to going to the doctor due to financial concerns, I can testify, at least in my case, that dark honey (as suggested in the article), or lemon/honey, or OTC cough syrups with Dextomethorophan HCl in no way compare to the cough relief offered by a codeine-based cough preparation. Having had surgeries as a child (cleft palate, 10 surgeries between 3mos and 17 years old), and adult (c-section, and orthopedic surgeries), I can comfortably state that in my experience, Ibuprofen is good, but codeine is superior in pain relief post surgery. Finally, like the vast majority of people, child and adult, who have been prescribed codeine as a part of their medical treatment, I've never become dependent upon codeine as a child or as an adult, but it was a valuable part of my recovery when it was needed.

    In conclusion, I'd like to see other studies.

    April 22, 2014 at 10:55 | Report abuse | Reply
    • Marie

      I think this is yet another example of the attempt by the FED to decrease heavily the use of all opiates and narcotics...thing is, sometimes, for REAL pain, codeine or other narcotics/ opiates are needed. Nothing else comes close to giving the same degree of pain relief.

      As an OR RN for 20 years, too many times I saw kids who'd had tonsillectomies or other fairly painful surgeries, sent home on JUST tylenol.....might as well give them a drink of water for all pain control that will give....

      If the parent is told the risks involved, makes sure they know what to watch out for (decreased respirations, hard to awaken child) then it should certainly be a useable drug and safe for almost everyone.

      Tylenol with Codeine is THE standby drug for REAL pain, after surgery, for broken bones, etc....nothing else comes close other that stronger narcotics which one wouldn't want to use on a child.....ALL drugs have side effects....aspirin, if was invented today, would be a prescription drug.....tylenol is very dangerous in terms of liver damage with overuse age.....yet they're demonizing codeine which is a safe drug when used properly.

      April 23, 2014 at 02:21 | Report abuse |
    • Mike

      I understand your thoughts on this, and I'm happy that you want more information, but please read the blog closer. The original thesis of the blog, thus the abstract of the study, was a survey of ER databases with regard to if the drug has been prescribed more or less since 1997, when the AAP set up guide lines for the drug to be given to children. The study itself has nothing to do with should it be or should it not be used by children.

      April 28, 2014 at 16:09 | Report abuse |
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      April 23, 2014 at 07:34 | Report abuse |
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      GOP Prayer

      "The GOP Prayer/Mantra/Solution: Dear God...With your loving kindness, help us to turn all the Old, Sick, Poor, Non-white, Non-christian, Female, and Gay people into slaves. Then, with your guidance and compassion, we will whip them until they are Young, Healthy, Rich, White, Christian, Male, and Straight. Or until they are dead. God...Grant us the knowledge to then turn them into Soylent Green to feed the military during the next "unfunded/off-the-books" war. God...Give us the strength during our speeches to repeatedly yell........TAX CUTS FOR THE RICH!!!..........and........GET RID OF SS AND MEDICARE!!!
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  8. CJ

    Funny how none of the 'safer alternatives' are mentioned.

    April 22, 2014 at 22:45 | Report abuse | Reply
  9. Farrok

    If you want a totally risk free life you are in the wrong wold. Anytime anyone takes a medication there is always a chance of a unwanted reaction. For example: Take an antibiotic or die from the infection. Risk Vs Reward.

    April 23, 2014 at 09:41 | Report abuse | Reply
  10. H H

    The DEA wants to get rid of pain meds and doesn't care if the patient, child or adult, is hurting. "It'll only last a few days. It's better to suffer it out than take a pill that will make you feel better until you heal. We know what's best for you. We're the government. Trust us." EVIL PIGS.

    April 24, 2014 at 14:17 | Report abuse | Reply
  11. sigh

    The problem is not the codeine, it's the Tylenol

    April 29, 2014 at 00:06 | Report abuse | Reply
  12. RastaLife

    Doctors that give this to children should be punished and parents should be ashamed....WAKE UP

    May 14, 2014 at 18:10 | Report abuse | Reply
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