In a very worrisome early release article from the AAP journal Pediatrics, an analysis of children and emergency room visits shows that while prescriptions for codeine in children have dropped slightly, it continues to be prescribed for children despite warnings and recommendations to the contrary.
Researchers looked at data from 2001-2010 and found that between 558,805 to 876,729 prescriptions for codeine per year were given to children. While there was a slight decline in codeine prescriptions as a percentage of visits, the decline was very slight. Furthermore, there was no decline seen in children age 8-12 years old, and only a small decline in 3-7 year olds.
Most concerning, however, was that there was NO decline in codeine prescriptions given to children for cough and cold symptoms. Researchers specifically looked at the rate before and after the latest recommendations in 2006 against the use of codeine in children and found no change four years later, which is very disappointing and alarming.
The American Academy of Pediatrics (AAP) warned in 1997 against the use of codeine in children for cough and cold symptoms, stating its dangers and the fact that it has no effect on symptoms and does not help children at all. They reissued the recommendations in 2006. Also in 2006, the American Academy of Chest Physicians warned against its use in children for the same reasons. In 2012, the World Health Organization (WHO) removed it from list of treatments, and the FDA issued warnings after several children died from codeine use after tonsillectomy and/or adenoidectomy. Both Canada and Europe have banned its use in children less than 12 years of age. Warnings have also been issued that codeine should not be used in breastfeeding women because it can lead to potentially dangerous levels in nursing babies.
Codeine is a precursor drug; the body converts it to morphine, which is the active drug. However, people convert it to morphine at different rates, which can result in very high levels of morphine in the bloodstream (and breastmilk). Giving people actual morphine is much safer than codeine, as is giving other active drugs such as oxycodone.
It would be one thing if it codeine actually helped children, but study after study shows that it does not. There are, however, many good alternatives for pain relief in children, and coughs and colds are treated completely differently. There is no need to give codeine to children, there are many better alternatives, it is not helpful, and is dangerous to children. The FDA reported that 1.7 million children had a prescription for a codeine product filled at a pharmacy in 2011, and sadly I have seen it several times recently from local emergency rooms in my own community. This should not be so. Doctors are supposed to prescribe medicines that are helpful, and are always supposed to follow the first principle: do no harm. If you see a doctor who wants to prescribe codeine to your child, ask if it is really necessary. Ask if there is an alternative. Ask the doctor if he or she is aware that it is not supposed to be used in children. It is becoming more and more important for people to take charge of their own health.
