Codeine isn’t supposed to be prescribed to kids anymore. After enough research, it’s shown that it can be highly addictive. There’s a big problem, though: It’s still being prescribed to countless kids all over the country.
Typically, codeine was prescribed to children who had their tonsils and adenoids removed. Prescriptions have decreased dramatically since the FDA began requiring a black box warning on the medication four years ago. However, according to the American Academy of Pediatrics, codeine is still being prescribed – along with various other opioid prescriptions. These prescriptions have been on the rise, identifying a number of problems.
Between the years of 2010 in 2015, doctors collected data on over 350,000 children privately insured up to the age of 18 for those who had gone through surgical procedures involving tonsils and adenoids. They monitored the prescriptions for codeine as well as alternative opioids.
Codeine had come under scrutiny as an opioid pain reliever due to many of the adverse effects on children. The FDA said that it led to serious breathing troubles as well as 24 deaths in children between January 1969 and May 2015.
An investigation was launched by the FDA in August 2012 to determine whether codeine was safe in children. Following the investigation, an announcement was made to require a black box warning so that it could call attention to the various risks.
The number of children receiving codeine was dropping prior to the FDA investigation. However, following the investigation, the drop was even more considerable according to Dr. Kao-Ping Chua, a new study’s lead author.
In December 2015, when the study ended, 1 in 20 children was still being given prescriptions for codeine according to researchers. Chua says that 5% does not sound like a lot, but tonsillectomy and adenoid removal is the second most common surgery for children to have.
Why is codeine such a problem for kids?
As Chua explains, codeine doesn’t have any effect on pain. Instead, it’s converted to morphine. At least 1 to 2% of people are considered ultra-metabolizers. They convert codeine to morphine quickly, causing a spike in blood morphine levels that can result in an overdose. No one knows who and ultra-metabolizers without doing an expensive test. This means that there is always the risk that children will overdose on codeine following the surgery.
Chua identifies that this is an “unacceptable gamble” considering that there are other and better alternatives then prescribing codeine.
A pediatric otolaryngologist, Dr. Kris Jatana, says that the study is actually underestimating the current codeine prescription rates. He says that it’s been two years since the study was completed. Prescribing patterns have changed. Within this patient population, there has been a further decrease in the use of Tylenol and codeine according to Jatana. The study shows that hydrocodone and oxycodone prescriptions are up following the black box warning from the FDA.
Even though doctors may be shifting away from codeine prescriptions, the alternative can be even more potent with oxycodone being prescribed as a narcotic.
While there is the goal to prescribe medication that manages pain, oxycodone and hydrocodone have a number of safety concerns on their own.
Jatana has been working to decrease opioid prescriptions and decrease the number of doses being prescribed to children.
Through intervention at the hospital he works at, nationwide Children’s Hospital, opioids are being prescribed to less than one-third of the patients. In the past, this number would have been more like 85%. Tylenol and ibuprofen are the first things to be provided. The only time an opioid is prescribed is if patients have severe pain. He says that if the child doesn’t require the medication inside of the hospital, the child is unlikely to need the prescription at home. If they do have to provide a prescription, it will typically be hydrocodone as opposed to Tylenol with codeine.
While doctors should be looking out for their younger patients, it’s also up to the parents to make sure that they are providing their children with the safest possible medications. This means looking at over-the-counter Tylenol or ibuprofen as they have shown to be effective in treating post-surgical pain. Further, they don’t have the safety concerns that codeine has.
Until codeine is banned entirely from being administered to children, it simply has to be monitored carefully. There are a number of old-school doctors who still prescribe it, not caring about the black box warnings that have been required by the FDA.