Too many kids given codeine in ERs despite risks

Codeine is prescribed for children during at least 500,000 emergency room (ER) visits each year, despite strong FDA warnings against its use in adolescents, a study published online this week in Pediatrics.

Authors of the study conclude that better options are available and too many children are being given codeine.

“Although there was a small decline in codeine prescription over 10 years, use for cough or URI [upper respiratory infection] did not decline after national guidelines recommending against its use,” the study stated. “More effective interventions are needed to prevent codeine prescription to children.”

In February 2013, FDA added a strong warning to labels of codeine-containing products advising against their use for pain relief in children after surgery to remove tonsils or adenoids. The agency asked healthcare professionals to use alternate pain relievers instead. Codeine is typically prescribed for pain relief and as a cough suppressant, but it can be prone to overdoses in pediatric patients.

According to the study, a mere 3% of kids’ ER visits in 2010 included a codeine prescription. However, 3% of more than 25 million visits add up to hundreds of thousands of codeine prescriptions for kids annually.

The study examined kids’ (aged 3 to 17 years) ER visits between 2001 and 2010. While the percentage of visits during which codeine was prescribed declined during the 10-year period, the yearly number of codeine prescriptions ranged from 560,000 to 877,000.

Lead study author Sunitha Kaiser, an associate pediatrics professor at the University of California, San Francisco, said doctors and parents should be aware of codeine's drawbacks and less-dangerous alternatives are available.  "We have hundreds of thousands of children still getting codeine, even though there are better and safer alternatives available,” Kaiser said.