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Too Much Codeine Still Prescribed to Kids: Study

ERs give potentially dangerous drug to thousands of children each year


The researchers found that rates of codeine prescriptions decreased from 3.7 percent to 2.9 percent during the 10-year period.

However, that small percentage still represents hundreds of thousands of prescriptions. The researchers also saw no decline in codeine prescriptions associated with professional recommendations against codeine use issued in 2006 by the AAP and the American College of Chest Physicians.

"When the American Academy of Pediatrics says something, as a practicing pediatrician I tend to listen to it and treat it with respect," Woolf said. "And yet on this issue, that guidance hasn't been effective."

The study authors estimated that each year up to 57,000 children who metabolize codeine quickly are at risk of overdose. Moreover, as many as 250,000 children who metabolize the drug poorly are at risk for low levels leading to inadequate pain relief.

Woolf said he believes doctors continue to prescribe codeine out of habit.

"Codeine is an old drug. It's a very well recognized, very commonly used. You might say it's well-worn drug that everybody knows about," he said. "My suspicion is many clinicians don't really put it in the same category as other narcotics like Demerol or oxycodone."

It also could be that doctors are so overwhelmed by the rush of new medical information and guidelines that they simply haven't gotten the memo, Kaiser said.

Kaiser and Woolf both said there's no good reason to ever prescribe codeine to young children.

Other pain relievers like ibuprofen, hydrocodone or even morphine itself are safer and more reliable, they said.

As far as cough suppression, Kaiser said clinical trials have shown that no drug or over-the-counter syrup beats dark honey in safety and effectiveness. Experts say that children under the age of 1 shouldn't be given honey, however.

Woolf said: "Codeine has never been shown by any well-controlled scientific study to have an effect on the severity or duration of children's coughs or colds. It's never been shown to be effective, and it's never been shown to be safe."

Several hospitals have created a simple and direct solution to the problem, Kaiser said -- they have removed codeine from their formularies, thus eliminating the temptation for doctors to prescribe it.

"That's an incredibly effective means, because physicians tend to reach for the drugs that are most easily available through their formulary," she said.


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