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Too Much Codeine Still Prescribed to Kids: Study

ERs give potentially dangerous drug to thousands of children each year


The AAP warned doctors twice -- in guidelines issued in 1997 and 2007 -- to avoid prescribing codeine to children.

This is the first study to attempt an estimate on the number of children being prescribed codeine in U.S. emergency rooms and to see if those warnings made any difference, Kaiser said.

She and her colleagues used a nationwide survey on hospital and outpatient care, performed annually by the U.S. National Center for Health Statistics, to determine the frequency of codeine prescriptions to children aged 3 to 17 during ER visits from 2001 through 2010.

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.

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