Every year, there are up to 870,000 prescriptions of codeine written for children in emergency rooms in the United States.
And that's a huge danger, because the narcotic can have particularly powerful effects on children. So powerful that the American Academy of Pediatrics issued guidelines against its use in 1997. Yet, despite those guidelines, a new study in the journal Pediatrics has found that little has changed in codeine prescribing habits.
Study author Dr. Sunitha Kaiser and her colleagues evaluated the National Hospital and Ambulatory Medical Care Survey database for emergency room visits of children between the ages of 3 and 17 from 2010 through 2010. They found found that in the nine years evaluated, the percentage of codeine prescriptions dropped very little - from 3.7% to 2.9%.
Codeine can be a particular threat to children, because they can metabolize it very differently than adults. Up to a third of all children don't process it efficiently, so that they need more than a standard dose. Another 8% of children metabolize it too quickly, meaning a standard dose can result in a fatal overdose.
"Codeine is notorious for rashes, hives, vomiting in kids, and constipation. You can be allergic to it," says Dr. Alan Woolf, director of the Pediatric Environmental Health Center at Boston Children's Hospital. Woolf wrote an accompanying editorial titled "Why Can't We Retire Codeine?" in the same issue of Pediatrics.
Kaiser and her colleagues found that children between the ages of 8 and 12 were most likely to be prescribed the drug. While coughs and colds were commonly cited as a reason for codeine, the AAP's guidelines specifically state "no well-controlled scientific studies were found that support the efficacy and safety of narcotics (including codeine)."
"Codeine's been around a long time. You know, just like many other drugs, there's complacency about it. Because it has such name value, people assume it's safe. ... And I don't think a lot of practitioners, and a lot of (the) public, makes the connection between codeine and narcotic," says Woolf.
In fact, codeine's use is so prevalent that, according to the Food and Drug Administration, over 1.7 million prescriptions for codeine or codeine based products were filled for children under 18 in 2011.
Woolf suggests asking your doctor for codeine alternatives, when presented with a codeine option. The AAP endorses using products with dark honey as a cough suppressant. Even when trying to manage pain, Woolf says there are much safer options for children.
So how to get doctors to stop prescribing codeine? "Education is part of the answer," Woolf suggests, along with "getting other hospital therapy committees to consider whether they need codeine in their formularies," and making stricter regulation on codeine prescribed through Medicaid. "Maybe a combination of all those things may help."