Codeine Still Frequently Prescribed to Kids in Emergency Department

The rate of prescription of codeine to children in emergency departments for injuries and cough and upper respiratory infection remained the same from 2001 through 2010 despite guidelines recommending against its use for these conditions.

The overall rate of codeine prescription to children in emergency departments declined from 2001 through 2010, but a substantial number of children are still treated with the medication, according to the results of a new study. The study also found that the proportion of children given codeine to treat injuries or cough or upper respiratory infections did not decrease, despite national guidelines that recommend against its use for these maladies.

Separate national guidelines issued in 2006 from the American Academy of Pediatrics and the American College of Chest Physicians recommend against use of codeine to treat pain and to treat cough or upper respiratory infections in children because the medication is often ineffective and has been associated with dangerous effects, including death. Recent research has indicated that the medication is still commonly prescribed to children in Europe, but whether or not the recommendations have affected prescribing practices in the United States has been unclear.

The current study, published online on April 21, 2014, in Pediatrics, estimated the frequency of codeine prescriptions for children in emergency departments over a 10-year period to assess the impact of the 2006 guidelines. Annual codeine prescription rates were estimated using data from the National Hospital and Ambulatory Medical Care Survey database on children aged 3 to 17 years who visited emergency departments from 2001 through 2010. The frequency of opioid prescriptions was estimated for all visits, for visits involving an injury, and for those involving cough or upper respiratory infection.

The results indicate that overall use of codeine among children has declined. Pediatric prescriptions for codeine decreased from 3.7% of all emergency department visits in 2001 to 2.9% in 2010. However, prescribing rates for children presenting with injuries and with upper respiratory infections or cough did not significantly change over the study period. On average, 2.8% of children who visited the emergency department for cough or respiratory infection were prescribed codeine each year, and these rates did not significantly change after the guidelines were released in 2006.

The results also found that children aged 8 to 12 years were more likely to be prescribed codeine than were those aged 3 to 7 years, and that providers outside of the Northeast were more likely to prescribe the medication. Non-Hispanic black children were less likely to be treated with the medication than were non-Hispanic white children, as were those covered by Medicaid compared with those with private insurance.

“More effective interventions are needed to prevent prescription of this potentially hazardous drug to children,” the study authors write, suggesting that ibuprofen and hydrocodone are safe and effective alternatives to codeine for children.