United States: Codeine continues to be prescribed to children despite adverse effects

A recent US study showed codeine is still being prescribed in children despite major contraindications. Researchers from the American Academy of Pediatrics noted that emergency room physicians prescribed codeine more than 500,000 times a year to children. It is known that more than 25 million emergency room visits are made to children, however, this number is still very high according to the researchers.  

The study examined codeine prescriptions in emergency hospitals in patients aged 3-17 years over 10 years (2001-2010). The researchers observed a slight drop in the number of prescriptions over the years, but not as expected, while national recommendations strongly recommend against the use of codeine in children. This medication can cause respiratory depression, leading in some cases to death.

Against cough, US researchers advise using honey in children over one year old. Another effective way is to use a humidifier in the rooms, especially in winter.  Against pain, ibuprofen should be used  instead of hydrocodone.

Link between codeine and morphine

Codeine is a substance derived from opium, like morphine, which belongs to the class of opiates. As Dr. Buclin, pharmacologist in Lausanne, Switzerland, in an interview given to the Swiss website Creapharma.ch “Codeine is chemically very similar to morphine, it is also converted into small amounts of morphine in the human body, acting as an analgesic. However, not all are equal in their metabolizing enzymes. For genetic reasons, 1 in 15 people have no effect with codeine (poor metabolisers). Conversely, 1 in 30 people may develop significant side effects.”

According to a study published in 2009 and in the “New England Journal of Medicine” this genetic defect would be present, according to estimates, in about 1% of Caucasians and up to 30% of Blacks. If the child is a rapid codeine metabolizer, the excessive concentration of morphine synthesized by the liver can lead to respiratory depression and death of the patient.

Codeine in adults is not contraindicated due to the risk of respiratory depression that does not exist or is too small at a therapeutic dose. However, there is a risk of dependence on high doses with this molecule. The Doctor. Buclin also recalls that the effectiveness of antitussives such as codeine or dextromethorphan has never been so great and they do little to improve the condition.

According to Dr. Dresse, MD in New York, interviewed by CBSNews: “This excess of codeine is perhaps due to the parents. After waiting hours in the ER with their child and the doctor advising herbal tea, salt water, honey or a humidifier, parents are frustrated and put under pressure to leave the office with a prescription.” This study was published April 21, 2014 in the journal Pediatrics.

The lesson of this study can be applied in pharmacy: it can be risky to administer codeine to children, especially black children, as they have a higher genetic risk.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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