Codeine given to kids despite warning, study finds

By: CBS
By: CBS

(CBS) -- A new report warns of kids being treated with the powerful painkiller codeine. The American Academy of Pediatrics finds emergency room doctors prescribe codeine to children more than 500,000 times per year.

The result comes despite national guidelines that urge against giving the drug to kids.

The 10-year study, published in Pediatrics, found just three percent of kids' emergency visits resulted in a codeine prescription in 2010, but with more than 25 million emergency room visits by children each year, the authors say far too many kids are getting the drug when better options are available.

The study's lead author, Dr. Sunitha Kaiser, an associate pediatrics professor at the University of California, San Francisco, says doctors and parents should know about codeine's drawbacks and that alternatives are available, including dark honey for coughs in children over age 1; and ibuprofen or the opiate drug hydrocodone, for pain including broken bones.

Dr. Dyan Hes, medical director at Gramercy Pediatrics in New York, said on "CBS This Morning" that she was "floored" by the study.

"I've never seen a doctor write codeine as a cough suppressant or as a painkiller in an emergency room," she said. "I worked in the Bronx. I worked in many hospitals, I've never seen it happen."

Codeine, Hes explained, carries the risk of respiratory suppression.

"Codeine is a pro-drug, which means it's converted into morphine by your liver," she said. "In children, not all of the enzymes work the same. In anybody actually, the enzyme can have different levels of activity, so some children can ultra-metabolize this, which means they rapidly convert it to morphine and that can lead to respiratory suppression and eventually death. It doesn't have a good safety protocol profile so the Academy of Pediatrics has recommended for a long time -- over 10 years -- to not use codeine as a cough suppressant and it's also not effective."

Emergency room staffing, Hes suggested, could be to blame for the codeine prescriptions for kids.

"A lot of hospitals around the country have a lot of adult emergency room doctors staffing their ER and they're covering the pediatrics side of the emergency room and it's more common to use codeine in adults because it has a better safety profile -- even though it doesn't really work well for a cough suppressant -- even if it does a little bit, it has a better safety profile," Hes said. "Your patient won't die of stopping breathing in the middle of the night. So they're used to writing it."

Parents, Hes added, may also be a factor in prescriptions.

"When people stay in an emergency room for six or eight hours...and they're told that their kid has a cold and they're to use a humidifier, saline drops, some tea and honey, a lot of parents get upset and they want a prescription," she said.

The bottom line, she said, is that codeine is "dangerous" and is not effective in treating a child's cough or cold.


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