Since 2013, the Food and Drug Administration (FDA) has required a black box warning on packaging of codeine prescriptions for children. This type of warning appears on the prescription drug’s label and is reserved for drugs with serious or life-threatening risks. A new study from the American Academy of Pediatrics that examined children’s prescriptions found that although codeine prescriptions for children have decreased since the black box warning came out, five percent of the children were still receiving them.
The study covered the years 2010 to 2015 and involved data on more than 350,000 children up to 18 years old who had surgery to remove their tonsils and adenoids. All the children were privately insured. Tonsillectomy and adenoid removal is the second most common surgery in children so the doctors were concerned to learn that one out of twenty children in the study were prescribed codeine.
Dangers of Codeine for Children
From January 1969 to May 2015, 24 children died and others experienced serious breathing troubles due to the adverse effects of codeine. Codeine works as a painkiller only because the liver converts it to morphine, but the rate of conversion depends on the individual. Some people are at risk for overdose because their body can convert codeine to morphine at an extremely fast rate. These “ultra-metabolizers” represent only one to two percent of the population, but there is no way to know who is an ultra-metabolizer without performing expensive tests. Even if the tests are done, the results may not come back in time for doctors to be able to make pain management decisions.
Alternatives to Codeine
Dr. Kao-Ping Chua, assistant professor of pediatrics and communicable diseases at the University of Michigan and C.S. Mott Children’s Hospital was the lead author of the study. He says that Tylenol and ibuprofen are effective alternatives for post-surgical pain and should be used first before resorting to any kind of opioid, such as hydrocodone or oxycodone. Prescriptions for hydrocodone and oxycodone rose after the FDA issued the black box warning for codeine. Opioid drugs have their own safety concerns and some children’s hospitals, such as Nationwide Children’s Hospital in Columbus, Ohio, do not prescribe opioids to outpatients unless they were necessary for pain management during the child’s hospital stay. Nationwide Children’s Hospital has been able to reduce opioid prescriptions to less than a third of the roughly 4,000 children who have tonsillectomies there each year. Previously, opioids were used with around 85 percent of patients.
Pediatricians advise parents to be aware of any drugs being prescribed to their children and ask about first managing pain with over the counter alternatives. Before leaving the hospital, parents should be sure they understand how much medicine their child needs and how often.
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