Codeine use among children in the United States: a nationally representative study from 1996 to 2013

Abstract

Background Concerns regarding the safety of codeine have been raised. Cases of life-threatening respiratory depression and death in children have been attributed to codeine’s polymorphic metabolic pathway. International health agencies recommend restricted use of codeine in children. Despite these recommendations, the epidemiology of codeine use among children remains unknown. Aims Our objective was to examine patterns of codeine use in the US among children. Methods A cross-sectional analysis of children ages 0–17 years from 1996–2013 in the US was performed. Data was extracted from MEPS, a nationally representative set of health care surveys. Prevalence rates of codeine use between 1996 and 2013 were examined. Multivariable logistic regression examined relationships between codeine use and patient demographics. Results Codeine use remained largely unchanged from 1996 to 2013 (1.08 vs. 1.03 million children, respectively). Odds of codeine use was higher in ages 12–17 (OR, 1.40; [1.21–1.61]), outside of the Northeast US, and among those with poor physical heath status (OR, 3.29 [1.79–6.03]). Codeine use was lower in children whose ethnicity was not white and those uninsured (OR, 0.47 [0.34–0.63]). Codeine was most frequently prescribed by emergency physicians (18%) and dentists (14%). The most common condition associated with codeine use was trauma-related pain. Conclusions Pediatric codeine use has declined since 1996, however more than 1 million children still used codeine in 2013. Health care providers must be made aware of guidelines advising against the use of codeine in children. Codeine is potentially hazardous and safer alternatives to treat children’s pain are available.

Individual short‐acting opioids and the risk of opioid‐related adverse events in adolescents

“…Although much of the literature focuses on the risks of opioids as a class, important pharmacokinetic and pharmacodynamic differences between individual opioids could affect their relative safety in adolescents. The most frequently prescribed opioids to adolescents for moderate pain related to minor trauma or dental, surgical, or medical procedures are hydrocodone, codeine, oxycodone, and tramadol . Both codeine and tramadol are prodrugs converted to μ‐opioid ligands by the cytochrome P‐450 2D6 (CYP2D6) isoenzyme .…”

“…The most frequently prescribed opioids to adolescents for moderate pain related to minor trauma or dental, surgical, or medical procedures are hydrocodone, codeine, oxycodone, and tramadol. [5][6][7][8][9] Both codeine and tramadol are prodrugs converted to μ-opioid ligands by the cytochrome P-450 2D6 (CYP2D6) isoenzyme. 10,11 After case reports of deaths for codeine and tramadol administered following tonsillectomy or adenoidectomy to children and adolescents who were CYP2D6 ultra-rapid metabolizers (UMs), 10,12,13 both opioids ultimately were contraindicated for adolescents 12 to 17 with these procedures, obesity, or serious respiratory conditions.…”

A false comfort with codeine

“…Livingstone et al . show us that codeine is still the monarch among opioids for children. Yet codeine offers no unique benefits over other opioids and has several well‐documented negatives.…”

“…The data presented by Livingstone and colleagues may not reflect the full impact of the position statements of these health care governing bodies, given the time line of data collection and the timing of the release of the statements. One can only hope that the next such practice review will show a decrease in the use of codeine in children regardless of professional and clinical context.…”

“…In this issue of Pediatric Anesthesia, Livingstone et al . traces the prescribing pattern for codeine products in children over an 18‐year time span in the United States. They make a few notable observations.…”