Are We Still Prescribing Codeine for Kids?

Written by Thomas Davis, MD.

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Codeine prescriptions for children after tonsillectomy and adenoidectomy substantially dropped after the FDA issued a black box warning over safety concerns.  Still, 1 in 20 children continue to inappropriately receive codeine after T&A.

Why does this matter?
Codeine is a prodrug that is metabolized to morphine.  Some children have slow metabolism and therefore have ineffective pain relief from codeine.  Others are fast metabolizers and have an increased risk for respiratory depression and death.  After an investigation in 2013, the FDA issued a black box warning.  But did the warning change prescribing habits?

NO-deine for children
This study retrospectively evaluated a private insurance database of 362,992 children who underwent tonsillectomy and/or adenoidectomy.  The study authors evaluated the frequency that codeine and opioid alternative prescriptions were filled within 7 days of T&A surgery.  They evaluated an approximately 2.5 year period before and after the FDA investigation and black box announcement.  There was an absolute reduction in codeine prescriptions by 13.3%.  Nonetheless, 5.1% of children continued to have codeine prescriptions filled after surgery.  There was a small increase in opioid alternative prescriptions filled, meaning that more children were using OTC pain medicine only.

Source
Effect of FDA Investigation on Opioid Prescribing to Children After Tonsillectomy/Adenoidectomy. Pediatrics. 2017 Nov 16. pii: e20171765. doi: 10.1542/peds.2017-1765. [Epub ahead of print]

Peer reviewed by Clay Smith, MD.

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