Codeine Can Be Deadly For Children, Physicians Warn

Health care providers and parents should stop giving children codeine, an opioid used as a painkiller and cough suppressant, because of potentially deadly reactions, the American Academy of Pediatrics announced this week in a new clinical report.

In the forthcoming October edition of the journal Pediatrics, the authors Dr. Joseph Tobias, Dr. Thomas Green and Dr. Charles Coté, all with the AAP, note in the report that codeine is still widely used in clinical settings. It is also legal to buy over-the-counter in some forms in 28 states and the Washington, D.C., despite the fact that the AAP, the FDA, Health Canada, the World Health Organization and the European Medicines Agency have issued strong warnings about its safety.

Codeine is often paired with acetaminophen in drugs and sold under names such as Capital Codeine; Phrenilin with Caffeine, Codeine; and Tylenol with Codeine; and Fioricet with Codeine. It is frequently prescribed to children after surgeries, such as tonsillectomies.

On its own, codeine is a relatively inert substance. Its components only become effective as medicine when they are metabolized by the liver and turned into morphine. However, people process codeine in a variety of ways, and some children rapidly metabolize the drug, causing them to produce excessive amounts of morphine. In some cases, the authors write, codeine reduces breathing and can lead to death.

Codeine use remains frequently used, according to the report, because there are few safe and effective drugs that are appropriate for pain relief in children. Pediatricians also have little else to offer children with coughs.

“Effective pain management for children remains challenging because children’s bodies process drugs differently than adults do,” said Tobias, the lead author, in a press release.

In light of the risk to children, the authors argue benefits of the codeine are not worth the danger.

"Maybe a little pain is better than the alternative,” Coté told the Associated Press.

Though in a December 2015 meeting the FDA voted to recommend against using codeine to treat coughs in children, previously it has suggested codeine could be used for certain types of pain "if the benefits are expected to outweigh the risks."

However, the FDA warned that caretakers should look out for signs of morphine overdose.

According to one study from the FDA, more than 800,000 children under age 11 appear to have received a prescription for codeine in 2011. Between the years 1965 and 2015, the FDA has identified 21 deaths in children under the age of death that were due to codeine use.

The authors suggest that codeine is most dangerous for children who already have breathing problems, such as those with sleep apnea, though the doctors cannot be confident that others won't also be harmed.

They end the report by calling for more research into the effects of opioid use in children and possible alternatives for pain management.

"The evolving information about the genetic variability in drug metabolism will yield important insights to guide physicians in the safe and effective treatment of their patients," the authors write. "Additional clinical research must extend the understanding of the risks and benefits of both opioid and nonopioid alternatives for orally administered, effective agents for acute pain."

Read the full report>>

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