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Study: ER Docs Still Give Codeine to Kids

2006 guidelines have little influence on prescribing

Despite recommendations against the use of codeine in children, a new study has found that many emergency room (ER) physicians still give the potentially dangerous opioid to kids for upper respiratory tract infections (URTIs) or cough.

Although codeine prescriptions for children in U.S. ERs decreased slightly from 2001 to 2010, between about 559,000 and 877,000 children were still receiving the drug in the ER setting each year, the study found.

The new findings were published in the May 2014 issue of Pediatrics.

The study’s key objectives were to assess changes over time in pediatric codeine prescription rates in ERs nationally and to determine factors associated with codeine prescription.

The investigators performed a cross-sectional analysis of ER visits for patients 3 to 17 years of age between 2001 and 2010 in the nationally representative National Hospital Ambulatory Medical Care Survey. They identified characteristics associated with codeine prescription and assessed changes in prescriptions for URTIs or cough associated with two 2006 national guidelines recommending against the use codeine for these indications.

The authors found that the proportion of visits (N = 189 million) with a codeine prescription decreased from 3.7% to 2.9% during the study period (P = 0.008). However, the odds of a codeine prescription were higher for children 8 to 12 years old (odds ratio [OR], 1.42) and among providers outside the northeast. The odds were lower for children who were non-Hispanic black (OR, 0.67) or with Medicaid (OR, 0.84). The 2006 guidelines were not associated with a decline in codeine prescriptions for URTI or cough visits.

According to a separate commentary, in 2011 more than 1.7 million codeine prescriptions were written in the U.S. for use in children 17 years old and younger.

The authors concluded that, although there was a small decline in codeine prescriptions over a 10-year period, use of the drug for URTIs or cough did not decline after national guidelines recommended against such use. The authors called for more effective interventions to prevent codeine prescription to children.

Sources: Pediatrics; April 21, 2014; and Reuters; April 21, 2014.

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