Children Nonetheless Get Dangerous Painkiller Put up-Tonsillectomy

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By Amy Norton

HealthDay Reporter

THURSDAY, Nov. 16, 2017 (HealthDay Information) — Regardless of security warnings from drug regulators, some U.S. kids are nonetheless being given a dangerous painkiller after having their tonsils eliminated, a brand new examine finds.

At subject is the opioid painkiller codeine. In 2013, the U.S. Meals and Drug Administration issued a “black field” warning, advising medical doctors towards prescribing codeine to kids to regulate tonsillectomy ache.

That got here after an investigation into experiences of youngsters overdosing on codeine prescriptions — together with some who died from respiratory misery.

The brand new examine, revealed on-line Nov. 15 in Pediatrics, checked out how nicely U.S. medical doctors are following the FDA warning.

The excellent news, the researchers mentioned, is that post-tonsillectomy codeine prescriptions have declined. Nevertheless, by December 2015 — nearly three years after the black field warning was issued — 5 % of children had been nonetheless getting the drug.

Medical specialists mentioned there is not any acceptable purpose for that.

“That determine needs to be right down to zero,” mentioned Dr. Kao-Ping Chua, the lead researcher on the examine. “Codeine carries a small however catastrophic threat for kids. Plus, there are options — like Tylenol [acetaminophen] and ibuprofen.”

Dr. Alyssa Hackett, an otolaryngologist at Mount Sinai Beth Israel in New York Metropolis, agreed.

“There is no acceptable purpose to prescribe codeine to those kids,” mentioned Hackett, who was not concerned within the examine.

Why is the treatment such a priority?

Codeine itself is “inert,” defined Chua, a pediatrician on the College of Michigan’s C.S. Mott Youngsters’s Hospital in Ann Arbor. As soon as codeine is ingested, he mentioned, the physique converts it into morphine.

The issue is that folks differ in how they metabolize codeine, based mostly on their genes. Some individuals are “ultra-metabolizers,” which implies they will develop dangerously excessive morphine ranges within the blood.

There is no means of realizing whether or not a baby matches that class, “so each time you prescribe codeine, you are principally rolling the cube,” Chua mentioned.

For the examine, his staff analyzed a nationwide database of medical health insurance claims. The researchers centered on almost 363,000 kids who had a tonsillectomy, adenoidectomy or each between 2010 and 2015. (Adenoids are tissues close to the tonsils.)


In January 2010, 31 % of children who’d had such surgical procedure got a codeine prescription after their operation. The speed steadily declined thereafter, after which accelerated after the FDA warning was issued.

Codeine was already falling out of favor earlier than the official warning, Chua mentioned, as a result of many medical doctors had been conscious of the protection issues. By December 2015, the proportion of children receiving a codeine prescription had fallen to five %.

It is not clear why some medical doctors continued to prescribe the drug. Chua mentioned he doesn’t suppose it is lack of expertise, as a result of black field warnings are clear.

He suspects there’s some “inertia” — medical doctors persevering with to do what they’re comfy with — and probably an absence of belief that different painkillers are efficient.

Each Chua and Hackett mentioned acetaminophen or ibuprofen needs to be the go-to for kids after tonsillectomy.

“Most youngsters are resilient and do very nicely with these drugs,” Hackett mentioned.

There are different opioid medication that aren’t as dangerous as codeine — corresponding to hydrocodone (the energetic ingredient in Vicodin) and oxycodone (OxyContin). However in accordance with Chua, they need to be a final resort, in instances the place a baby doesn’t get aid from the over-the-counter choices.

“The default place needs to be, ‘let’s keep away from opioids,’ ” Chua mentioned.

Hackett agreed, saying she doesn’t prescribe any opioids to kids youthful than 12.

The codeine subject goes past post-tonsillectomy ache, nonetheless, Chua mentioned. Codeine can also be present in some cold-and-cough merchandise, and remedy pointers now say that youngsters youthful than 18 shouldn’t take these drugs.

In truth, the American Academy of Pediatrics has mentioned codeine has no place in pediatrics in any respect.

“This is not nearly tonsillectomy,” Chua mentioned. “We should not be utilizing codeine for any purpose in kids.”

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