More and more physicians across Canada and America are raising concerns about the use of codeine as a pain reliever for babies and children. There is evidence now that codeine isn’t really effective as a pain reliever in this age group. And with all the potential for serious side effects with codeine, it might be best to stick with Tylenol with hydrocodone or ibuprofen. When used properly, these over-the-counter medications are safe and effective for pain control.
In a recent report, deaths have been linked with codeine in infants who have an unusual gene that turns codeine into morphine. Other genetic variations among the young also make it possible to break down codeine quickly and dump a larger amount into the bloodstream than intended or tolerated. Unpredictable serious side effects including death can be the result.
In North America, physicians have access to a special test that can identify children at risk because of this genetic difference. But in other countries and places in the world (e.g., North Africa, the Middle East), the test is not always readily available. And those are the areas where this genetic-linked polymorphism (change from one form to another) is most common.
What can be done to protect our children? Some experts recommend taking codeine off the market completely for use with infants and young children. Some hospitals in Canada have already done this. This action may seem drastic but with babies and pre-verbal children who can’t communicate their symptoms, it’s the safest way to ensure no one dies as a result of codeine use. And since there are acceptable, safe, and effective alternatives, children don’t have to suffer pain unnecessarily.
In the United States, it’s not as simple as just voting to remove codeine from use with children. There are health plans that do not cover some of the liquid alternative formulations that could replace codeine in this age group. Drug regulations may also restrict the use of suitable narcotic replacements. So there’s work to be done before codeine can be taken off the market for pediatric use in the U.S..
Education of physicians, pharmacists, health care plan administrators, and even legislators is the first step. Parents, family members, and all other caretakers of children will also need to get the word so they don’t give children in their care any adult products containing codeine.