Codeine for kids on banned list: Local hospitals played it safe 2 years ago
New research emerged Monday suggesting the routine practice of giving children codeine after tonsil surgery can be deadly but Windsor's hospitals have been playing it safe for nearly two years.
"It's been a long-standing concern," said Christine Donaldson, the regional director of pharmacy for all three of the Windsor-area hospitals.
"We decided to make a global statement in restricting (codeine's) use," Donaldson said.
The latest research, published in this week's issue of the journal Pediatrics, reports on three cases in which two children died and one girl (who was treated in Southwestern Ontario) had to be resuscitated after receiving codeine following surgery for sleep apnea.
It was discovered that these children were "ultrarapid metabolizers" of codeine.
When codeine enters the body and breaks down, or metabolizes, it changes to morphine, which can slow breathing.
Some children are born with a genetic variation that causes their bodies to convert codeine to morphine far faster than most other children, leading to an overload of morphine that can be deadly, even when the child is given a recommended standard dose.
Children are usually prescribed codeine in syrup form, Donaldson said.
In April 2010 pediatricians at Windsor Regional Hospital voted to remove codeine from the list of treatment options when it came to pediatric cases after researchers at Toronto's Hospital for Sick Children looked at the first reported case of a child dying after receiving codeine, Donaldson said.
Hotel-Dieu Grace Hospital and Leamington District Memorial Hospital – which see fewer pediatric cases – quickly followed suit.
Now, Windsor Regional uses "more predictable" painkillers after surgery, such as regular Tylenol or small doses of morphine, Donaldson said.
Given Windsor's ethnic makeup, it also makes sense to stop prescribing codeine to children, she said, since the genetic variation occurs more often in certain ethnic populations.
Codeine was developed in northern Europe, where less than two per cent of the population is an ultrarapid metabolizer, said Dr. Michael Rieder, the head of pediatric clinical pharmacology at the University of Western Ontario.
However, in populations from the Middle East, southern Europe and southern India, for example, that number can be as high as 30 per cent, he said.
There are tests available to determine if someone carries the genetic variation, but it is not standard practice to test for it, said Lauren Kelly, a PhD student in physiology and pharmacology at Western who led the study.
"There's no current standard of care across North America," Kelly said.
More research needs to be done to understand the risk factors when it comes to prescribing codeine to children, she said, and more has to be done to understand what constitutes the safe and effective use of the drug.
email@example.com or Twitter.com/bfantoni