National patterns of codeine prescriptions for children in the emergency department

Abstract

Background and objectives: National guidelines have recommended against codeine use in children, but little is known about prescribing patterns in the United States. Our objectives were to assess changes over time in pediatric codeine prescription rates in emergency departments nationally and to determine factors associated with codeine prescription.

Methods: We performed a serial cross-sectional analysis (2001-2010) of emergency department visits for patients ages 3 to 17 years in the nationally representative National Hospital Ambulatory Medical Care Survey. We determined survey-weighted annual rates of codeine prescriptions and tested for linear trends over time. We used multivariate logistic regression to identify characteristics associated with codeine prescription and interrupted time-series analysis to assess changes in prescriptions for upper respiratory infection (URI) or cough associated with two 2006 national guidelines recommending against its use for these indications.

Results: The proportion of visits (N = 189 million) with codeine prescription decreased from 3.7% to 2.9% during the study period (P = .008). Odds of codeine prescription were higher for children ages 8 to 12 years (odds ratio [OR], 1.42; 95% confidence interval [1.21-1.67]) and among providers outside the northeast. Odds were lower for children who were non-Hispanic black (OR, 0.67 [0.56-0.8]) or with Medicaid (OR, 0.84 [0.71-0.98]). The 2006 guidelines were not associated with a decline in codeine prescriptions for cough or URI visits.

Conclusions: Although there was a small decline in codeine prescription over 10 years, use for cough or URI did not decline after national guidelines recommending against its use. More effective interventions are needed to prevent codeine prescription to children.

Keywords: codeine; emergency medicine; health care surveys.

FIGURE 1

Frequency of codeine and opiate prescription during pediatric emergency department visits, 2001 to 2010. There was a statistically significant decline in frequency of codeine prescriptions for all visits (P = .008). There was no statistically significant change in frequency of codeine prescriptions for injury visits (P = .72) or URI/cough visits (P = .28), or in opiate prescriptions for all visits (P = .06).

FIGURE 2

Adjusted codeine prescription rate for cough/URI before and after guidelines. There was no statistically significant change in codeine prescription rate at guidelines release (P = .50) and no significant difference between prescription rate in 2010 as compared to the rate predicted by pre-guideline trends (P = .21).