Codeine is an opioid drug that has been used for decades in over-the-counter cough formulas and prescription pain medicines. The liver converts codeine into morphine. Genetic factors determines how quickly an individual’s body breaks down the drug and it therefore has a too strong relief for some patients, while providing inadequate relief for others. Certain individuals, especially those with obstructive sleep apnea and children, are “ultra-fast metabolizers” and may experience breathing rates that are severely slowed, or even die after taking normal doses of codeine.

Despite growing evidence linking the common painkiller to fatal breathing or life-threatening reactions, use of the drug is continued in a pediatric setting. The American Academy of Pediatrics (AAP) is now calling for restrictions on its use, especially in patients under the age of 18. The Academy also urges health providers and parents to stop giving codeine to children, advocating for more education about its risks.

In 28 states and the District of Columbia, the drug still is available from outpatient pharmacies without a prescription in over-the-counter cough formulas. This despite the well-documented risks and with concerns expressed by groups including the World Health Organization, the U.S. Food & Drug Administration and the AAP.

According to the AAP report, codeine is also still commonly prescribed to children after surgical procedures such as adenoid and tonsil removal. Between 2007 and 2011, codeine was prescribed to more than 800,000 patients under the age of 11. The AAP report cites one study claiming that otolaryngologists prescribe codeine/acetaminophen liquid formulations the most frequent (19.6 %), followed by dentists (13.3 %), pediatricians (12.7 %) and family physicians / general practice (10.1 %).

The report’s lead author, Joseph D. Tobias, MD, FAAP admits that although the clinical report proposes potential alternatives to provide pain relief in children, relatively few effective, safe drugs are available for pediatric use. He adds that because children’s bodies process drugs differently than adults do, effective pain management for children remains a challenge.

Full research has been published in the journal Pediatrics.