(121) Prescribing Patterns of Codeine and Alternatives in Children Across Five EEA Countries Between 2010 and 2017

Publication Number: 1166

Background: Concerns over serious respiratory depression in children led to two European Union (EU) referral procedures (2013 and 2015) to review the benefit-risk balance of codeine in this population when used for pain relief, cough or cold. Codeine should no longer be used in children < 12 years and restrictions were introduced for treatment in children ≥12 years.

Objectives: This multinational collaborative study aimed to assess the effectiveness of these risk minimisation measures and to evaluate changes in prescribing of alternative treatments.

Methods: Children under 12 and between 12 to 18 years were followed between 2010-2017 to analyse quarterly trends in prescribing of codeine and alternative treatments in electronic health records from France, Germany, Norway, Spain and the United Kingdom using interrupted time series.

Results: Overall prescribing of codeine in children decreased in all five countries, reaching extremely low prevalence in children under 12. This was accompanied by an increase in use of opioid analgesics in France, Norway, the United Kingdom, and an increase in non-opioid analgesics in Norway after the referral for pain. The referral for cough/cold led only to a decrease in use of opioid and non-opioid antitussives in children below 12 in France. Overall prescribing trends for codeine and alternatives were consistent across both age groups within each country.

Conclusions: The decrease in use of codeine shows that healthcare professionals followed the adopted measures and switched prescribing patterns for pain management in children under 18 towards opioid or non-opioid analgesics depending on national clinical and reimbursement practices. Whist the magnitude differed between countries, the second referral on cough/cold had a minimal impact on the use of codeine and antitussives.