Doctors Still Prescribe Codeine To Children After Tonsillectomy Despite FDA Black Box Warning

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Despite a warning from the Food and Drug Administration about the dangers of codeine, doctors still continue to prescribe the opioid medication to children after undergoing surgeries, a new study finds.

Codeine Prescriptions

Back in 2013, the FDA issued an official safety announcement, which warned against the use of codeine in children who underwent tonsillectomy and adenoidectomy.

Since then, the number of codeine prescriptions managed to drop by around 13 percent. However, in the new study published in the journal Pediatrics, researchers found that around 5 percent or one in 20 children was still getting the drug to treat their pain since December 2015.

Researchers came to this conclusion after reviewing over 300,000 cases of children who had their tonsils and adenoids removed between 2010 and 2015.


Codeine is an opioid painkiller used to treat mild to moderately severe pain. The drug is also used along with other medication as a cough suppressant. According to the FDA, doctors prescribed the drug to about 1.7 million patients under the age of 17 in 2011 alone.

Codeine used to be the drug of choice for treating kids after tonsillectomy and adenoidectomy. However, after the FDA received 13 reports of children who died as a result of the drug, they decided to issue a strong warning against its use.

Unsafe And Ineffective

Many of those children who died from codeine overdose are known to have “ultra-rapid metabolizers” of codeine. This means that their liver can change codeine into morphine faster and completely than others, and their blood is more likely to contain higher levels of morphine.

Kao-Ping Chua, an assistant professor of pediatrics and communicable diseases at the University of Michigan and lead author of the study, said that while some children can rapidly metabolize codeine into morphine in their liver, other children can’t, which makes the drug not only unsafe but also ineffective.

Chua added that many children do not experience severe pain after having their tonsils and adenoids removed. They can usually manage with other “safer and more effective alternatives” like ibuprofen or acetaminophen. If they require something stronger, doctors can prescribe either hydrocodone or oxycodone.

Tonsillectomy And Adenoidectomy

A tonsillectomy is a surgical procedure that involves removing the tonsils, which are small round glands located in the back of the mouth. Adenoidectomy, on the other hand, is a procedure to remove the adenoids, which are similar to tonsils but they are located above the mouth.

Doctors recommend tonsillectomy for children who usually have recurring tonsillitis or strep infections including swollen tonsils that make it hard for them to breathe during sleep and eat chewy food.

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