Abstract
Codeine use was restricted in 2013 and is currently contraindicated for children below the age of 12 years. We examined how the prescription of opioid analgesics in children in France evolved between 2012 and 2018. Our population-based study from the SNIIRAM database (National System of Health Insurance Inter-Regime Information) was designed to determine trends in opioid prescription from 2012 to 2018 in all French children. The number of children who received at least one opioid prescription gradually declined from 452,665 in 2012 (347.5 children per 10,000) to 169,338 in 2018 (130.3 children per 10,000). This decrease was especially marked for codeine (36 children per 10,000 in 2018 vs. 308.5 children per 10,000 in 2012), whereas the number of tramadol prescriptions increased by 171% in 2018 (94.6 children per 10,000). Despite the increase, strong opioids still formed only a small proportion of prescriptions (2.6 children per 10,000 given opioids in 2018). Overall opioid prescriptions in French children dramatically decreased between 2012 and 2018, probably owing to restrictions on the use of codeine. Codeine has been partly replaced by tramadol. Morphine is still probably underused. This suggests that opioids are being used less often for pain management in children.
Highlights
Opioid analgesics have been used for many years for the treatment of pain in both adults and children
The use of tramadol has become controversial in recent years, leading to the same restrictions as for codeine in the United States since 2017 [8]
Our study shows that overall opioid prescriptions in French children dramatically decreased after codeine was contraindicated
Summary
Opioid analgesics have been used for many years for the treatment of pain in both adults and children. An increase in the prescriptions of opioid analgesics has been observed, in both adults [1] and children [2,3]. New measures have brought restrictions on the use of certain opioids. This is so for codeine, a prodrug whose main active metabolite is morphine. Owing to serious adverse effects in children, the EMA (European Medicines Agency) in 2012, [5] the FDA in the United States in 2013 [6], and the ANSM in France in April 2013 [7] recommend restricting the use of codeine in children under the age of 12 years and after tonsillectomy and/or adenoidectomy. In France, it remains available from age 3, subject to increased vigilance in its use [9]
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