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. 2024 Mar 4;14(1):5370.
doi: 10.1038/s41598-024-55758-3.

Health Canada advisory impacts on the prevalence of oral codeine use in the Pediatric Canadian population: comparative study across provinces

O Sheehy  1 , S Eltonsy  2 , S Hawken  3   4   5 , M Walker  3   4   6   7   8   9 , P Kaul  10 , B Winquist  11 , O Barrett  12 , A Savu  10 , R Dragan  13 , M Pugliese  3   14 , S Bernatsky  15 , J Gorgui  1 , A Bérard  16   17   18
Affiliations

Health Canada advisory impacts on the prevalence of oral codeine use in the Pediatric Canadian population: comparative study across provinces

O Sheehy et al. Sci Rep. .

Abstract

Health Canada (HC) has, since 2013, issued safety alerts restricting the use of codeine-containing drugs among breastfeeding women and children/adolescents under 18 years of age. These products are linked to breathing problems among ultra-rapid CYP2D6 metabolizers and early use of opioid can lead to future opioid misuse. Using a multi-province population-based cohort study, we estimate the impact of federal safety alerts on annual rates of codeine use in the Canadian pediatric population. We analyzed data from 8,156,948 children/adolescents in five Canadian provinces between 1996 and 2021, using a common protocol. Children/adolescents were categorized as: ≤ 12 years (children) or > 12 years (adolescents). We defined codeine exposure by ≥ 1 prescription filled for codeine alone or combined with other medications. For both age categories, we obtained province-specific codeine prescription filling rates per calendar year by dividing the number of children/adolescents with ≥ 1 codeine prescription filled by the number of person-time. Annual rates of codeine use per 1000 persons vary by province from 3.0 (Quebec) to 10.1 (Manitoba) in children, and from 5.5 to 51.3 in adolescents. After the 2013 HC advisory, exposure decreased in all provinces (adjusted level change from - 0.6 to - 18.4%) in children and from - 2.1 to - 17.9% in adolescents after the 2016 advisory. Annual rates declined over time in all provinces, following HC safety alerts specific to each of the two age categories.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Rates of children and adolescents with ≥ 1 filled codeine prescription per 1000 children/year prior and after the two Health Canada Safety alerts. (a–e) Safety alert 2013: medications containing codeine were no longer recommended for pain or cough treatments in children (≤ 12 years of age); Safety alert 2016: codeine prescriptions were not recommended in children and adolescents (< 18 years old).
Figure 1
Figure 1
Rates of children and adolescents with ≥ 1 filled codeine prescription per 1000 children/year prior and after the two Health Canada Safety alerts. (a–e) Safety alert 2013: medications containing codeine were no longer recommended for pain or cough treatments in children (≤ 12 years of age); Safety alert 2016: codeine prescriptions were not recommended in children and adolescents (< 18 years old).
Figure 1
Figure 1
Rates of children and adolescents with ≥ 1 filled codeine prescription per 1000 children/year prior and after the two Health Canada Safety alerts. (a–e) Safety alert 2013: medications containing codeine were no longer recommended for pain or cough treatments in children (≤ 12 years of age); Safety alert 2016: codeine prescriptions were not recommended in children and adolescents (< 18 years old).
Figure 2
Figure 2
Mean daily and cumulative dosage of filled codeine prescription by province. (a–d) The distribution of mean daily and cumulative dosage are presented after removing the outlier (represented by dots). The boxes are delimited by the 25th percentile at the bottom and the 75th percentile at the top. The mean is presented by the center bar and the median by the X symbol. The horizontal lines show the minimum and maximum value.
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