My articles seldom discuss issues for the pediatric population. The Altoona Lung Specialists are not trained in pediatric illnesses. However, a recent FDA advisory committee recommendation about the use of codeine in pediatric cough medications caught my eye, and I thought it was worthy of reporting.
The exact statement that made me take notice is as follows: “The majority of a Food and Drug Administration advisory panel agreed that the benefit versus risk of prescription opioid cough suppressants for pediatric patients was not favorable.” What this statement means is that the use of opioid cough suppressants, such as codeine and hydrocodone, is not recommended for various age groups between 6 to 18 years of age.
Much of this review comes out of the concern for opioid dependency in children and adolescence. According to some experts, adolescents are the most at-risk population for opioid misuse. The reasoning is based on the neurobiology of the brain in this age group and the developing reward pathways. How our brain interprets important and unimportant rewards varies with age. Adolescents are particularly at risk because their pleasure center feedback makes them unhappy with small rewards but extremely happy with large rewards. This makes them particularly vulnerable to substance abuse.
We often prescribe codeine containing cough suppressants for our adult patients. The term “salience” is the term for distinguishing important versus unimportant rewards. Adults seem to have proportional, accurate, and balanced salience to rewards, making them less vulnerable to abuse.