Codeine v. morphine

Thank you for identifying the risks associated with codeine’s wide use in Canada as a perceived safe and effective analgesic.1 As a family physician, I respectfully suggest that the use of morphine instead of codeine for pain relief in children might lead to another serious side effect: unrelieved pediatric pain. Given the lack of education on chronic pain in most Canadian undergraduate medical curricula as well as recent concerns about overuse of opiates leading to addiction and diversion,2^,3 I suspect that many nonspecialist physicians will be loathe to use morphine when needed. Parents may also raise concerns about using what they perceive to be a very potent opiate for their children.

Tramadol, which has been shown to be safe and effective in children,4 may be more acceptable for moderate non-cancer pain, provided that drug plans cover it. Our pediatrician colleagues can support those of us in primary care by commenting on the safety and efficacy of this drug, which has been widely used for decades in other countries. In the meantime, if we rashly discard codeine, let’s be sure we have a workable back-up plan; otherwise we might truly be throwing the baby out with the bathwater.