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Letter

Codeine v. morphine

Ruth E. Dubin
CMAJ January 11, 2011 183 (1) 84-85; DOI: https://doi.org/10.1503/cmaj.111-2006
Ruth E. Dubin
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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.

Footnotes

  • Some letters have been abbreviated for print. See www.cmaj.ca for full versions.

References

  1. ↵
    1. MacDonald N,
    2. MacLeod SM
    . Has the time come to phase out codeine? CMAJ 2010;182:1825.
    OpenUrlFREE Full Text
  2. ↵
    1. Watt-Watson J,
    2. McGillion M,
    3. Hunter J,
    4. et al
    . A survey of prelicensure pain curricula in health science faculties in Canadian universities. Pain Res Manag 2009;14: 439–44.
    OpenUrlPubMed
  3. ↵
    1. Furlan AD,
    2. Reardon R,
    3. Weppler C
    National Opioid Use Guideline Group. Opioids for chronic noncancer pain: a new Canadian practice guideline. CMAJ 2010;1282:923–30.
    OpenUrl
  4. ↵
    1. Brown SC,
    2. Stinson J
    . Treatment of pediatric chronic pain with tramadol hydrochloride: siblings with Ehlers–Danlos syndrome — hypermobility type. Pain Res Manag 2004;9:209–11.
    OpenUrlPubMed
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Canadian Medical Association Journal: 183 (1)
CMAJ
Vol. 183, Issue 1
11 Jan 2011
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Codeine v. morphine
Ruth E. Dubin
CMAJ Jan 2011, 183 (1) 84-85; DOI: 10.1503/cmaj.111-2006

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Codeine v. morphine
Ruth E. Dubin
CMAJ Jan 2011, 183 (1) 84-85; DOI: 10.1503/cmaj.111-2006
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