title: Impact of Safety-Related Regulations on Codeine Use in Children: A Quasi-Experimental Study Using Taiwan's National Health Insurance Research Database.
abstract: Safety concerns regarding potential life-threatening adverse events associated with codeine have resulted in policy decisions to restrict its use in pediatrics. However, whether these drug safety communications have had an immediate and strong impact on codeine use remains in question.
  
  
  
  We aimed to investigate the impact of the two implemented safety-related regulations (label changes and reimbursement regulations) on the use of codeine for upper respiratory infection (URI) or cough.
  
  
  
  A quasi-experimental study was performed using Taiwan's National Health Insurance Research Database. Quarterly data of codeine prescription rates for URI/cough visits were reported, and an interrupted time series design was used to assess the impact of the safety regulations on the uses of codeine among children with URI/cough visits. Multivariable logistic regression models were used to explore patient and provider characteristics associated with the use of codeine.
  
  
  
  The safety-related regulations were associated with a significant reduction in codeine prescription rates of -4.24% (95% confidence interval [CI] -4.78 to -3.70), and the relative reduction compared with predicted rates based on preregulation projections was 60.4, 56.6, and 53.2% in the first, second, and third year after the regulations began, respectively. In the postregulation period, physicians specializing in otolaryngology (odds ratio [OR] 1.47, 95% CI 1.45-1.49), practicing in district hospitals (OR 6.84, 95% CI 5.82-8.04) or clinics (OR 6.50, 95% CI 5.54-7.62), and practicing in the least urbanized areas (OR 1.60, 95% CI 1.55-1.64) were more likely to prescribe codeine to children than their counterparts.
  
  
  
  Our study provides a successful example of how to effectively reduce the codeine prescriptions in children in the 'real-world' settings, and highlights areas where future effort could be made to improve the safety use of codeine. Future research is warranted to explore whether there was a simultaneous decrease in the incidence rates of codeine-related adverse events following the safety-related regulations.
authors.affiliation: Taiwan Drug Relief Foundation, Taipei, Taiwan.
authors.forename: Chih-Wan
authors.initials: CW
authors.lastname: Lin
authors.affiliation: Taiwan Drug Relief Foundation, Taipei, Taiwan.
authors.forename: Ching-Huan
authors.initials: CH
authors.lastname: Wang
authors.affiliation: Taiwan Drug Relief Foundation, Taipei, Taiwan.
authors.forename: Wei-I
authors.initials: WI
authors.lastname: Huang
authors.affiliation: Taiwan Drug Relief Foundation, Taipei, Taiwan.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Ke
authors.affiliation: Taiwan Drug Relief Foundation, Taipei, Taiwan.
authors.forename: Pi-Hui
authors.initials: PH
authors.lastname: Chao
authors.affiliation: Taiwan Drug Relief Foundation, Taipei, Taiwan.
authors.forename: Wen-Wen
authors.initials: WW
authors.lastname: Chen
authors.affiliation: Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Room 220, 33, Linsen S. Rd, Taipei, 10050, Taiwan. fyshsiao@ntu.edu.tw.|School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan. fyshsiao@ntu.edu.tw.|Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan. fyshsiao@ntu.edu.tw.
authors.forename: Fei-Yuan
authors.identifier: 0000-0003-1660-9120
authors.initials: FY
authors.lastname: Hsiao
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003061:Codeine / Q000008:administration & dosage* / Q000009:adverse effects*; D003371:Cough / Q000188:drug therapy / Q000453:epidemiology; D016208:Databases, Factual; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007223:Infant; D007880:Legislation, Drug; D008297:Male; D009313:National Health Programs / Q000458:organization & administration*; D010818:Practice Patterns, Physicians'; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000453:epidemiology; D013624:Taiwan
chemical_list: D003061:Codeine