July 15, 2020

Cough and cold products containing opioids: prescribing and patient utilization patterns in the pediatric population.

Q# 19-06 – Cough and cold products containing opioids: prescribing and patient utilization patterns in the pediatric population.

Research question:

What are the physician’s prescribing patterns and patients’ use patterns of prescribed cough and cold opioid-containing medicines (CCOMs) in paediatrics?

Context and rational:

Opioid-related harms constitute a major public health concern in Canada, currently ranked as second in per capita prescription opioid use, after the United States. The last Canadian national report of apparent opioid-related deaths, updated in December 2018, revealed that there were more than 9,000 apparent opioid-related deaths between January 2016 and June 2018. Of them, 2,066 occurred between January and June 2018 and 94% were accidental. Most accidental apparent opioid-related deaths involved fentanyl and fentanyl analogs and occurred among males (76%), and middle age adults. Only 1% of accidental apparent opioid-related deaths occurred in <19 years of age1. There are no data that discuss the role of CCOMs in the opioid related harms occurred in Canada.

Given the identified knowledge gap, studies aiming to address the potential role of CCOMs in the opioid-related risks among the pediatric population, should help to provide Canadian prescribers and patients with meaningful information for decision making, validate the recommendation provided in the SA and help to understand the individual contribution of CCOMs to the National opioid crisis.


Within each provincial administrative/hospital databases, a birth cohort will be formed including all births that occurred in the province between 1998-2018. Date of entry in the cohort will be the date of birth (DOB) and children will be required to be publicly insured for their medications.

Follow-up will be done from DOB until i) the child is 18 years of age, ii) end of medication coverage, or iii) December 31, 2018, whichever comes first.

CCOMs considered will be fentanyl, codeine, hydrocodone, normethadone, dextroethorphane alone or in combination forms (i.e. acetaminophen and codeine, etc.); pills, syrups, oral formulations or elixirs will be studied.

Current status:

The query was obtained at the end of December 2019. Contracts for transfer funds and detailing collaboration with sites from four provinces, including University of Saskatchewan, Ottawa Hospital Research Institute, University of Alberta, University of Manitoba, are in progress. We plan to start the study soon as our research center re-opens after COVID-19, and the contracts finalized. The protocol was presented to the team at the CAMCCO symposium on February 20th, 2020 (CHR KT funding). We are on track with proposed timeline.