New guidance from Health Canada says that children and teens under 18 should not use cough products containing opioids because they “may be a factor in problematic substance use later in life.”

A review by the public health department found “limited evidence” to support the effectiveness of certain cough and cold products in children.

“Following a safety review of cough and cold products containing opioids, Health Canada is advising that Canadian children and adolescents should not use cough and cold products containing codeine, hydrocodone and normethadone, as a precautionary measure,” Health Canada said in a news release.

“While the review did not find any strong evidence linking cough and cold products that contain opioids with opioid use disorders in children and adolescents, it did find that the early use of opioids may be a factor in problematic substance use later in life.”

Health Canada previously advised against the use of all cough and cold medicines in children younger than six, and said caution should be exercised when these formulas are used in older children. A 2009 review found over-the-counter cough and cold products were not effective in young children.

“Serious harm, including misuse, overdose and side-effects may occur in children under six years of age when using over-the-counter cough and cold products, although the risk of such serious harm is low,” the department wrote.

Following a safety review in 2015 to assess the risk of serious breathing problems in children, Health Canada recommended that codeine prescription products not be given to kids under 12.

Health Canada has started a review of all non-prescription products for children that contain codeine due to its potential for abuse, to determine whether similar action is appropriate.

Dr. Michael Rieder, a member of the drug safety committee with the Canadian Pediatric Society and a professor of pediatric pharmacology at Western University, welcomed the move by Health Canada.

“As a prudent regulator I think it’s a good idea to use it with caution because Health Canada’s right, there not a lot of data that says it’s effective and not a lot data saying it’s safe,” he told CTV News.

Rieder believes cough and cold products containing certain opiates should only be administered to children if a physician specifically prescribes the products.

“There are probably individual patients who could benefit, but that requires an astute clinician making a judgement on a patient they know well and using a drug that they’re very familiar with,” he said. “Without that, I think it’s a bit of a Russian roulette and I don’t think it’s a game we should be playing with our adolescents.”

Health Canada has asked medicine manufacturers to update their product safety information to reflect its new recommendation. It advised parents to ask their doctor for alternatives to products containing opioids and reminded them to always read the labels.

“It’s an excellent move and it should have happened sooner,” said Marc Paris, executive director of Drug Free Kids Canada. He anticipates the move will help make it difficult for children and teens to buy cough syrup without ID.

“For us the risks outweigh the benefit,” he added. 

The use of prescription cough and cold products containing opioids has been declining among children over the past five years and represents just four per cent of the total such prescriptions dispensed in Canada, Health Canada said.

Meanwhile, a 2017 Centre for Addiction and Mental Health study found about one in ten Ontario students in Grade 7 through 12 were using over-the-counter cough and cold medicine to get high.

The Drug Free Kids Canada charity said medication with the active ingredient dextromethorphan (DXM) was the most used to get high. DXM can be extremely dangerous in excessive amounts, it said.  

The Canadian Pediatric Society is holding its annual meeting in June in Toronto, where Rieder says Health Canada’s determination will be discussed further.

With files from CTV’s medical affairs specialist Avis Favaro and producer Elizabeth St. Philip