Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Related Sciences

First Advisor

Dr. Clarence Biddle

Second Advisor

Dr. T. Corey Davis

Third Advisor

Dr. Pramit Nadpara

Fourth Advisor

Dr. Jackie Shannon


Due to reports of significant adverse events, the U.S. FDA placed a Boxed Warning on the opioid codeine in February 2013 – contraindicating its use in pediatric patients undergoing tonsillectomy and/or adenoidectomy. Studies conducted in privately insured children showed a reduction in codeine prescribing and a slight increase in alterative opioid prescribing following the FDA warning, yet the extent to which the FDA warning impacted prescribing in publicly insured children is unknown. Using a quasi-experimental interrupted time series design, this study evaluated codeine and alternative opioid prescribing before and after the FDA warning in both publicly and privately insured children and compared prescribing between groups. Data on 5603 children undergoing tonsillectomy and/or adenoidectomy at Oregon Health and Science University from 2010 – 2018 was analyzed via segmented regression analysis. Findings suggest codeine and alternative opioid prescribing decreased in both groups after the FDA warning and prescribing was comparable between groups. There was no difference in the mean level (p = 0.664) or pre-post intervention slopes (p = 0.383) of codeine prescribing and no difference in the mean level (p = 0.103) or pre-post intervention slopes (p = 0.088) of alternative opioid prescribing between groups. Additional findings of interest included the effect of age, procedure indication and body habitus on opioid prescribing. Of these, young age appeared to influence opioid prescribing to the greatest degree. Results of this study indicate codeine and alternative opioid prescribing decreased after the FDA warning and prescribing did not appear to differ based on health insurance status, though clinical factors appeared to influenced prescribing.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission