Children treated in the emergency room for pain or coughs are often prescribed codeine, a potentially dangerous opioid, a new study finds.

Organizations including the American Academy of Pediatrics and American College of Chest Physicians recommend against using codeine for coughs or upper respiratory infections in children, according to Reuters.

While codeine prescription rates decreased from 3.7 percent to 2.9 percent between 2001 and 2010, many children still received the drug. Between 559,000 and 877,000 children were prescribed codeine in the emergency room each year during that time, the researchers report in Pediatrics. Codeine can be dangerous because it slows breathing. Up to one-third of people break down the drug much faster than usual, which can lead to an overdose, the article notes. About one-third of children who take codeine have no relief from symptoms, while one in 12 can accumulate toxic amounts of the drug, causing slowed breathing and possible death.

Dr. Alan D. Woolf, a pediatrician at Boston Children’s Hospital who wrote an editorial that accompanied the study, told Reuters that parents whose children are prescribed codeine can ask the doctor if there is an alternative treatment. “At Boston’s Children Hospital, we’ve taken it off the formulary so you can no longer easily prescribe it,” he said.

Study author Dr. Sunitha Kaiser of the University of California, San Francisco said codeine prescriptions for children are an issue outside of the ER. “Despite strong evidence against the use of codeine in children, the drug continues to be prescribed to large numbers of them each year,” she said in a news release. “It can be prescribed in any clinical setting, so it is important to decrease codeine prescription to children in other settings such as clinics and hospitals, in addition to emergency rooms.”

She noted ibuprofen is equal to or better than codeine for treating injury pain.