Florida Doctor

2018 Summer issue

Florida Doctor Magazine. Helping Doctors to a better practice and better life

Issue link: https://issues.floridadoctormag.com/i/1011962

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Page 16 of 71

S U M M E R 2 0 1 8 17 CYP450 enzymes in the liver responsi- ble for drug metabolism. Some of these patients are "ultra-rapid" metabolizers of certain drugs such as codeine. is means they convert codeine to mor- phine more rapidly than other patients resulting in potential supra-therapeutic dosing. Conversely, some patients are "slow metabolizers" and therefore do not efficiently metabolize codeine and thus never achieve therapeutic levels. Cauca- sian and African American populations have approximately equal proportions of fast and slow acetylators, whereas Asian groups have almost 90% fast acetylators. New Opioid Legislation Pain management has been the focus of many regulatory agencies and hospital or- ganizations, eventually leading to changes in pain assessment and documentation. In 2001, e Joint Commission established the standards for pain assessment and treatment due to the under-treatment of pain. "e Joint Commission's current standards require that organizations es- tablish policies regarding pain assessment and treatment and conduct educational efforts to ensure compliance." e foun- dational standards were: 1) the hospital educates all licensed independent practi- tioners on assessing and managing pain 2) the hospital respects the patient's right to pain management and 3) the hospital assesses and manages the patient's pain. During this time clinicians were advised to consider pain as a vital sign requiring immediate attention and correction. is paradigm shi in pain management—re- sulting from e Joint Commission pain standards and its impact on patient satis- faction scores—is thought by many to be one of the predominant causative factors for the opioid epidemic. e opioid epidemic has expanded to all socioeconomic classes, the elderly, adoles- cents and newborns of addicted mothers. In 2016, 46 Americans died every day from a prescription opioid-related overdose. An estimated 2.7 million older adults are projected to abuse psychotherapeutic drugs and opioids by 2020. is age group has the fastest growing rate for opioid use disorder and largest rate of increased hospitalizations for opioid overuse. Unfor- tunately, non-opioid alternatives, such as ibuprofen, are also risky for older patients. is crisis negatively impacts children secondary to ingestions, with the rate of pediatric opioid-related US hospitaliza- tions doubling between 2004 and 2015. is crisis prompted the Centers for Disease Control and Prevention (CDC) to issue their Guideline for Prescribing Opi- oids in 2016 and launch a website dedicat- ed to reporting opioid epidemic statistics. e medical community faces a dilemma of balancing. We must balance safe opioid prescribing and high-risk patient recog- nition with appropriate pain management strategies for those in significant pain (trauma, cancer, postop). is must be accomplished while being mindful of different types of pain, individual pain factors, genetics and comorbidities—and while considering the array of multimodal treatment options, pharmacologic and non-pharmacologic. Until recently, pain education was lacking in medical profes- sional schools. However, that is rapidly changing and many states now have pain and addiction curriculums, including mandatory CME requirements. On January 1, 2018, e Joint Commis- sion implemented new and revised pain assessment and management standards in an effort to mitigate the effects spawned

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