Mitigating the Opioid Crisis for Wound Care Providers Using Opioid Stewardship

Robert George Smith, DPM, MSc, RPh


Wounds. 2020;32(6):146-151. 

In This Article

P: Pharmacokinetics and Pharmacodynamics

"P" stands for pharmacokinetics and pharmacodynamics of opioids. Wound care providers must be aware of the possible deadly drug-drug interactions that result from dangerous combinations of opioid medications with over-the-counter products, herbal supplements, energy products, and prescription medications. At times, dangerous drug combinations are indeed prescribed for legitimate reasons, without prescribers realizing the possible dangerous effects. Furthermore, the disease states that the patients present during an encounter may affect or be affected by opioid treatments. Opioids are highly varied and generally thought to possess similar pharmacokinetic activity. Opioids are rapidly absorbed in the gut, feature a high rate of first-pass effects in the liver, conjugate in the liver, create metabolites, and vary in distribution based on their differing protein affinity; subsequently, they are excreted via bile to feces or via kidneys. Liver disease may make using acetaminophen challenging, while renal disease often prevents the use of NSAIDs.[5] Therefore, the combination of clinical judgment with the interpretation of drug pharmacokinetics is often instrumental when prescribing medication. Guo et al[27] related that oral morphine has traditionally been widely used for treating patients with moderate or severe pain. Guo et al[27] identified no remarkable difference in analgesic efficacy or in the tolerability of oxycodone and morphine as the first-line therapy in patients experiencing moderate to severe cancer pain. In the context of opioid stewardship, clinical coping suggestions[28] pertaining to dosing opioids, taking into account patient demographics and disease states, are summarized and presented in Table 2.