![]() These conversion factors should not be applied to dosage decisions related to the management of opioid use disorder.Buprenorphine products approved for the treatment of pain are not included in the table due to their partial mu receptor agonist activity and resultant ceiling effects compared to full mu receptor agonists.Use particular caution with transdermal fentanyl since it is dosed in mcg/hr instead of mg/day, and its absorption is affected by heat and other factors.Use particular caution with methadone dose conversions because methadone has a long and variable half-life, and peak respiratory depressant effect occurs later and lasts longer than peak analgesic effect.Do not use the calculated dose in MMEs to determine the doses to use when converting one opioid to another when converting opioids, the new opioid is typically dosed at a substantially lower dose than the calculated MME dose to avoid overdose due to incomplete cross-tolerance and individual variability in opioid pharmacokinetics.Equianalgesic dose conversions are only estimates and cannot account for individual variability in genetics and pharmacokinetics.All doses are in mg/day except for fentanyl, which is mcg/hr.For example, tablets containing hydrocodone 5 mg and acetaminophen 325 mg taken four times a day would contain a total of 20 mg of hydrocodone daily, equivalent to 20 MME daily extended-release tablets containing oxycodone 10mg and taken twice a day would contain a total of 20mg of oxycodone daily, equivalent to 30 MME daily. To determine dose in MMEs, multiply the dose for each opioid by the conversion factor. Morphine Milligram Equivalents (MMEs) for Commonly Prescribed OpioidsĬalculating the total daily dose of opioids helps identify patients who may benefit from closer monitoring, reducing or tapering opioids, prescribing of naloxone, or other measures to reduce risk of overdose. Arrangement of treatment for opioid use disorder.Considerations for co-prescribing benzodiazepines.Review of prescription drug monitoring program (PDMP) data.Evaluation of risk factors for opioid-related harms and ways to mitigate risk to patient.Assessing risk and addressing harms of opioid use. ![]() Considerations for follow-up and discontinuation of opioid therapy.Selection of immediate-release or extended-release and long-acting opioids.Opioid selection, dosage, duration, follow-up, and discontinuation.Discussion of risks and benefits of therapy with patients.Selection of nonopioid pharmacologic therapy (including acetaminophen, non-steroidal anti-inflammatory drugs, and selected antidepressants and anticonvulsants), or opioid therapy.Selection of non-pharmacologic therapy (interventions such as exercise, multidisciplinary rehabilitation, mind-body interventions).Determining when to initiate or continue opioids for chronic pain.The three main focus areas in the Guideline include: The CDC Guideline addresses patient-centered clinical practices including conducting thorough assessments, considering all possible treatments, closely monitoring risks, and safely discontinuing opioids. Read the full CDC Guideline for Prescribing Opioids for Chronic Pain
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