PDMP
Morphine Milligram Equivalents Fact Sheet
e MME/day metric is oen used as a gauge of the overdose potential of the
amount of opioid prescribed. Higher dosages of opioids are associated with higher
risk of overdose and death. Calculating the total daily dosage of opioids helps identify
patients who may benet from closer monitoring, reduction or tapering of opioids,
co-prescribing of naloxone, or other measures to reduce risk of overdose.
WHY SHOULD A PROVIDER CONSIDER MME?
Morphine milligram equivalents (MME) or morphine equivalent doses (MED) are values
that represent the potency of an opioid dose relative to morphine. MME is intended to help
clinicians make safe, appropriate decisions concerning changes to opioid regimens. Using
a standard conversion factor developed by the CDC, the MME equates the many different
opioids into a standard value that is based on morphine and its potency.
MME assigned to each prescription: MME/day is displayed in the PDMP for each prescription
and is based on the CDC conversion factor, dosage, and days supply.
Average MME/day assigned to the patient: MME is calculated by adding the total daily
amount of each opioid that a patient is prescribed, converting each value to MME using a
conversion factor based on morphine, then calculating the average daily rate.
This information is provided by the Prescription Drug Monitoring Program (PDMP).
1
https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#T1_down
• When changing opioid prescriptions, the dosage of the opioid to which the
patient is being converted should be lower than the calculated MME of the
current opioid regimen to avoid unintentional overdose caused by incomplete
cross-tolerance and individual dierences in opioid pharmacokinetics.
1
Not all
opioids behave similarly; consult the medication label for additional information.
• Use extra precautions when increasing to ≥50 MME per day such as:
- Monitor and assess pain and function more frequently.
- Discuss reducing dose or tapering and discontinuing opioids if benets
do not outweigh harms.
• Consider oering naloxone and discussing with your patients how and when
to use naloxone.
CAVEATS IN USING MME:
This information is provided by the Prescription Drug Monitoring Program (PDMP).
PDMP
Naloxone Co-Prescribing Fact Sheet
*e dose conversions are estimated and cannot account for all individual dierences in genetics and pharmacokinetics.
**Fentanyl patch: dosed in mcg/hr instead of mg/day, and absorption is aected by heat and other factors.
***Fentanyl lozenge: conversion factor should be multiplied by the number of micrograms in a given tablet or lozenge.
****Methadone: the conversion factor increases at higher doses.
USE EXTRA CAUTION with transdermal fentanyl, and medications for opioid use disorder:
• Transdermal fentanyl is dosed in mcg/hr instead of mg/day, and absorption is aected by heat
and other factors.
• Dosing methadone is complicated because of its long and unpredictable half-life, as well as its
association with QTc prolongation and potential cardiac arrhythmia.
• e relation between dosage and overdose risk is dierent for buprenorphine. ere is not a
calculation to identify equivalency therefore MME is not available for buprenorphine products.
• Conversion factors for drugs used as part of medications for opioid use disorder should not be
evaluated using opioid dosage indexes intended for chronic pain.
CALCULATING MORPHINE MILLIGRAMS EQUIVALENTS (MME)
*
OPIOID
(doses in mg/day except where noted)
CONVERSION FACTOR
Codeine 0.15
Fentanyl transdermal (in mcg/hr)** 2.4
Fentanyl buccal, sublingual, or lozenges (mcg)*** 0.13
Hydrocodone 1
Hydromorphone 4
Methadone****
1-20 mg/day 4
21-40 mg/day 8
41-60 mg/day 10
≥61-80mg 12
Morphine 1
Oxycodone 1.5
Oxymorphone 3
