Opioid MME and rotation
Two calculators for ADULT patients, kept apart on purpose. The daily total scores an opioid burden on one scale. The rotation converts one opioid to another from a different table, with a reduction for incomplete cross tolerance. Choose one below. The guideline that publishes the total's factors states they must not be used to convert one opioid to another.
These factors do not apply to the dosing of medication for opioid use disorder.
CDC 2022 Clinical Practice Guideline (Table 1)
Opioid 1
Where the two tables disagree
- Hydromorphone: the CDC 2022 table gives 5, and the VA/DoD table gives 4.
Both figures are published. This calculator averages neither. The total above names the table it came from.
Reference tables
These tables are printed for reading. Neither calculator above computes anything from them, and no figure below is entered for you.
Methadone dose bands, VA/DoD Table D-6
This calculator computes no methadone conversion. The table below is the published band table, and it is here to read.
Methadone conversion is not linear and the ratio to morphine widens as the dose rises. The Faculty of Pain Medicine prints no potency figure for it, and ASRA states there are no easy conversion rates. This calculator shows the published dose band only. A methadone conversion needs a clinician experienced with the drug.
| Oral morphine, mg/day | Ratio of morphine to methadone |
|---|---|
| 0 to 30 | 2 to 1 |
| 31 to 99 | 4 to 1 |
| 100 to 299 | 8 to 1 |
| 300 to 499 | 12 to 1 |
| 500 to 999 | 15 to 1 |
| 1000 to 1200 | 20 to 1 |
| 1201 and above | The source says to consult rather than giving a ratio. |
The ratio widens as the dose rises. A ratio taken from a low band and applied at a high dose gives a large overdose.
Transdermal fentanyl patch, Faculty of Pain Medicine
| Patch, mcg/hr | Oral morphine, mg/day |
|---|---|
| 12 | 30 |
| 25 | 60 |
| 50 | 120 |
| 75 | 180 |
| 100 | 240 |
Buprenorphine patch, weekly schedule
The weekly schedule and the twice weekly schedule are separate schedules. Their numbers are not interchangeable. Read the schedule name before you read a row.
| Patch, mcg/hr | Oral morphine, mg/day | Codeine, mg/day |
|---|---|---|
| 5 | 12 | 120 |
| 10 | 24 | 240 |
| 20 | 48 |
The source prints no codeine figure at 20 micrograms per hour. That cell is empty here for the same reason. The value is not interpolated.
Buprenorphine patch, twice weekly schedule
This is a different schedule from the weekly table above. Do not read a row from one schedule against the other.
| Patch, mcg/hr | Oral morphine, mg/day |
|---|---|
| 35 | 84 |
| 52 | 126 |
| 70 | 168 |
Opioids this calculator refuses
Each drug below is absent from the calculators above on purpose. The reason is printed with it.
Buprenorphine
Refused for the daily total and for a rotation.
The CDC table excludes buprenorphine, and the VA/DoD guideline states that its work group is unable to give any equianalgesic dosing figure for it. Buprenorphine is a partial agonist with a ceiling effect, so a single factor does not describe it. A conversion needs a clinician experienced in this drug.
Meperidine (pethidine)
Refused for the daily total and for a rotation.
No table read carries a conversion factor for meperidine.
Levorphanol
Refused for the daily total and for a rotation.
No table read carries a conversion factor for levorphanol.
Pentazocine
Refused for the daily total and for a rotation.
No table read carries a conversion factor for pentazocine.
Butorphanol
Refused for the daily total and for a rotation.
No table read carries a conversion factor for butorphanol.
Nalbuphine
Refused for the daily total and for a rotation.
No table read carries a conversion factor for nalbuphine.
Fentanyl, intravenous or intramuscular
Refused for the daily total and for a rotation.
No source read states an equianalgesic dose for parenteral fentanyl. The only fentanyl conversions found are transdermal. Do not scale the transdermal figure to an intravenous dose.
Opioid tolerance, the FDA label definition
The label names these daily doses. It states a minimum duration of 7 days.
| Opioid | Daily dose |
|---|---|
| Morphine, oral | 60 mg/day |
| Fentanyl, transdermal | 25 mcg/hr |
| Oxycodone, oral | 30 mg/day |
| Hydromorphone, oral | 8 mg/day |
| Oxymorphone, oral | 25 mg/day |
| Hydrocodone, oral | 60 mg/day |
What these calculators assume
- Morphine milligram equivalents score a daily burden. The guideline that publishes the factors states they must not be used to convert one opioid to another.
- The published tables disagree with each other. Hydromorphone is 5.0 in the CDC table and 4 in the VA/DoD table, and tramadol and codeine differ between CDC and the Faculty of Pain Medicine. The source is named on every figure and no figure is averaged.
- Buprenorphine has no conversion factor in these sources and is refused in both directions.
- Methadone is not linear. The ratio to morphine widens with the dose, so a band table is shown and no single factor is applied.
- The 50 morphine milligram equivalents per day figure is the point the CDC 2022 guideline names for additional care. It is a CDC figure whichever conversion table produced the total, and the VA/DoD guideline names a different one. CDC sets no hard ceiling and states there is no single threshold below which risk is removed.
- These factors do not apply to the dosing of medication for opioid use disorder.
This calculator reports published conversion factors and names the source of each. It does not choose between sources that disagree, it refuses the drugs its sources refuse, and it never returns a rotation dose from the morphine milligram equivalent factors.