Pharmacology
Opioid MME & Equianalgesic Converter
Totals a multi-drug regimen as daily morphine milligram equivalents, stratifies overdose risk against CDC thresholds, and works out a rotated dose with a cross-tolerance reduction.
Educational tool — verify against your own protocol
Total daily morphine equivalent
75MME/day
Moderate Risk (50–89 MME/day — CDC Caution)
Clinical safety advisory
Current regimen
Every scheduled and breakthrough opioid the patient is taking. A patch is entered as its mcg/hr rate.
In mg.
40 mg/day × 1.5 = 60 MME/day
In mg.
10 mg/day × 1.5 = 15 MME/day
Clinical archetypes
One-click regimens for working through the method.
Rotation target
The opioid being rotated to, and the safety reduction applied.
25%–50% is standard practice.
Patient risk modifiers
These change the risk tier and the naloxone recommendation.
Rotated target prescription
30% safety reduction applied.
Do not exceed 3–4 breakthrough doses per 24 hours without reassessing the scheduled dose.
Conversion factors used
Multipliers to oral morphine equivalent, as implemented on this page.
| Opioid | Unit | × to oral morphine | Note |
|---|---|---|---|
| Morphine (Oral) | mg | × 1 | MS Contin, Roxanol |
| Morphine (IV / SC) | mg | × 3 | Infumorph |
| Oxycodone (Oral) | mg | × 1.5 | OxyContin, Roxicodone, Percocet |
| Hydrocodone (Oral) | mg | × 1 | Norco, Vicodin, Zohydro |
| Hydromorphone (Oral) | mg | × 4 | CDC 2022 gives ×5 |
| Hydromorphone (IV / SC) | mg | × 20 | Dilaudid IV |
| Fentanyl (Transdermal Patch) | mcg/hr | × 2.4 | Duragesic (q72h) |
| Fentanyl (IV / SC) | mcg | × 0.3 | Sublimaze |
| Codeine (Oral) | mg | × 0.15 | Tylenol #3 |
| Tramadol (Oral) | mg | × 0.1 | CDC 2022 gives ×0.2 |
| Oxymorphone (Oral) | mg | × 3 | Opana PO |
| Oxymorphone (IV) | mg | × 30 | Opana IV |
| Tapentadol (Oral) | mg | × 0.4 | Nucynta |
Each line of the regimen becomes a daily MME, and the lines are summed:
line MME/day = dose × doses per day × factor to oral morphine
A transdermal patch is the exception: its mcg/hr rate is taken as the daily quantity directly, because delivery is continuous.
Rotation runs the total back out through the target drug's factor, then reduces it:
24h target dose = total MME / target factor × (100 − reduction) / 100
The per-administration dose divides that by the chosen frequency, and the breakthrough dose is 10–15% of the daily total. CDC tiers are read off the total: under 50 MME/day low, 50–89 moderate, 90 and above high, 200 and above extreme. Every figure is rounded to one decimal.
Common questions
Tolerance to one opioid transfers only partly to another, so an exactly equianalgesic dose of the new drug can be effectively an overdose. Standard practice reduces the calculated dose by 25–50%, and more in frail or elderly patients, then titrates upward with breakthrough cover.
Tramadol is ×0.1 on this page against the CDC's ×0.2, and oral hydromorphone is ×4 against ×5. Both understate the MME. They are left as the original tool had them so the migration changes no numbers, and the page flags them whenever either drug is in use.
Neither has a fixed ratio. Methadone's conversion factor rises with the dose being switched from and it accumulates over days; buprenorphine is a partial agonist with high receptor affinity. Both need specialist protocols rather than a single multiplier.
No. The CDC thresholds are prompts to review, not limits. Above 50 MME/day the guidance is to weigh benefit against harm and offer naloxone; at 90 and above to justify carefully and consider tapering. Patients with active cancer or in palliative care are explicitly outside that framing.
Prepared by the PharmaWallah student team. Verify results with your textbook or instructor. Report an error · Editorial policy