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The Difficulty of Morphine Milligram Equivalent (MME) Calculations

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Every day, at least 130 people are projected to die from opioid-related drug overdoses, reports the U.S. Department of Health and Human Services. That's just one of the many shocking statistics associated with the U.S. opioid epidemic. Several initiatives have been implemented to help combat the opioid crisis. One such effort concerns the use of the morphine milligram equivalent (MME) in making decisions concerning opioid prescriptions.

This article will define MME, explain its importance, discuss the challenge of calculating this figure, and tell you how Meds 360° from Cureatr makes MME easy.

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What is a Morphine Milligram Equivalent?

In simple terms, MME is the amount of morphine in milligrams equivalent to the strength of the opioid dose prescribed. Using MME allows comparison between the strength of different types of opioids. For example, the Vermont Prescription Monitoring Systems notes that following medications provide 50 MME per day:

  • Ten (1) tablets of hydrocodone/acetaminophen 5/300
  • Two (2) tablets of oxycodone sustained-release 15 mg
  • < three (3) tablets of methadone mg

As another example, Wolters Kluwer states that a 100 mg morphine-equivalent dose equals each of the following:

  • 100 mg of hydrocodone
  • 25 mg of hydromorphone
  • 65 mg of oxycodone
  • 37 mcg/hour of fentanyl

Why is Morphine Milligram Equivalent Important?

As MedlinePlus notes, opioids can cause side effects that increase safety risks, including drowsiness, mental fog, nausea, and constipation. Opioids may also cause slowed breathing, which can contribute to overdose deaths. Furthermore, they are linked to high levels of dependence and addiction.

MME is intended to help clinicians make safe, appropriate decisions concerning changes to opioid regimens. As the Centers for Disease Control and Prevention (CDC) notes, "The MME/day metric is often used as a gauge of the overdose potential of the amount of opioid that is being given at a particular time. Calculating the total daily dose of opioids helps identify patients who may benefit from closer monitoring, reduction or tapering of opioids, prescribing of naloxone, or other measures to reduce risk of overdose."   

A Drug Topics report noted, "The CDC found that higher MME per day can increase the likelihood of addiction — rates of addiction for patients using between 50 and 100 MME/day were 1.9 to 4.6 times greater than patients using less than 20 MME/day. The CDC added that increasing doses beyond 50 MME/day increased the chances of addiction to opioids while adding little benefit."

One frequently cited randomized trial found there was no difference in pain or function between a more liberal opioid dose escalation strategy — an average final dosage 52 MME — and the maintaining of the current dosage — an average final dosage 40 MME.

What makes calculating MME difficult?

While MME provides a valuable means of helping clinicians make educated prescription choices for their patients, calculating MME can be a challenging process, despite essentially only requiring a few steps. Clinicians should first determine the total daily amount of each opioid taken by a patient. Then the clinician should convert each to MMEs by multiplying the dose for each opioid by its conversion factor. Finally, these converted figures should be added together.

On the surface, this doesn't sound too difficult. But then consider the number of different types of opioids and their wide-ranging MME conversion factors, as noted by the Centers for Medicare & Medicaid Services. Then consider the number of people taking opioids. In 2017, the prescribing rate was 58.7 prescriptions per 100 persons (a total of more than 191 million total opioid prescriptions), according to CDC.

Clinicians are faced with several challenges associated with MME. First, calculating the daily MME for most patients is not easy or straightforward as multiple opioids must be considered, and clinicians must determine (and should verify) each of the opioids' conversion factors before proceeding with the calculations. This multi-step process — if completed — is often performed using pen, paper and a calculator.

Second, it is not always easy for clinicians to be aware of opioids that are being prescribed by their colleagues working outside their institution. This increases the likelihood of an inaccurate MME calculation.

Then there is the matter of performing this complex process for all patients taking opioids. As a recent Spok survey of clinical staff at U.S. hospitals and health systems found, 89% of respondents stated that burdensome or increased workload was a contributor to clinician burnout. Clinicians are under pressure to see and provide care for more patients in less time. This often leads clinicians to skip the completion of important processes, such as calculating MME.

Furthermore, patients may not always know the type and/or strength of the opioids they are taking or may provide inaccurate or incomplete information about their prescription(s). These can create obstacles for successful medication reconciliation and, therefore, MME calculation.

Other risks include clinicians who choose to skip the MME calculation process because they do not recognize the potential for danger when modifying an opioid regimen or clinicians who estimate the calculation.

How Meds 360° Makes MME Simple

When clinicians use the Meds 360° patient medication history solution, calculating MME is a process they don't have to worry about anymore. Meds 360° has built-in functionality that automatically calculates a patient’s MME and instantly notifies the clinician if the patient has exceeded the CDC's recommended guidelines (50 MME per day for 90-plus days).

Beyond performing the actual conversion, the notification feature is a huge benefit to busy clinicians who may not have the time to stay abreast of the opioid intake of their patients, particularly over the course of three months. Meds 360° provides this vital information to clinicians immediately, permitting them to intervene and make appropriate care decisions before the patient comes to harm. 

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