For each opioid, select the strength from the drop down menu and enter the number of tablets per day (for fentanyl transdermal, see instructions below). Remember to enter all opioids the patient is taking. The total daily morphine milligram equivalents (MME) will be displayed.
This tool is not intended for use in the setting of end-of-life care.
If dosing reaches 100 MME/day, the New York City Department of Health and Mental Hygiene recommends thorough reassessment of the patient's pain status and treatment plan, and reconsideration of other approaches to pain management.
Dosages >=20 MME/day can also increase overdose risk compared to dosages of 1-20 MME/day, however the overdose risk is even higher for dosages >=100 MME/day.
This tool is not for use in children due to unpredictable metabolism and risk for possible harm.
If initiating therapy, remember to take into account whether the patient is opioid naive or opioid tolerant. Use additional caution with opioid-naive patients to prevent overdose.
Long-acting opioids (fentanyl transdermal, methadone) should not be used in opioid naive patients.
Do not use this tool to convert from one opioid to a different opioid.
The following source was used for morphine equivalent conversion factors per mg of opioid: Korff MV, Saunders K, Thomas Ray G, et al. De facto long-term opioid therapy for noncancer pain. Clin J Pain. 2008 Jul-Aug;24(6):521-7.
The following source was used for overdose risk associated with dosage: Dunn KM, Saunders KW, Rutter CM, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010 Jan 19;152(2):85-92.