# Opioid equivalency

## What drugs are considered opiates?

The term opiates is historically used to identify drugs derived from the opium poppy plant. While opioids are their synthetic counterparts like Percocet, Oxycodone, Methadone, and Vicodin. Today, the two terms are used synonymously. Both forms are potentially addictive and abused.

## Is morphine stronger than hydrocodone?

Morphine, when given as injection, is a much stronger medication than hydrocodone. However, when taken by mouth, morphine’s strength is greatly reduced, and 20mg of oral morphine has the same pain relieving power as 20mg of hydrocodone — they’re equivalent in strength.

## How to calculate Ome?

Calculate the 24-hour OME: 24-hour OME = 24-hour dose of current opioid X 30 /Number of equianalgesic units in current opioid. (24-hour OME for this patient is: 60 x 30 / 10 = 180 mg) Determine new opioid and route of administration: Unlike morphine, IV hydromorphone has a short half-life and lacks clinically relevant metabolites, and is …

## What is stronger Dilaudid or oxycodone?

Dilaudid and other versions of hydromorphone are stronger drugs than Oxycodone. Comparing the relative strength of Dilaudid vs Oxycodone, Dilaudid is around three to five times more potent. This means a five milligram dose of Dilaudid is roughly equal to a 15-20 mg dose of Oxycodone.

## How are morphine equivalents determined?

Average MME/day assigned to the patient: MME is calculated by adding the total daily amount of each opioid that a patient takes, converting each value to MME using a conversion factor based on morphine, then calculating the average day rate.

## How do you measure opioid tolerance?

The FDA defines a patient as opioid tolerant if for at least 1 week he or she has been receiving oral morphine 60 mg/day; transdermal fentanyl 25 mcg/hour; oral oxycodone 30 mg/day; oral hydromorphone 8 mg/day; oral oxymorphone 25 mg/day; or an equianalgesic dose of any other opioid.

## How quickly does opioid tolerance go down?

It takes as little as 3-7 days to lose your tolerance to opioids.

## Does opioid tolerance ever go away?

A person with opioid tolerance will become accustomed to high doses. If they stop using the drug, tolerance reverses and the brain’s receptor levels return to normal.

## How many people are sedated by opioids?

Sedation occurs in 20% to 60% of patients, most commonly when initiating opioid therapy or when doses increase.[10] Mild-to-moderate sedation is usually self-limiting, resolving in a few days. If persistent, it may improve with drug therapy.[11] Moderate-to-severe sedation responds to dose reduction but may also necessitate opioid rotation.

Routes for common opioids include intravenous (IV), intramuscular (IM), subcutaneous (SQ), Oral (PO), and transdermal (TD). Intramuscular administration is not recommended for pain management while using the SQ route is limited to circumstances such as lack of IV availability. The most common routes of administration of opioids are PO, IV, and TD.  Oral short-acting opioids are dosed 3 to 4 hours apart due to their short half-life. Stable patients on chronic opioid therapy benefit from preventive analgesia and often have regimens that combine a long-acting opioid, dosed 8 to 12 hours apart, and a short-acting opioid, the latter being used as a breakthrough opioid when pain transiently increases in intensity above the pain addressed by the ongoing analgesics. Intravenous opioids are generally dosed for acute pain relief in situations where an oral opioid is ineffective, or the oral route is unavailable. Intravenous opioids are dosed 2 to 3 hours apart or can be dosed as a continuous infusion or as patient-controlled analgesia (PCA).

## Which opioids are used in mechanical ventilation?

Patients receiving mechanical ventilation: Fentanyl, morphine, or hydromorphone are preferred because these opioids are fast-acting and titratable. Remifentanil may occasionally be selected if early extubation is expected as it has an ultrashort duration of action.

## Why do you decrease the dose of opioids?

Decrease dose of new opioid due to incomplete cross-tolerance: Since the new drug is unchanged, tolerance to the new formulation of the same drug will be the same. One does not need to decrease the dose.

## What is the purpose of monitoring opioids?

Monitoring. All patients on chronic opioid therapy regimens require monitoring for continued efficacy as well as an indication for treatment. Monitoring includes a thorough pain assessment that takes into account pain levels, change in the quality of pain, pain recurrence and side effects from analgesics.

## What are the side effects of opioids?

In particular, patients on opioids should be monitored for constipation, nausea, vomiting, sedation, impaired psychomotor function, and urinary retention . Among gastrointestinal side effects, opioid-induced constipation (OIC) affects between 45% and 90% of patients [1] and is a source of significant morbidity.

## Why is remifentanil preferred?

Patients requiring frequent neurologic assessments: Remifentanil is preferred because of its ultrashort duration of action.

## Why is buprenorphine not included in the calculator?

Buprenorphine is not included in the calculator because it is a partial agonist and morphine equivalent doses are uncertain. Please refer to the label for dosing parameters.

## Can a patient be co-prescribed with benzodiazepines?

Is the patient co-prescribed benzodiazepines? Yes No

## Is equianalgesic ratio crude?

Published equianalgesic ratios are considered crude estimates at best and therefore it is imperative that careful consideration is given to individualizing the dose of the selected opioid. Dosage titration of the new opioid should be completed slowly and with frequent monitoring.

## Do conversion ratios apply to repeated doses of opioids?

Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. The amount of residual drug in the patient’s system must be accounted for. Example: fentanyl will continue to be released from the skin 12 to 36 hours after removal of the patch.

## How much is the recommended reduction for opioids?

Suggested reduction closer to 50% in patients on high dose of current opioid regimen, not of Caucasian ethnicity, elderly, renal impairment, or medically frail

## What is inter-converting between IV and oral opioids?

Inter-converting between oral and IV opioids is a very common situation encountered in clinical anesthesiology both in the context of treating acute perioperative pain, in the setting of chronic pain management or in combination.

## What is equianalgesic data?

This equianalgesic data aims to provide relative potency information between different opioids, which can be defined according to Knotkova et al. as “the ratio of opioid doses necessary to obtain roughly equivalent [analgesic] effects”. This data was derived from various randomized, controlled, clinical trials conducted in the 1950s and 1960s with typically a partial cross over design where morphine (IV or PO) was used as the standard for comparison in order to derive relative potency information. This data collected over 50 years ago was published as equianalgesic opioid dosing tables that have remained mostly unchanged. This data however has limitations as the study population primary included patients with acute post operative pain and that were relatively opiate naive which calls into question whether this data can truly be applied to populations on chronic and large doses of opioids.

## Why do you switch analgesics?

There may be several possible reasons to switch analgesics including: drug cost, availability, lack of effectiveness of the current drug, or to minimize adverse effects . This tool also provides precise control over methadone conversions as well as corrections for incomplete cross-tolerance.

## Is equianalgesic ratio crude?

Published equianalgesic ratios are considered crude estimates at best and therefore it is imperative that careful consideration is given to individualizing the dose of the selected opioid. Dosage titration of the new opioid should be completed slowly and with frequent monitoring.

## Do conversion ratios apply to repeated doses of opioids?

Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. The amount of residual drug in the patient’s system must be accounted for. Example: fentanyl will continue to be released from the skin 12 to 36 hours after removal of the patch.

## What is an equianalgesic chart?

An equianalgesic chart is a conversion chart that lists equivalent doses of analgesics (drugs used to relieve pain). Equianalgesic charts are used for calculation of an equivalent dose (a dose which would offer an equal amount of analgesia) between different analgesics. Tables of this general type are also available for NSAIDs, benzodiazepines, depressants, stimulants, anticholinergics and others as well.

## What are the factors that affect the half life of analgesics?

Tolerance, sensitization, cross-tolerance, metabolism, and hyperalgesia may be complex factors in some individuals. Interactions with other drugs, food and drink, and other factors may increase or decrease the effect of certain analgesics and alter their half-life.

## How much MOR is used for pain?

MOR is the most commonly used opioid analgesic for pain relief, and its oral daily dose (20 to 1000 mg) is relatively high (44). On the other hand, DHE produces rapid analgesic effects at an extremely low dose, 20 ìg sublingually in humans (60, 78). … ^ “Carfentanil”.

## What are the variables that influence the effect of a drug on the body?

Patient variables such as sex, age, and organ function may also influence the effect of the drug on the system. These variables are rarely included in equianalgesic charts.

## Is levorphanol stronger than morphine?

For example, the narcotic levorphanol is 4–8 times stronger than morphine, but also has a much longer half-life. Simply switching the patient from 40 mg of morphine to 10 mg of levorphanol would be dangerous due to dose accumulation, and hence frequency of administration should also be taken into account.

## Is equianalgesic chart a good tool?

An equianalgesic chart can be a useful tool, but the user must take care to correct for all relevant variables such as route of administration, cross tolerance, half-life and the bioavailability of a drug . For example, the narcotic levorphanol is 4–8 times stronger than morphine, but also has a much longer half-life. Simply switching the patient from 40 mg of morphine to 10 mg of levorphanol would be dangerous due to dose accumulation, and hence frequency of administration should also be taken into account.