Keeping Up With Clinical Trends — Morphine Equivalent Dose

Sarah Randolph
Clinical Account Executive, PharmD, RPh

Our clinical pharmacists are passionate about educating our clients surrounding safe opioid prescribing practices. Questions our pharmacists have been frequently receiving are a relatively new concept in the workers’ compensation industry — Morphine Equivalent Dose (MED). In this issue of Keeping Up with Clinical Trends, we share tools you can use to ensure patient safety and reduce inappropriate usage of opioids.

Our state is in the process of creating workers’ comp treatment guidelines. Recently, I read an article saying that they are going to include a limit of “100 MED” for opioids. What is Morphine Equivalent Dose (MED) and why ‘100’ versus a different value?

Many states are beginning to include safe opioid prescribing within their treatment guidelines and/or formularies. The use of MED is one way in which we can better understand and evaluate the dosage and level of risk for various opioid prescriptions. The drug morphine is considered the “original” opioid from which we developed other medications. These include drugs such as oxycodone, codeine and fentanyl. Since these other medications have varied potencies, it can be difficult to gauge how much opioid the injured worker is actually consuming. We can apply morphine equivalency conversion factors to these other drugs which relates the dosage back to the original morphine level. This can tell us more about how “at risk” this person might be for an overdose event.

The Centers for Disease Control and Prevention (CDC) recently published guidelines about safe opioid practices. Studies show that patients receiving greater than 100 MED are nine times more likely to overdose. Of that, 12% of overdoses will result in death. If you would like to read more about this, you can read the “CDC’s Guideline for Prescribing Opioids for Chronic Pain” where you will find excellent tips that define how the MED values can be used to improve the safe prescribing of opioids.

 

Sometimes I see opioid doses related in MED and sometimes in MME. What is the difference between these two values, if any? 

MED stands for Morphine Equivalent Dose and MME stands for Morphine Milligram Equivalent. For our essential use in managing workers’ compensation claims, we can consider these terms interchangeable. Depending upon the guideline you read, they may phrase their morphine equivalencies in MED or MME – for instance the State of Washington Agency Medical Directors Group uses the term MED, whereas the Centers for Disease Control and Prevention uses MME.

 

Are there any tools publicly available to help me calculate MED?

There are several published sources to use as a tool for morphine equivalent conversions. The Centers for Medicaid Services (CMS), Agency Medical Directors Group (AMDG), American College of Occupational and Environmental Medicine (ACOEM) and Official Disability Guidelines (ODG) are some of the more well-known references. Since some MED calculations can be complex, depending upon the kinetics of the drug, some sources also offer easy-to-use calculators or even a mobile phone app.

  • A calculator that has been used for several years in workers’ comp is from the AMDG. Both web-based and Excel-based calculators are available here.
  • The ODG offers an online calculator, however please be aware that a subscription is required. Visit their website and then click ‘Opioid MED Calculator’ in the tool drop down menu.
  • The CDC offers a mobile phone Opioid Guideline App. It is designed to help prescribers apply the CDC guidelines into practice. This app also comes equipped with a calculator tool. From your mobile app store, simply search for “CDC Opioid Guideline”.
  • A third option, also in app format, is provided by the New York City Department of Health and Mental Hygiene. Some of our clients have reported back that this is the easiest to use. It also takes up less storage space on your phone at 18 MB instead of the CDC’s 30 MB.

It is important to remember that the above tools we use for managing our workers’ comp claims are different from those that would be used to convert an injured worker’s treatment plan from one opioid to another. MED/MME is not an equianalgesic dose value.

myMatrixx supports state MED limitations and guidance to ensure patient safety and reduce inappropriate use of opioids. We continue to explore the value of this parameter. It has been incorporated into our various clinical intervention programs including Drug Regimen Review (DRR), Alert Review and Manage (ARM®) and One Drug Review (ODR). myMatrixx business intelligence department also provides reporting solutions for monitoring MED to identify these “at-risk” patients.

If you have any questions regarding MED or other related inquiries, please reach out to our Clinical team by emailing Clinical@myMatrixx.com or calling 1-800-785-0881.