MME Calculator (Morphine Milligram Equivalent)
Total Daily MME & Risk Assessment
Calculation Breakdown
Opioid | Daily Dose | MME |
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Understanding MME & CDC Guideline Thresholds
Morphine Milligram Equivalent (MME) is a value that standardizes the potency of various opioids to a morphine equivalent. This allows clinicians to assess the total opioid exposure for a patient, which is a key factor in overdose risk.
The CDC Guideline for Prescribing Opioids for Chronic Pain highlights two important MME/day thresholds:
- ≥ 50 MME/day: At this level, clinicians should exercise increased caution. The risk of overdose is significantly higher compared to lower doses. This should trigger a re-evaluation of the current treatment plan.
- ≥ 90 MME/day: Dosages at or above this level are associated with a very high risk of overdose. Clinicians should avoid or carefully justify prescribing at this level and consider offering naloxone.
Frequently Asked Questions (FAQ)
What if an opioid is not on the list?
This calculator includes the most common opioids with established conversion factors from the CDC. For less common opioids or formulations not listed, consult the official prescribing information, clinical guidelines, or a pharmacist.
How is the Fentanyl Patch (mcg/hr) converted?
The conversion for the Fentanyl patch is complex. This calculator uses the CDC-recommended conversion factor of 2.4. The calculation is: (patch strength in mcg/hr) × 2.4 = MME/day. This is an approximation and clinical judgment is critical, especially when rotating patients to or from fentanyl.
What about Methadone?
Methadone is not included in this calculator because its MME conversion is complex, non-linear, and varies significantly based on the total daily dose. A specific, careful approach guided by an experienced clinician is required for methadone. Do not use standard MME calculators for methadone.
What should a clinician do if the total MME is high?
A high MME (especially ≥50 MME/day) should prompt a clinician to reassess the patient's pain, function, and treatment plan. This includes evaluating the risks and benefits of continued opioid therapy, considering non-opioid treatments, optimizing the current dosage, and strongly considering offering naloxone for overdose reversal.
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