If You are on Opioids, You Should Know your Morphine Equivalent Dose, by Vinay M. Reddy, M.D.

Morphine Equivalent Dose (MED), also known as Morphine Milligram Equivalents (MME) is a numerical way to compare different opioids (narcotics). For example, if person A is on 4 tablets of Norco (hydrocodone/acetaminophen) 10/325 and person B is on 4 tablets of Percocet (oxycodone/acetaminophen) 10/325, how do we know who is on a higher dose? We can calculate the MEDs. 1mg of Hydrocodone has an MED of 1, whereas 1 mg of Oxycodone has an MED of 1.5. Therefore, person A is on 40 MEDs per day and person B is on 60 MEDs per day.

If person C is on 20 mg of oxycontin (oxycodone ER) twice a day and taking 4 Norco, then the total MED is 100.

Why is this important?

It is important because opioids are always associated with a risk of overdose and death. Higher doses of opioids are also associated with lower rates of return to work and higher rates of emergency room visits.

People with total MEDs greater than 50 (5 Norco per day) have a 2 fold increased risk of overdose compared to people with MEDs lower than 20 (2 norco a day). People with MEDs of 100 or higher have a 9 fold increased risk of overdose.

A 2016 study published in The Journal of Addictive Disorders (J Addict Dis. 2016 ; 35(1): 42–51. doi:10.1080/10550887.2016.1107264) found that most patients on opioids under-estimated their risk of overdose.

Knowing you MED will help you understand your risk and may save your life!

A chart to calculate MED is available from the Centers for Disease Control and Prevention at https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf