Opioid Morphine Equivalent Conversion Factors1 - Cms

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1
Opioid Morphine Equivalent Conversion Factors
MME Conversion
Type of Opioid
Factor
2
Buprenorphine patch
12.6
Buprenorphine tab or film
10
Butorphanol
7
Codeine
0.15
Dihydrocodeine
0.25
3
Fentanyl buccal or SL tablets, or lozenge/troche
0.13
4
Fentanyl film or oral spray
0.18
5
Fentanyl nasal spray
0.16
6
Fentanyl patch
7.2
Hydrocodone
1
Hydromorphone
4
Levorphanol tartrate
11
Meperidine hydrochloride
0.1
Methadone
3
Morphine
1
Nalbuphine
1
Opium
1
Oxycodone
1.5
Oxymorphone
3
Pentazocine
0.37
Tapentadol
0.4
Tramadol
0.1
1
Centers for Disease Control and Prevention, Atlanta, GA, May 2014. For more information, send an email to Mbohm@cdc.gov.
2
The MME conversion factor for buprenorphine patches is based on the assumption that one milligram of parenteral
buprenorphine is equivalent to 75 milligrams of oral morphine and that one patch delivers the dispensed micrograms per hour
over a 24 hour day. Example: 5 ug/hr buprenorphine patch * 24 hrs = 120 ug/day buprenorphine = 0.12 mg/day buprenorphine =
9 mg/day oral morphine milligram equivalent. In other words, the conversion factor not accounting for days of use would be 9/5
or 1.8. However, since the buprenorphine patch remains in place for 7 days, we have multiplied the conversion factor by 7 (1.8 X
7 = 12.6). In this example, MME/day for four 5 μg/hr buprenorphine patches dispensed for use over 28 days would work out as
follows: Example: 5 ug/hr buprenorphine patch * (4 patches/28 days)* 12.6 = 9 MME/day.
3
The MME conversion factor for fentanyl buccal tablets, sublingual tablets, and lozenges/troche is 0.13. This conversion factor
should be multiplied by the number of micrograms in a given lozenge/troche.
4
The MME conversion factor for fentanyl film and oral spray is 0.18. This reflects a 40% greater bioavailability for films compared
to lozenges/tablets and 38% greater bioavailability for oral sprays compared to lozenges/tablets.
5
The MME conversion factor for fentanyl nasal spray is 0.16, which reflects a 20% greater bioavailability for sprays compared to
lozenges/tablets.
6
The MME conversion factor for fentanyl patches is based on the assumption that one milligram of parenteral fentanyl is
equivalent to 100 milligrams of oral morphine and that one patch delivers the dispensed micrograms per hour over a 24 hour
day. Example: 25 ug/hr fentanyl patch * 24 hrs = 600 ug/day fentanyl = 60 mg/day oral morphine milligram equivalent. In other
words, the conversion factor not accounting for days of use would be 60/25 or 2.4. However, since the fentanyl patch remains in
place for 3 days, we have multiplied the conversion factor by 3 (2.4 X 3 = 7.2). In this example, MME/day for ten 25 μg/hr
fentanyl patches dispensed for use over 30 days would work out as follows: Example: 25 ug/hr fentanyl patch * (10 patches/30
days)* 7.2 = 60 MME/day.
Opioid Morphine Equivalent Conversion Factors.docx
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