What goes into the Opioid conversion (MME)

Current opioid: Morphine (oral); Morphine (IV); Oxycodone (oral); Hydrocodone (oral); Hydromorphone (oral); Hydromorphone (IV); Oxymorphone (oral); Fentanyl (IV, mcg); Tapentadol (oral); Tramadol (oral); Codeine (oral); Fentanyl patch (mcg/h)
Total dose in 24 h (mg; patch in mcg/h; IV fentanyl in mcg)
Convert to: Morphine (oral); Morphine (IV); Oxycodone (oral); Hydrocodone (oral); Hydromorphone (oral); Hydromorphone (IV); Oxymorphone (oral); Fentanyl (IV, mcg); Tapentadol (oral); Tramadol (oral); Codeine (oral)

How to interpret the result

MME/day = total daily dose × conversion factor (e.g., oxycodone 1.5, hydromorphone oral 5, hydrocodone 1, tramadol 0.2, fentanyl patch 2.4 per mcg/h)
≥ 50 MME/day: increased overdose risk; offer naloxone and reassess benefits and risks
≥ 90 MME/day: high risk; justify carefully and consider specialist input
New opioid: reduce the calculated equivalent by 25–50%, then titrate; breakthrough dose about 10–15% of the daily total

Conversion tables are approximate and differ between sources; IV hydromorphone ratios vary from about 1:4 to 1:7 with oral morphine.
Methadone conversion is non-linear (the ratio rises with dose) and has a long, variable half-life; do not use a fixed factor. Get specialist or pharmacy help.
Do not convert to a fentanyl patch from MME alone: use the product label's conversion table, and only in opioid-tolerant patients.
Reduce more (≥ 50%) in older adults, frailty, kidney or liver impairment, or when the switch is for adverse effects. Avoid morphine and codeine in kidney failure.
MME is a measure of overdose risk and potency, not proof of equivalent analgesia in every patient.

Dowell D, et al. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep. 2022;71(No. RR-3):1-95.

For education only. Check the inputs and the population the score was validated in before acting on it. Not a substitute for clinical judgment.