Checking Each Other's Math: Is It Possible Without a Single Standard for Opioid Dose Equivalence?

For the last decade or more, there has been a proliferation of guidance, policies, and protocols on opioid prescribing that rely on oral morphine equivalents (OME) or morphine equivalent daily doses (MEDD) (1–4). Almost exclusively, this guidance has presumed that OME calculations are standardized and predictable, while those of us who do the work of specialist palliative care on a daily basis know that not to be true. Some experts are encouraging us to dispense with the concept of “equianalgesia” altogether and instead adopt conversion tables as our primary clinical decision aides (5). Few studies have examined the safety and efficacy of opioid dosing decision aids. As such, the tool we use at University of California San Diego Health (6) is different from tools used at other institutions across the country or in widely utilized online calculators such as MD CalcTM. Given this fact, we teach our rotating learners that they should advocate for use of one equianalgesic tool at their institution, choosing a method of equianalgesic calculation that makes sense to them and stick with it. This may minimize intraand inter-tool variability in their clinical decisions and also facilitate direct comparison among colleagues/ teams using other decision tools. Results