Working Diagnosis.

Opioid Equivalence Calculator

❍ Convert doses using NZ guidelines
Clinical support tool. This calculator uses equianalgesic dosing based on HealthPathways, NZ MoH Opioid Framework, and international guidelines. Equivalence is approximate. Always assess individual tolerance, renal/hepatic function, drug interactions, and risk factors before switching opioids. Reduce calculated dose by 25-50% if opioid-naive or switching from one class to another.
❍ Step 1: Enter current opioid dose

Morphine Milligram Equivalent (MME)

mg morphine/day
Morphine Reference
1.0
equianalgesic ratio

Your Conversion Summary

❍ Convert to other opioids

Equianalgesic Doses

These doses should produce equivalent analgesia to your input dose. Reduce by 25-50% if switching opioids (tolerance may not cross fully). Adjust based on clinical response.

❍ PRN & breakthrough pain

Breakthrough Dosing

❍ Opioid profiles

How Each Opioid Works (NZ Context)

❍ Clinical considerations

Dose Switching & Risk Assessment

Always reduce dose when switching. Even opioid-tolerant patients may not have cross-tolerance. Reduce equianalgesic doses by 25-50%, then titrate based on response over days to weeks.
When to Use Each Opioid

First-line for acute pain: Oral immediate-release morphine or oxycodone (good bioavailability, short onset).

Chronic pain (cancer/non-cancer): Modified-release morphine or oxycodone once stable on IR. Transdermal fentanyl/buprenorphine for patients with swallowing difficulty or poor compliance. Methadone and buprenorphine require specialist input.

Weak opioids (codeine, tramadol, dihydrocodeine): Limited efficacy; codeine conversion is non-linear and genetically variable (CYP2D6). Reserve for mild-moderate pain unresponsive to non-opioid analgesia.

Fentanyl patches: Reserve for opioid-tolerant patients (≥60 mg morphine/day) due to risk of overdose in opioid-naive patients. Patches take 12-24 h to reach steady state; bridge with IR opioid.

Buprenorphine patches: Lower overdose risk than fentanyl (ceiling effect on respiratory depression). Useful in older adults and patients with respiratory compromise. Avoid mixing with strong opioids (competitive antagonism).

Adjust Your Calculation Based On:
  • Renal impairment: Reduce dose for morphine, codeine, tramadol (accumulation of active metabolites). Fentanyl/methadone less affected.
  • Hepatic impairment: Use with caution; reduce dose. Methadone requires particular care.
  • Age >70 years: Reduce by 25-50%; lower metabolism, higher comorbidity burden.
  • Drug interactions: CYP3A4 inhibitors (ketoconazole, ritonavir) increase fentanyl/methadone levels. Avoid with CNS depressants (benzodiazepines, alcohol) due to respiratory depression risk.
  • Opioid-naive patients: Start low (e.g., 5-10 mg morphine IR) and titrate. Calculator assumes tolerance.
  • Obesity: Fentanyl dosing may not scale linearly; patch absorption can be unpredictable.
  • Switching from weak to strong opioid: Cannot reliably calculate; reduce strong opioid by 50% and titrate.
Common Issues & NZ Approaches

Constipation (80% of patients): Routine laxation with stimulant (bisacodyl) + osmotic (polyethylene glycol). Consider naloxegol (opioid antagonist) for refractory cases.

Nausea: Common in first 1-2 weeks; usually resolves. First-line: metoclopramide or cyclizine. Avoid antihistamines (increase constipation).

Drowsiness/cognitive impairment: Tolerance develops over days. If persistent, reduce dose or switch opioid. Stimulants (methylphenidate) rarely indicated.

Respiratory depression: Risk with rapid titration, renal/hepatic impairment, or concurrent CNS depressants. Monitor respiratory rate; avoid in severe COPD (seek respiratory specialist input).

Opioid-induced hyperalgesia: Rare; consider dose reduction or opioid rotation.

Key Distinctions

Physical dependence: Predictable; develops with regular use. Managed by slow tapering. Not addiction.

Tolerance: Need for dose increase over time to maintain effect. Normal with chronic opioid use; not a sign of failure or addiction.

Addiction (opioid use disorder): Loss of control over use, continued use despite harm, preoccupation with obtaining drug. Requires assessment using DSM-5 criteria and input from addiction specialist (many GPs in NZ have acquired competency). Opioid agonist therapy (methadone, buprenorphine) or buprenorphine/naloxone may be indicated.

NZ guidance: HealthPathways and NZ MoH Opioid Framework recommend universal precautions (baseline risk assessment, regular review, urine drug screening if high-risk), not universal suspicion. Cannabis co-use is common; not a contraindication but increases respiratory depression risk.

❍ Reference

Equianalgesic Dosing Table

Doses that produce equivalent analgesia to 10 mg morphine IV/SC (parenteral reference). Oral doses are ~2-3�- higher due to first-pass metabolism.

Opioid Route Equianalgesic Dose Notes
Morphine Oral (IR) 30 mg Gold standard; reference opioid
IV/SC 10 mg Parenteral reference
Oxycodone Oral (IR) 20 mg ~1.5�- more potent than morphine orally
Hydromorphone Oral 7.5 mg 4�- more potent; shorter duration
Fentanyl Transdermal (mcg/h) 2.4 mcg/h ≈ 60 mg morphine/day 100 mcg/h patch ≈ 2500 mg morphine/day
SL tablet/spray 100-200 mcg For breakthrough pain in opioid-tolerant
Buprenorphine Transdermal (mcg/h) 7 mcg/h ≈ 30 mg morphine/day Partial agonist; lower overdose risk
Methadone Oral 2-4 mg Highly variable; specialist dosing required. Long half-life (24-36 h); risk of accumulation.
Codeine Oral 200 mg Non-linear. Prodrug (CYP2D6 conversion); poor analgesic at high doses. Avoid >240 mg/day.
Tramadol Oral 100 mg Also SNRI; seizure risk at high doses. Avoid in renal impairment (metabolite accumulation).
Dihydrocodeine Oral ~30 mg Similar profile to codeine; better efficacy but less evidence.
❍ Sources

References & Guidance Documents

  1. NZ Ministry of Health. Opioid Medication Framework. Wellington: MoH; 2022. https://www.health.govt.nz
  2. HealthPathways New Zealand. Chronic Pain Management & Opioid Dosing. https://www.healthpathways.org.nz [cited 2024]
  3. Mercadante S. Opioid rotation for cancer pain: rationale and clinical aspects. Cancer. 1999;86(9):1856-66.
  4. Portenoy RK, Lesage P. Management of cancer pain. Lancet. 1999;353(9165):1695-700.
  5. Coffman CW. Equianalgesic dosing of opioids: a clinical reference. J Pain Palliat Care Pharmacother. 2015;29(2):152-8.
  6. New Zealand Pharmacovigilance Centre. Opioid-related adverse events: monitoring and reporting. Dunedin: University of Otago; [cited 2024].
  7. Ritter JM, Flower RJ, Henderson G, et al. Rang and Dale's Pharmacology. 9th ed. Edinburgh: Elsevier; 2020.