SIS-06 - Malevolent MEDDs: The Lost Art of Morphine Equivalency Utilization

Have we lost the true utility of calculating morphine equivalent daily doses? With heavy influences, unintended or not, by the CDC guideline for prescribing opioids for chronic pain, Morphine Equivalent Daily Dose (MEDD) calculations are increasingly being used to justify arbitrary opioid dosing cutoffs and in assessing outcomes relating to opioid risks, rather than combining them with additional clinical and functional assessments for effectiveness of pain relief. In particular, they are often used as the sole metric by opioid stewardship teams when evaluating potential opioid overdose risk in chronic pain patient populations when there are additional considerations such as co-morbid medical conditions. Yet, the question remains, is this what MEDDs are supposed to be used for? Are we losing sight of not only the art behind these calculations, but the reasons for their use itself?

During this interactive discussion, we will unravel the intricacies of all things MEDD related. From their original intent in optimizing analgesia during opioid rotation, to their use now in assessing risk of opioid-related adverse effects, and all the fallacies in between. We will propose additional methods of risk assessment beyond MEDD alone and apply them to patient scenarios. Clinical cases will be used to demonstrate when to utilize MEDD, which MEDD conversions to consider, practice with calculating MEDD, how to safely perform opioid rotations from MEDD calculations and how to combine the calculations with other clinical factors to determine appropriateness of therapy and assess risk. The lost art of morphine equivalency utilization will once again be relearned!