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Opioid morphine milligram equivalents (MME) calculator

Adds up the total daily morphine milligram equivalents (MME) of up to ten opioids, using the conversion factors in the CDC 2022 clinical practice guideline (Dowell 2022). MME is a risk estimate, not a conversion tool.

  • Conversions
  • CDC 2022
  • Runs on your device

Short answer

Morphine milligram equivalents (MME) add up the daily dose of each opioid multiplied by its conversion factor, using the CDC 2022 clinical practice guideline (Dowell 2022). The total is a risk estimate, not a conversion between drugs.

Opioid morphine milligram equivalents (MME)

Runs on your device. Nothing you enter is saved or sent.

Estimate only. Interpret it with the patient's clinical picture and the product label.

Sources

1
  1. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC clinical practice guideline for prescribing opioids for pain, United States, 2022. MMWR Recomm Rep. 2022;71(3):1–95. DOI 10.15585/mmwr.rr7103a1 PubMed 36327391

Formula version: Morphine milligram equivalents (CDC 2022) · MediHelp calc v1.3.1

Formula and sources checked on 2026-11-02

When this estimate is not valid

5
  • MME is a risk estimate. Do not use the factors to switch from one opioid to another: cross-tolerance is incomplete and the new drug is usually started at a much lower dose.
  • Use particular caution with methadone: long, variable half-life, and peak respiratory depression comes later and lasts longer than the analgesic effect.
  • Fentanyl patches are entered in micrograms per hour, not milligrams per day.
  • Buprenorphine products are not included (partial agonist with a ceiling effect). The factors do not apply to opioid use disorder treatment.
  • The total is not a reason for abrupt dose reduction or discontinuation: CDC 2022 warns of harm from rapid tapering.

Estimate only. Interpret it with the patient's clinical picture and the product label.

About this calculator

What it is
Morphine milligram equivalents add up a patient's daily opioid doses using the CDC 2022 conversion factors.
Why it is used
Total daily MME is a marker of overdose risk used to decide on reassessment, naloxone and monitoring.
How to use it
Enter the total daily dose of each opioid in mg per day (fentanyl patch in micrograms per hour); include all regular and as-needed doses.
How to read the result
CDC 2022 advises careful reassessment and naloxone at 50 MME/day or more and notes little added benefit with more risk at 90 or more, without a fixed ceiling. MME is a risk estimate, not a conversion for switching opioids, and not a reason for abrupt reduction.

How it is calculated

MME/day = Σ (daily dose × factor)

Each daily dose is multiplied by the factor for that drug, and the results are added up. Doses are entered in mg per day; a fentanyl patch is entered in micrograms per hour (mcg/h).

codeine 0.15, hydrocodone 1, hydromorphone 5, methadone 4.7, morphine 1, oxycodone 1.5, oxymorphone 3, tapentadol 0.4, tramadol 0.2, fentanyl patch 2.4 (per mcg/h)

The factors are codeine 0.15, hydrocodone 1, hydromorphone 5, methadone 4.7, morphine 1, oxycodone 1.5, oxymorphone 3, tapentadol 0.4, tramadol 0.2 and fentanyl patch 2.4 (per mcg/h).

At 50 MME per day or more, the CDC 2022 guideline advises careful reassessment of benefits and risks and offering naloxone. At 90 MME per day or more it found little added benefit and higher overdose risk, and it no longer sets a fixed ceiling; it again advises reassessing benefits and risks and offering naloxone. The total is not a reason for abrupt dose reduction or discontinuation. The calculator shows these notes.

Notes also appear when methadone is included (its factor is only an estimate and its half-life is long and variable), when a fentanyl patch is included (absorption varies with heat, fever and skin), and for tapentadol and tramadol (it is not known whether overdose risk scales with dose as it does for pure mu-agonists).

Buprenorphine products are not included: they are a partial agonist with a ceiling effect, and the factors do not apply to the treatment of opioid use disorder. Each drug has an upper limit for the entered dose, and at least one dose above 0 is needed.

Worked example

Morphine 30 mg per day and oxycodone 40 mg per day:

  1. morphine: 30 × 1 = 30
  2. oxycodone: 40 × 1.5 = 60
  3. 90.0 MME/day

Total daily MME 90.0 MME/day (morphine 30 MME, oxycodone 60 MME). At 90 MME per day or more the calculator shows the CDC 2022 note.

Questions

Can I use the factors to switch from one opioid to another?

No. MME is a risk estimate. Cross-tolerance is incomplete, so the factors are not for switching from one opioid to another; the new drug is usually started at a much lower amount.

Does a high MME mean the opioid should be cut abruptly?

No. The total is not a reason for abrupt dose reduction or discontinuation, and CDC 2022 warns of harm from rapid tapering.

Why take extra care with methadone?

Its factor is only an estimate, its half-life is long and variable, and peak respiratory depression comes later and lasts longer than the analgesic effect.

How are fentanyl patches and buprenorphine handled?

Fentanyl patches are entered in micrograms per hour, not milligrams per day, and absorption varies with heat, fever and skin. Buprenorphine products are not included.

Use the calculators in the MediHelp app

Estimate only. Interpret it with the patient's clinical picture and the product label.