Navigating Opioids for Chronic Pain

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Sometimes the best of intentions lead to devastating consequences. Canada and the U.S. are the two highest consumers of prescription opioids even though we don’t have good evidence that they are effective for chronic pain. Since there are many different opioids used for the same purpose, we use morphine equivalence to compare how strong they are.

As the number of morphine milligram equivalents per day (MME/D) increases, the harms associated with opioid therapy also increase.

Navigating-Artboard IS HIGH DOSE PRESCRIBING SAVING OR SINKING YOU? NEXT There is no safe dose of opioids. Harms and complications can happen at any dose, but are less likely at lower MMEs/D. There is up to a 5x increase in overdose risk in this range as compared to lower doses. The CDC recommends that prescribing above 90 MME/D be avoided. There is up to a 9x increase in overdose risk in this range as compared to lower doses. Overdoses that happen at doses greater than 100 MME/D are more likely to be fatal. People on higher doses tend to have higher rates of complications like sleep apnea, generalized pain, addiction, low testosterone levels and disability from work. Most chronic pain can be managed well below 200 MME/D. 0 50 50

Navigate through different morphine equivalent dose ranges to find out if high dose prescribing is saving or sinking you.

Prescription examples from 0-50 MME/D

Codeine Contin 100mg 2 tabs/day 30 MME
Tylenol #3 8 tabs/day 30 MME

Prescription examples from 50-100 MME/D

MS Contin 30mg 2 tabs/day 60 MME
Percocet 10 tabs/day 75 MME
Hydromorphone 4mg 4 tabs/day 80 MME

Prescription examples from 100-200 MME/D

Hydromorphone SR 12mg 2 caps/day 120 MME
OxyNEO 40mg 3 tabs/day 180 MME
Fentanyl 50mcg Patch 200 MME

Prescription examples >200 MME/D

Oxycodone CR 80mg 2 tabs/day 240 MME
Hydromorph Contin 30mg 2 caps/day 300 MME
Fentanyl 100mcg Patch 400 MME

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Developed By:

University of Toronto, Continuing Professional Development
The Institute for Safe Medication Practices Canada
Physicians for Responsible Opioid Prescribing

Endorsed By:

Canadian Agency For Drugs And Technologies In Health
The Canadian Medical Association
The Canadian Patient Safety Institute (CPSI)

Funding for this infographic is provided in part by the Government of Canada. The views expressed herein do not necessarily represent the views of the Government of Canada.

Sources: Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (2010); CDC Guideline for Prescribing Opioids for Chronic Pain (2016)

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