Although the 2022 revision of the 2016 CDC Opioid Prescribing Advice is an improvement over the original document, it still refers to Morphine Milligram Equivalents (MME) as a guide to physicians. Unfortunately, this number does not accurately reflect the relative strength of opioid painkillers. Dr. Jeff Singer and I explain why in a new op-ed in the NY Daily News.
Over the past several years, our government has taken control of doctors’ prescription pads. In an attempt to reduce opioid overdose deaths, lawmakers placed hard quantitative limits on the maximum daily dose of painkilling drugs doctors can prescribe. These dose limits were calculated from a conversion table that was the crux of the Centers for Disease Control. and Prevention (CDC) 2016 opioid prescribing guidelines. But a review of the scientific literature shows that the evidence upon which the table is based is either flimsy or non-existent. Even if the CDC recants its 2016 prescribing guidelines when it updates them later this year, the damage has already been done.
The CDC conversion table was intended to help doctors calculate the appropriate dose of a given opioid by comparing its strength relative to morphine. Supposedly, the use of these “morphine milligram equivalents” (MME) would act as a quick reference for physicians. The CDC recommended 90 MME (90 milligrams of morphine) as the maximum daily dose and that the dose of other drugs be adjusted accordingly. For example, the maximum dose of oxycodone, a drug that is twice the strength of morphine, would be given at half the dose of morphine, or 45 milligrams per day.
Although some scientists voiced skepticism, the recommendations became gospel, and later, law. Indeed, by 2022 38 states enacted laws that restricted the number and dose of opioids doctors may prescribe. Many impose daily limits of 90 MME or less. Medicare requires pharmacists to “confirm the medical need” for patients prescribed doses exceeding 90 MME. Health plans impose restrictions on prescriptions exceeding 90 MME.
#Reprinted with permission. The full article can be read here.