Pain is one of our senses – like vision, hearing, or taste. It aids our survival by identifying noxious and harmful stimuli. But unlike the other sensations, it's ethically challenging for us to study pain. Instead, we rely on animal studies. Pain’s underlying physiology is understood, but not our experience of pain, unlike other sensations that we can readily share, like listening to music or watching a sunset. That difference makes it difficult to treat.
It is indeed another day and time to complete my deeper look at the origin and uses of Morphine Milligram Equivalents (MME). It is time to consider the uncertainty introduced in how MMEs are calculated and how that makes the research on MME a minefield of unintended errors and variation.
They are the foundation of the CDC's 2016 opioid guidelines, resulting in legislation that limits opioid prescribing in 36 states. Morphine milligram equivalents, or MMEs, are used to set arbitrary prescribing limits for opioids by physicians, since many state legislators fail to understand – and translate into policy and law – the ‘16 guidelines. If we had all known the history of MMEs, perhaps we would not have been so eager to embrace them.
The FDA is conducting a workshop to discuss the science (lack thereof, really) of Morphine Milligram Equivalents as it applies to the atrocious CDC 2016 Opioid Prescribing Guidelines. Public comments have been solicited. Here are mine.