Opioid MME Calculations Public Deposited

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  • June 9, 2021
  • Objective: Morphine-standardized doses are used in clinical practice and research to account for molecular potency. Ninety milligram of morphine equivalents (MME) per day are considered a “high dose” risk threshold in guidelines, laws, and by payers. Although ubiquitously cited, the “CDC definition” of daily MME lacks a clearly defined denominator. Our objective was to assess denominator-dependency on “high dose” classification across competing definitions. Methods: To identify definitional variants, we reviewed literature and electronic prescribing tools, yielding 4 unique definitions. Using Prescription Drug Monitoring Programs data (July to September 2018), we conducted a population-based cohort study of 3,916,461 patients receiving outpatient opioid analgesics in California (CA) and Florida (FL). The binary outcome was whether patients were deemed “high dose” ( > 90 MME/d) compared across 4 definitions. We calculated I2 for heterogeneity attributable to the definition. Results: Among 9,436,640 prescriptions, 42% overlapped, which led denominator definitions to impact daily MME values. Across def- initions, average daily MME varied 3-fold (range: 17 to 52 [CA] and 23 to 65 mg [FL]). Across definitions, prevalence of “high dose” individuals ranged 5.9% to 14.2% (FL) and 3.5% to 10.3% (CA). A definitional variation would impact a hypothetical surveillance study trying to establish how much more “high dose” prescribing was present in FL than CA: from 34% to 79% more. Meta-analyses revealed strong heterogeneity (I2 range: 86% to 99%). In sensitivity analysis, including unit interval 90.0 to 90.9 increased “high dose” population fraction by 15%. Discussion: While 90 MME may have cautionary mnemonic bene- fits, without harmonization of calculation, its utility is limited. Comparison between studies using daily MME requires explicit attention to definitional variation. Key Words: opioids, milligrams of morphine equivalents (MME), definitions, epidemiology, Prescription Drug Monitoring Programs (PDMP)
  • Additional information available at: https://www.opioiddata.org/studies/equations-for-calculating-mmes/
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