AskCalc
Home › Pharmacology & Dosing › MME

Morphine Milligram Equivalents (MME) Calculator, CDC 2022

Total daily morphine milligram equivalents (MME) from the CDC 2022 conversion factors (e.g. oxycodone 1.5, hydromorphone 5, methadone 4.7, fentanyl patch 2.4 per mcg/h). Overdose risk rises with dose; ≥50 MME/day warrants reassessment and naloxone, and ≥90 MME/day should be avoided or carefully justified. MME is a risk measure, not a tool for converting between opioids.

  • Opioid: Morphine (mg/day); Codeine (mg/day); Dihydrocodeine (mg/day); Hydrocodone (mg/day); Hydromorphone (mg/day); Methadone (mg/day); Oxycodone (mg/day); Oxymorphone (mg/day); Tapentadol (mg/day); Tramadol (mg/day); Fentanyl transdermal patch (mcg/h)
  • Total daily dose (mg/day; fentanyl patch: mcg/h)
  • Second opioid (optional): None; Morphine (mg/day); Codeine (mg/day); Dihydrocodeine (mg/day); Hydrocodone (mg/day); Hydromorphone (mg/day); Methadone (mg/day); Oxycodone (mg/day); Oxymorphone (mg/day); Tapentadol (mg/day); Tramadol (mg/day); Fentanyl transdermal patch (mcg/h)
  • Second opioid total daily dose (mg/day; fentanyl patch: mcg/h)
—

Interpretation

ResultMeaning
< 50 MME/dayLower range
50–89 MME/dayIncreased risk; reassess, offer naloxone
≥ 90 MME/dayHigh risk; avoid or justify

Formula

MME/day = Σ (total daily dose × CDC 2022 conversion factor). Factors: codeine 0.15, dihydrocodeine 0.25, fentanyl patch 2.4 (per mcg/h), hydrocodone 1, hydromorphone 5, methadone 4.7, morphine 1, oxycodone 1.5, oxymorphone 3, tapentadol 0.4, tramadol 0.2.

Clinical pearls

  • Not for conversion between opioids: when switching, the new opioid is usually started at a substantially lower dose than the calculated MME (typically 25–50% lower) because of incomplete cross-tolerance.
  • CDC 2022 uses a single methadone factor (4.7); methadone potency actually increases with dose and its half-life is long and variable, so switching to or from methadone needs specialist tables.
  • Buprenorphine is not included in MME totals; these factors should not be applied to opioid use disorder treatment.

Examples

mme oxycodone 30 mg per dayfentanyl patch 25 mcg/h mmemorphine equivalents for hydromorphone 8 mg/day plus oxycodone 60 mg/daywhat is the daily MME of tramadol 300 mg a day

FAQ

How do you calculate morphine milligram equivalents?

Multiply each opioid's total daily dose by its CDC conversion factor and add them. Example: oxycodone 30 mg/day × 1.5 = 45 MME/day.

What MME is considered high risk?

Overdose risk increases with dose. CDC 2022 advises careful reassessment and naloxone at 50 MME/day or more, and avoiding or carefully justifying 90 MME/day or more.

What is the MME of a fentanyl patch?

Multiply the patch strength in mcg/h by 2.4. A 25 mcg/h patch is 60 MME/day.

Evidence

  1. Dowell D et al. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep 2022;71(3):1–95.

Pharmacology & Dosing · Reviewed 2026-10-14 · Methodology