What is the maximum daily dose of morphine (opioid analgesic) that can be prescribed by a family physician (General Practitioner, GP)?

From the Guidelines

There is no specific maximum daily morphine dose that is legally allowed to be prescribed by family physicians, but doses above 90 morphine milligram equivalents (MME) per day should be carefully justified and monitored, as recommended by the CDC guideline for prescribing opioids for chronic pain 1.

Key Considerations

• The CDC guideline recommends starting opioids at the lowest effective dosage and using caution when increasing opioid dosages, with careful reassessment of benefits and risks when considering increasing dosage to 50 MME or more per day 1.
• Higher doses, typically above 90-120 MME per day, warrant additional justification, closer monitoring, and possibly consultation with pain specialists.
• Family physicians should follow a stepwise approach, starting with the lowest effective dose and titrating carefully while monitoring for efficacy and adverse effects.

Important Factors to Consider

• Patient's medical condition, pain severity, opioid tolerance, and individual response to treatment
• Risk mitigation strategies, such as naloxone prescriptions, frequent follow-ups, and urine drug testing, should be implemented when prescribing higher doses
• The appropriate dose varies significantly between opioid-naïve patients and patients with cancer pain or opioid tolerance, who may require substantially higher doses

Guideline Recommendations

• The CDC guideline recommends avoiding increasing opioid dosages to 90 MME or more per day or carefully justifying a decision to titrate dosage to 90 MME or more per day based on individualized assessment of benefits and risks 1.
• The guideline also recommends establishing a tapering plan for patients who are already prescribed high dosages of opioids (≥90 MME/d) and wish to reevaluate their continued use of opioids at high dosages.

From the Research

Maximum Daily Morphine Dose

• The maximum amount of daily morphine dose legally allowed to be prescribed by a family physician is not explicitly stated in the provided studies 2, 3, 4.

Morphine Dosage in Clinical Studies

• A study on the analgesic efficacy of morphine sulfate immediate release vs. oxycodone/acetaminophen for acute pain in the emergency department used a dose of 15 mg MSIR combined with 650 mg of Acetaminophen 2.
• Another study on the dosage range evaluation of opioid analgesic for breakthrough pain in cancer patients found that immediate-release morphine was used at a dose percentage between 6.67-60% of the daily dose, with a frequency of use between 2 to 6 times a day 3.

Regulatory Guidelines

• There is no mention of regulatory guidelines or legal limits on the maximum daily morphine dose in the provided studies 2, 3, 4.

Clinical Considerations

• The dosage of morphine should be determined based on individual patient needs and medical history, rather than a fixed maximum daily dose 3.
• Clinicians should consider the potential for adverse effects, such as constipation, nausea, and vomiting, when prescribing morphine 3.