From the FDA Drug Label
Pharmacodynamics Buprenorphine hydrochloride is a parenteral opioid analgesic with 0. 3 mg buprenorphine being approximately equivalent to 10 mg morphine sulfate in analgesic and respiratory depressant effects in adults.
The Morphine Milligram Equivalent (MME) of Suboxone (buprenorphine/naloxone) 16 milligrams daily can be calculated as follows:
- 0.3 mg buprenorphine is equivalent to 10 mg morphine
- To find the MME of 1 mg buprenorphine, divide 10 mg morphine by 0.3 mg buprenorphine: 10 mg morphine / 0.3 mg buprenorphine = 33.33 mg morphine per 1 mg buprenorphine
- Multiply this ratio by the daily dose of buprenorphine: 16 mg buprenorphine * 33.33 mg morphine per 1 mg buprenorphine = 533.33 mg morphine However, since the Morphine Milligram Equivalent (MME) is typically used to compare the potency of different opioids, and considering the partial agonist properties of buprenorphine, the actual MME may be lower than this calculated value. Given the information provided in the drug label 1, it is not possible to determine a precise MME for Suboxone (buprenorphine/naloxone) 16 milligrams daily, as the conversion is based on analgesic and respiratory depressant effects, which may not directly translate to MME.
From the Research
The morphine milligram equivalent (MME) of Suboxone 16 mg daily is approximately 48-96 MME. Suboxone contains buprenorphine, a partial opioid agonist, which has a conversion factor of approximately 3-6 MME per 1 mg of buprenorphine 2. Therefore, 16 mg of buprenorphine in Suboxone would equate to 48-96 MME daily. However, it's essential to note that this conversion is somewhat theoretical because buprenorphine has a ceiling effect on respiratory depression, making it safer than full opioid agonists at higher doses. Additionally, buprenorphine has unique pharmacological properties that make direct MME comparisons less clinically relevant than with other opioids. When transitioning between buprenorphine and other opioids, special protocols should be followed due to buprenorphine's high binding affinity for opioid receptors and the risk of precipitated withdrawal 3, 4. The naloxone component in Suboxone doesn't contribute to the MME calculation as it has minimal bioavailability when taken as prescribed sublingually. Some studies have shown that high-dose buprenorphine can be effective for treatment of high potency opioid use disorder, with doses up to 40 mg daily being used in some cases 5. However, the specific MME conversion for Suboxone 16 mg daily remains approximately 48-96 MME, based on the available evidence 2.
Some key points to consider when using buprenorphine include:
- Buprenorphine has a high binding affinity for opioid receptors, which can increase the risk of precipitated withdrawal when transitioning from other opioids 3, 4
- The ceiling effect of buprenorphine on respiratory depression makes it a safer option than full opioid agonists at higher doses 2
- Special protocols should be followed when transitioning between buprenorphine and other opioids to minimize the risk of precipitated withdrawal 3, 4
- The naloxone component in Suboxone does not contribute to the MME calculation due to its minimal bioavailability when taken as prescribed sublingually.
It's also important to note that the evidence for buprenorphine use in opioid use disorder is continually evolving, with new studies and protocols being developed to improve treatment outcomes 6, 5. However, based on the current evidence, the MME conversion for Suboxone 16 mg daily remains approximately 48-96 MME.