What is the Morphine Milligram Equivalent (MME) of oral oxycodone for a patient with chronic pain?

MME Conversion Factor for Oral Oxycodone

The morphine milligram equivalent (MME) conversion factor for oral oxycodone is 1.5, meaning you multiply the total daily oxycodone dose by 1.5 to calculate the MME. 1

Standard Conversion Calculation

• To calculate MME for oxycodone: multiply the total daily dose in mg by 1.5 1
• For example, a patient taking oxycodone 10 mg tablets twice daily (20 mg total daily) equals 30 MME daily (20 mg × 1.5 = 30 MME) 1
• A patient taking oxycodone 60 mg total daily would equal 90 MME daily (60 mg × 1.5 = 90 MME) 2

Guideline Consensus Across Time

• The CDC 2022 guideline confirms the oxycodone conversion factor as 1.5 1
• The CDC 2016 guideline also established the oxycodone conversion factor as 1.5 1
• This conversion factor has remained consistent and is the standard used for risk assessment and opioid prescribing decisions 3, 4

Critical Safety Considerations

• These conversion factors are estimates only and cannot account for individual variability in genetics and pharmacokinetics 1
• When converting between opioids (opioid rotation), do NOT use the calculated MME dose directly—the new opioid should typically be dosed 25-50% lower than the calculated equianalgesic dose to avoid overdose from incomplete cross-tolerance 1, 3
• The MME calculation is intended for risk assessment and monitoring purposes, not for determining doses when switching between opioids 2

Clinical Risk Thresholds Using MME

• Clinicians should pause and carefully reassess individual benefits and risks before increasing total opioid dosage to ≥50 MME/day 1, 3
• The CDC recommends careful monitoring for respiratory depression when total MME exceeds 90 MME/day 2
• Dosages ≥90 MME/day are associated with progressively increasing overdose risk 1

Common Pitfall to Avoid

• Do not confuse the 1.5 conversion factor (used for MME calculation and risk assessment) with the clinical conversion ratio when switching from oxycodone to morphine, which research suggests may be closer to 1:1 for oral-to-oral conversion 5, 6
• The 1.5 factor is specifically for calculating morphine milligram equivalents for monitoring and risk stratification, not necessarily for direct dose conversion in clinical practice 1, 3