From the Guidelines
The MME (Morphine Milligram Equivalent) of Suboxone is not typically calculated due to its unique pharmacological properties as a partial opioid agonist. When considering the management of opioid use disorder or pain, it's essential to understand that buprenorphine, the primary active opioid in Suboxone, has a ceiling effect on respiratory depression, making it safer at higher doses compared to full agonists 1. Suboxone contains buprenorphine (a partial opioid agonist) and naloxone (an opioid antagonist), and its primary use is for opioid use disorder treatment rather than pain management. Some studies suggest that buprenorphine is approximately 30-40 times more potent than morphine, but this comparison is not clinically useful due to buprenorphine's partial agonist properties 1. Key points to consider include:
- Buprenorphine's unique pharmacology makes standard opioid equivalency calculations inappropriate.
- Healthcare providers don't typically include Suboxone when calculating a patient's total daily MME.
- Suboxone is generally excluded from MME calculations in clinical practice and opioid monitoring programs. Given the most recent and highest quality evidence, healthcare providers should not calculate the MME of Suboxone due to its distinct pharmacological properties and primary use for opioid use disorder treatment 1.
From the FDA Drug Label
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 MME (Morphine Milligram Equivalent) of Suboxone (buprenorphine) is approximately 30-40 MME per 8mg of buprenorphine, however this is not directly stated in the provided label. Based on the provided information, 0.3mg of buprenorphine is equivalent to 10mg of morphine. To calculate the MME of 8mg of buprenorphine:
- 0.3mg of buprenorphine = 10mg of morphine
- 8mg of buprenorphine = x
- x = (8mg * 10mg) / 0.3mg
- x = 266.67mg of morphine
- Since this is an estimate and the actual MME may vary, it's best to consult a reliable MME conversion chart or a medical professional for an accurate calculation. 2
From the Research
Definition of MME
- MME stands for Morphine Milligram Equivalent, which is a measure used to calculate the equivalent dose of different opioid medications in terms of morphine [ 3 ].
- It is used to standardize the dosage of various opioids and to facilitate comparison and conversion between different medications.
Calculation of MME
- The calculation of MME involves multiplying the dose of the opioid medication by a conversion factor specific to that medication [ 4 ].
- For example, the conversion factor for buprenorphine is 30, which means that 1 mg of buprenorphine is equivalent to 30 mg of morphine.
MME of Suboxone
- Suboxone is a combination medication containing buprenorphine and naloxone [ 5 ].
- The MME of Suboxone can be calculated by multiplying the dose of buprenorphine by the conversion factor of 30 [ 6 ].
- For example, a 8mg dose of Suboxone (containing 8mg of buprenorphine) would be equivalent to 240mg of morphine (8mg x 30).
Clinical Significance of MME
- The MME is an important tool in clinical practice, as it allows healthcare providers to compare and convert between different opioid medications [ 7 ].
- It is also used to monitor and manage opioid use, particularly in patients with opioid use disorder.