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Morphine Equivalent Daily Dose (MEDD)

Morphine Equivalent Daily Dose (MEDD) for opioid rotation and dosing.
Guidelines & Evidence

Clinical Details

Section 1

When to Use

When to Use

Standardization of opioid doses for safe comparisons across different agents
Opioid rotation and equianalgesic dosing
Assessment of total opioid burden for deprescribing decisions
Methadone titration and conversion from other opioids
Section 2

Formula & Logic

Conversion Principles

MEDD standardizes all opioids to morphine equivalents using established potency ratios from Palliative Care Formulary and clinical guidelines.

Common Conversion Factors

Morphine (oral)1:1 ratio
Oxycodone (oral)1:1.5 (morphine:oxy)
Codeine (oral)1:0.15
MethadoneVariable (1:4 to 1:12 depending on prior MEDD)
Fentanyl transdermal1 mcg/hr ≈ 2.4 mg MEDD
Section 3

Pearls/Pitfalls

Key Advantages

Essential tool for safe opioid rotation and dose adjustments
Enables standardized communication about opioid burden
Helps identify high-dose opioid patients at risk for side effects

Known Limitations

Conversion ratios are approximate; individual variation significant
Methadone conversions particularly complex and non-linear
Does not account for tolerance or individual opioid sensitivity

Last Comprehensive Review: 2026

Related Palliative Care Tools

Palliative Performance Scale
Palliative Prognostic Index
Palliative Prognostic
e-PaP Score
Menten Score
Edmonton Symptom Assessment System
IPOS
Distress Thermometer
Memorial Symptom Assessment Scale
Opioid Risk Tool
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