OpiCalc

1121 Clinical Tools

Morphine Equivalent Daily Dose (MEDD)

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

Opioid Type

Daily Dose

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
Methadone	Variable (1:4 to 1:12 depending on prior MEDD)
Fentanyl transdermal	1 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

AKPS — Australia-modified Karnofsky Performance Status

Death Rattle Scoring

Distress Thermometer

Edmonton Symptom Assessment System

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