Opi
Calc
BODE Index (Palliative context)
CAM-S (Confusion Assessment Method - Severity)
CPOT (Critical-Care Pain Observation Tool)
Death Rattle Scoring (Victoria)
Distress Thermometer
Edmonton Symptom Assessment System (ESAS-r)
FAST Scale (Dementia)
IPOS (Integrated Palliative Outcome Scale)
Memorial Symptom Assessment Scale (MSAS)
Menten Score
Morphine Equivalent Daily Dose (MEDD)
Nursing Delirium Screening Scale (Nu-DESC)
Opioid Risk Tool (ORT)
PAINAD Scale
Palliative Performance Scale (PPSv2)
Palliative Prognostic (PaP) Score
Palliative Prognostic Index (PPI)
Respiratory Distress Observation Scale (RDOS)
Richmond Agitation-Sedation Scale (RASS-PAL)
e-PaP Score
Morphine Equivalent Daily Dose (MEDD)
Morphine Equivalent Daily Dose (MEDD) for opioid rotation and dosing.
Opioid Type
Morphine (oral)
Oxycodone (oral)
Codeine (oral)
Fentanyl (transdermal)
Daily Dose
Convert to MEDD
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
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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