For opioids, the daily dosage equivalent to morphine should be a “guidance but not a dogma”
Schatman ME. The Morphine Equivalent Daily Dose (MEDD) Myth: Ethical Implications for Research and Practice. Presented at: The Eastern Congress of Clinical Rheumatology; May 12-15, 2022; Destin, Florida.
Disclosures: Schatman declares to be a consultant for Modoscript.
DESTIN, Fla. — Physicians considering opioids for pain should do hand calculations before consulting conversion charts and online calculators, according to a speaker from the Eastern Clinical Rheumatology Congress.
“[Morphine equivalent daily dosage (MEDD)] is a very flawed concept, and it does not take into account pharmacogenetic differences, which are important,” Michael E. SchatmanPhD, CPEclinical instructor at New York University Grossman School of Medicine and editor of the journal of pain research, told attendees. “He refuses to recognize the need for personalized medicine, which is also important.”
Initially, the concept of a MEDD was developed and implemented as a research aid and not intended for clinical use, Schatman said.
Michael E. Schatman
“In terms of research, we have ethical concerns,” he added.
Citing a study by Dunbar and colleagues, Schatman pointed out that accepted conversion rates for opioids were beginning to appear clearly inaccurate, and that comparing conversion rates for different opioids was similar to comparing “apples to oranges.” “.
“Ethically, research on the impact of an intervention should look at morphine levels, patients on hydrocodone, patients on oxycodone, etc., individually,” he said.
According to Schatman, researchers who rely on the MEDD can argue that getting rid of it would make research more difficult.
“And wouldn’t the search be more difficult?” Yeah, you bet it would, but it would be more accurate, and accuracy is our friend,” he said.
Although he awaits more research on specific opioids, Schatman suggested doctors proceed with caution when using online calculators for dose conversions.
“Opioid dose conversion based on the MEDD should be taken as guidance, but not
dogma, assuming it will be used at all,” Schatman said. “The systemic review of conversion based on the MEDD is extremely disheartening, and the online calculators that many use are particularly dangerous.”
Until more research is conducted and new methods are developed, Schatman suggested that prescribing physicians only use calculators after they have already completed the five-step sequence for manual conversion, citing an article by Constantino and his colleagues.
“Using manual calculations doesn’t necessarily guarantee complete accuracy, but it’s definitely more accurate than a lot of those conversion charts and online calculators,” Schatman said.
He added: “We tend to trust technology way too much.”