Variability in Opioid Equivalence Calculations

Rennick, Amanda; Atkinson, Timothy; Cimino, Nina M.; Strassels, Scott A.; McPherson, Mary Lynn; Fudin, Jeffrey

doi:10.1111/pme.12920

Cited by 46 publications

(37 citation statements)

References 7 publications

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“…Omission of other covariates and confounders is an inherent limitation. Recent studies have shown that MED dose calculation can be used reliably in some cases, but there can be a wide range of dose estimations across provider groups . The calculation also does not account for other prescriptions that individuals received, or any pharmacologic and non‐pharmacologic responses that may affect drug metabolism.…”

Section: Discussionmentioning

confidence: 99%

Effect of an opioid management program for Colorado workers’ compensation providers on adherence to treatment guidelines for chronic pain

Tenney

McKenzie

Matus

et al. 2018

American J Industrial Med

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Objective: The aim of this study was to examine adherence of state guidelines for Colorado workers’ compensation physicians/providers treating individuals as injured workers with chronic pain after initiation of an opioid management program and provider incentives. Methods: A retrospective cohort of chronic, non-cancer pain claims was constructed from the Colorado’s workers’ compensation database. Adherence to treatment guidelines and opioid prescribing practices were evaluated during implementation of a new billing code to incentivize adherence. Results: Overall, less than 33% of claims showed evidence of opioid management. Comprehensive opioid management was observed in only 4.4% of claims. In 2010, after implementing the new billing code, the ratio of long acting opioids to short acting opioids decreased from 0.2 to 0.13; returning to 0.2 in one year. Similarly, morphine equivalent doses declined for a short period. Conclusions: Incentivizing physicians to adhere to chronic pain management guidelines only temporarily improves prescribing practices.

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Section: Discussionmentioning

confidence: 99%

Effect of an opioid management program for Colorado workers’ compensation providers on adherence to treatment guidelines for chronic pain

Tenney

McKenzie

Matus

et al. 2018

American J Industrial Med

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“…When using different forms of opioid drugs, the opioid equivalence dosage was compared using oral morphine equivalent dose [ 3 – 5 ]. The administration of opioid was launched with the basal infusion and a demand bolus dose.…”

Section: Methodsmentioning

confidence: 99%

Patient-Controlled Intravenous Analgesia for Advanced Cancer Patients with Pain: A Retrospective Series Study

Peng

Zhang

Guo

et al. 2018

Pain Research and Management

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Objective To compare the efficacy and side effects of patient-controlled intravenous analgesia (PCIA) with hydromorphone, sufentanil, and oxycodone on the management of advanced cancer patients with pain. Methods Patients allocated to receive PCIA between January 2015 and December 2016 were chosen for this study. After reviewing medical records, we verified if hydromorphone, sufentanil, or oxycodone for PCIA could equally provide effective pain relief. A numeric rating scale (NRS) of cancer pain was applied before PCIA, at 4 hours after PCIA, and at the discontinuation of PCIA. Secondary, the incidence of clinical side effects attributed to PCIA was observed. Results A total of 85 medical records were reviewed. PCIA with hydromorphone (n=30), sufentanil (n=34), and oxycodone (n=21) was used for cancer pain management. PCIA successfully improved pain control in 97.6% of the patients. The most common side effects were constipation (11.8%), nausea (8.2%), and sedation (5.9%). Drug addiction, delirium, or respiratory depression associated with PCIA was not reported in this case series study. No significant intergroup difference was observed in NRS at any of the abovementioned time points. There was no significant difference of analgesic effect among the hydromorphone, sufentanil, or oxycodone. Conclusion PCIA provided timely, safe, and satisfactory analgesia for advanced cancer patients with pain and may be useful for titration of opioids, management of severe breakthrough pain, and conversion to oral analgesia. There was no significant difference of analgesic effect and side effect among the hydromorphone, sufentanil, and oxycodone.

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“…Furthermore, the pharmacokinetics of intravenous and oral opioids is substantially different, which might have influenced the effectiveness of the opioid medication irrespective of the dosing and the opioid used. Several publications have questioned the validity of conversions of opioid equivalents by highlighting relevant interindividual variations; however, this is a widely accepted approach to compare opioid regimens, which were highly standardized in this study despite the use of different opioids [31,37]. In addition, an overall effect over 24 h was measured, so that the specific pharmacokinetics probably had little influence on the assessment, apart from maximum pain intensity.…”

Section: Limitationsmentioning

confidence: 99%

The effectiveness of an oral opioid rescue medication algorithm for postoperative pain management compared to PCIA

et al. 2020

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Level "2" Long-acting oxycodone (at 8.00 am and 8:00 pm) + level"1" Level "1" 3x 600mg ibuprofen p.o. In case of contraindication 4x1g metamizol p.o., or 4x paracetamol 1g p.o. : Pain Intensity NRS > 3 NRS≤ 3 Immediately after the third administration of "RescueMedication": Information to the ward-physician and check surgical reasons for pain. After the third administration of "Rescue Medication": within 24h: Increase the basic analgesics to level "2" or increase the dosage of long-acting oxycodone to 10mg. Continue analgesics for 24h: if NRS remains ≤ 3 decrease basic analgesics level from "2" to "1", or if dosage of oxycodone is still > 10mg decrease oxycodone in steps of 10 mg Clinical procedure On the evening prior to surgery and the following morning all patients received 640 Der Anaesthesist 9 • 2020

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Variability in Opioid Equivalence Calculations

Cited by 46 publications

References 7 publications

Effect of an opioid management program for Colorado workers’ compensation providers on adherence to treatment guidelines for chronic pain

Effect of an opioid management program for Colorado workers’ compensation providers on adherence to treatment guidelines for chronic pain

Patient-Controlled Intravenous Analgesia for Advanced Cancer Patients with Pain: A Retrospective Series Study

The effectiveness of an oral opioid rescue medication algorithm for postoperative pain management compared to PCIA

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