Morphine Milligram Equivalent (MME)
- Dr. Peter Jacobsen, PhD, DDS
- Jun 23
- 2 min read
Updated: Jun 24
What is Morphine Milligram Equivalvent (MME)? Why is it important?
And how do I easily incorporate it into my opioid prescribing?
In all cases of managing dental pain, the evidence is clear that nonopioids are the best and safest choice.
However, there are infrequent times when refractory pain or an intolerance to NSAIDs and Acetaminophen may require the use of opioid analgesics.
If you prescribe opioids, you should be certain that you are complying with CDC guidelines for responsible opioid prescribing and best practice.
That is when understanding Morphine Milligram Equivalent (MME) calculations will ensure that you are complying with current guidelines. The guide below is a useful resource for MME calculations.
MME is a way to measure both the strength and amount of opioids each patient receives on a daily basis and in total, for every prescription written for opioids.
It is important because whenever the MME exceeds 20 on a daily basis, the risk of overdose for that patient increases. Daily MME between 50-100 increases the risk of overdose nearly 5 times, and above 100 the risk of overdose is almost 7 times greater than a daily MME of 20.
The table below shows the comparative MME between different opioids.
How do we put this into practice? Morphine and hydrocodone are equivalent MME, so 5mg of hydrocodone equals 5MME. Oxycodone is 1.5 the MME of morphine so 5mg of oxycodone equals 7.5MME. Tramadol is 0.1 the MME of morphine so 50mg of tramadol equals 5 MME. This is the MME per pill/dose.
To calculate the daily MME, if the opioid is to be taken 4x daily, hydrocodone has a daily MME of 20, oxycodone a daily MME of 30, and tramadol a daily MME of 20.
To calculate the total prescription MME, multiply the individual pill MME by the total number of pills prescribed. If 20 pills are prescribed, that amounts to a total prescription MME of 100 for hydrocodone, 150 for oxycodone, and 100 for tramadol.
The CDC recommends that daily MME be below 50, and every attempt should be made to target 20 MME per day. The CDC recommends a total prescription MME of 100 or below.
These guidelines minimize both the risk of overdose and addiction. Professional judgment is appropriate and necessary for each individual patient’s medical and addiction history. Plus, as already stated, nonopioids should always be the first choice, because they are the most effective choice, for acute dental pain management. If opioids are the only option, prescribing the lowest dose for the shortest duration (fewest number of tablets) possible is the best practice to minimize “leftover” pills, which are the primary temptation for abuse and addiction.
The sample prescriptions below will help you stay within or close to CDC recommendations.
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