Morphine Milligram Equivalents

MME Calculator

Total daily morphine milligram equivalents across one or more opioid prescriptions, using the CDC 2022 Clinical Practice Guideline conversion factors.

CDC 2022 FactorsMulti-Drug TotalsRisk Thresholds

Clinical disclaimer: This tool is for education and dose verification only. MME conversion factors must not be used to switch a patient between opioids — cross-tolerance is incomplete and equianalgesic rotation requires clinical judgement. Never change any dose without the prescribing clinician.

Daily Opioid Regimen

Add each opioid with its per-dose strength and doses per day (fentanyl patches use mcg/hr directly)

Opioid

Dose (mg)

Doses / day

45.0 MME

Total Daily MME

45.0 MME/day

Below 50 MME/day

Lower relative risk band, but no opioid dose is risk-free — always follow the prescriber's plan.

How Daily MME Is Calculated (Worked Example)

For each opioid: daily mg × conversion factor, then sum across drugs. A patient taking oxycodone 10 mg every 8 hours plus tramadol 50 mg twice daily: oxycodone 30 mg × 1.5 = 45 MME; tramadol 100 mg × 0.2 = 20 MME; total 65 MME/day — in the CDC's elevated 50–89 band, warranting a risk-benefit review before any increase.

CDC 2022 Conversion Factor Table

Opioid	Factor	Example
Morphine (oral)	1	30 mg/day → 30 MME
Codeine	0.15	120 mg/day → 18 MME
Hydrocodone	1	30 mg/day → 30 MME
Oxycodone	1.5	30 mg/day → 45 MME
Oxymorphone	3	20 mg/day → 60 MME
Hydromorphone	5 (2022; was 4)	8 mg/day → 40 MME
Tramadol	0.2 (2022; was 0.1)	200 mg/day → 40 MME
Methadone	4.7 (2022 flat)	20 mg/day → 94 MME
Fentanyl patch	2.4 per mcg/hr	25 mcg/hr → 60 MME

Source: CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022), which replaced the discontinued 2016 NDC/MME conversion file. Tapentadol is omitted here because published sources conflict on its 2022 factor; buprenorphine is excluded from MME by design.

Reading the 50 and 90 MME Thresholds

The CDC identifies 50 MME/day as the point where overdose risk roughly doubles compared with under 20 MME/day, and advises prescribers to avoid or carefully justify ≥90 MME/day, pairing higher doses with naloxone availability. State prescription-monitoring programs surface these same bands to pharmacists. They are surveillance thresholds — decisions for an individual patient (tapering, continuing, rotating) belong to the treating clinician, never to a calculator.

Frequently Asked Questions

What are morphine milligram equivalents (MME)?

MME expresses any opioid dose as the equivalent daily dose of oral morphine, so different drugs can be compared on one scale. Oxycodone 10 mg three times daily = 30 mg × 1.5 = 45 MME/day. Prescribers, pharmacies, and prescription-monitoring programs use MME to gauge cumulative opioid exposure.

What MME level is considered high risk?

The CDC 2022 Clinical Practice Guideline flags increased overdose risk starting around 50 MME/day and advises avoiding or carefully justifying 90 MME/day or more. These are population-level caution lines, not hard limits — some patients are stable above them under specialist care.

What changed in the CDC 2022 MME factors?

Two notable updates from the older 2016 file: tramadol's factor doubled from 0.1 to 0.2, hydromorphone rose from 4 to 5, and methadone moved from dose-dependent tiers to a single 4.7 factor. Databases that updated in 2022 can therefore report higher MME for the same regimen than older tools.

How is a fentanyl patch converted to MME?

Transdermal fentanyl converts at 2.4 MME per mcg/hr of patch strength: a 25 mcg/hr patch is 60 MME/day. Enter the patch strength directly — no frequency is needed because patches deliver continuously.

Why is methadone's conversion special?

Methadone's potency rises non-linearly with dose and it accumulates over days, which is why older tables used dose-dependent tiers (4 to 12). The CDC 2022 file simplified to a flat 4.7 for surveillance purposes — one more reason MME must not be used to rotate a patient onto or off methadone.

Can I use MME to switch between opioids?

No. MME factors are built for measuring total exposure, not for equianalgesic rotation. Cross-tolerance between opioids is incomplete, so a 'mathematically equivalent' dose of a new opioid can overdose a patient. Opioid rotation requires deliberate dose reduction and clinical supervision.

Is buprenorphine included in MME totals?

No — the CDC excludes buprenorphine from MME calculations because as a partial agonist its overdose-risk profile differs from full agonists, and it's often prescribed specifically for opioid use disorder.

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Disclaimer: This calculator is for general educational purposes only and is not medical advice. It does not diagnose, treat, or replace consultation with a qualified healthcare professional. Always discuss your results with your doctor.