# What is my total daily MME?

Adds up the total daily morphine milligram equivalents (MME) of one or more opioids with the CDC 2022 conversion factors. It does not convert one opioid to another.

- Page: https://www.acalculator.org/health/mme-calculator
- JSON spec: https://www.acalculator.org/health/mme-calculator.json
- Version: 88cefb180e3f

## Default answer

Example with the default inputs (Opioids taken [Opioid Oxycodone (mg), Strength per dose 10, Doses per day 2]): The total is 30 morphine milligram equivalents (MME) per day.

## Inputs

| Key | Label | Description |
| --- | --- | --- |
| op | Opioids taken | One row per opioid: the opioid, the strength of one dose, and how many doses a day. |

## Outputs

| Key | Label | Description |
| --- | --- | --- |
| total | Total daily MME | The morphine milligram equivalents per day of all rows added up, to 1 decimal. |
| breakdown | MME per opioid | Each row as strength × doses per day × CDC factor, to 1 decimal. |

## Method

MME per day = Σ (strength per dose × doses per day × CDC conversion factor). For a fentanyl patch: patch mcg/hr × patches × 2.4.

## Assumptions

- Conversion factors from the CDC Clinical Practice Guideline for Prescribing Opioids for Pain, 2022.
- MME is for adding up opioid exposure. It is not a way to convert one opioid to another.
- Buprenorphine is not included, as in the CDC table. The total is rounded to 1 decimal, halves up.

## Worked examples

1. op = {"opioid":"oxycodone","strength":10,"perDay":2} or undefined gives total = 30, breakdown = Oxycodone: 30 MME/day. Source: CDC 2022 guideline, Table footnote: oxycodone 10 mg twice a day is 20 mg a day, equivalent to 30 MME.
2. op = {"opioid":"hydrocodone","strength":5,"perDay":4} or undefined gives total = 20. Source: CDC 2022 guideline, Table footnote: hydrocodone 5 mg four times a day is 20 mg, equivalent to 20 MME.
3. op = {"opioid":"fentanylPatch","strength":25,"perDay":1} or {"opioid":"oxycodone","strength":5,"perDay":3} gives total = 82.5, breakdown = Fentanyl patch: 60 MME/day; Oxycodone: 22.5 MME/day. Source: CDC 2022 factors: 25 mcg/hr × 2.4 = 60.
4. op = {"opioid":"codeine","strength":30,"perDay":4} or {"opioid":"tramadol","strength":50,"perDay":3} gives total = 95. Source: CDC 2022 factors: 30 × 4 × 0.15 = 18.

## FAQ

### What is MME?

Morphine milligram equivalents (MME) express the strength of different opioids on one scale, the milligrams of oral morphine with a similar effect. Adding the MME of every opioid a person takes gives one number for total daily opioid exposure.

### How is MME calculated?

For each opioid, multiply the strength of one dose by the doses per day and by the CDC conversion factor, then add the results. Oxycodone 10 mg twice a day is 20 mg × 1.5 = 30 MME per day.

### Can I use MME to switch from one opioid to another?

No. The CDC guideline says not to use MME to set the dose of a new opioid, because people do not tolerate a new opioid fully (incomplete cross-tolerance) and the new drug is usually started at a much lower dose. Switching is a decision for the prescriber.

### Why does MME matter?

The 2022 CDC guideline notes that the risk of overdose rises with the total daily MME. The guideline uses MME to inform care, not as a hard limit, and it warns against applying the numbers rigidly to any one patient.

### How is a fentanyl patch counted?

Patches are dosed in micrograms per hour, not milligrams per day. The CDC factor is 2.4, so a 25 mcg/hr patch is 25 × 2.4 = 60 MME per day. Type the patch strength and the number of patches worn at once.

## Sources

- Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain, United States, 2022. MMWR Recomm Rep. 2022;71(3):1-95. Table: MME conversion factors. https://doi.org/10.15585/mmwr.rr7103a1