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New Guidance For Policymakers And Payers On Opioid Dosing Limits

Thursday, September 7, 2017   (0 Comments)
Posted by: Nicole Stagg
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New white paper reviews the science behind calculating morphine equivalent doses and shows why policies based on these can be problematic

LENEXA, KS, September 6, 2017 – The Academy of Integrative Pain Management (AIPM) today released a new white paper, entitled, Opioid Dosing Policy: Pharmacological Considerations Regarding Equianalgesic Dosing. This white paper provides guidance to policymakers and payers, who are increasingly responding to the nation’s opioid epidemic by limiting doses of opioid pain relievers. In so doing, however, they may be unwittingly exposing patients to increased risk due to an inadequate understanding of the science underlying the concept of equianalgesic dosing.

Because opioids differ in their per-milligram potency, equianalgesic dosing tables are used to calculate equivalent doses of different opioids, which are often expressed in terms of “morphine equivalent daily doses”. As outlined in the white paper, the science supporting these tables and the larger concept of equianalgesic dosing is problematic, and using them to determine allowable opioid pain reliever doses can expose patients to both unintentional overdose and underdose.

“In the interest of the people with pain for whom our members provide care, we felt it was necessary to outline our concerns about the key concept of equianalgesic dosing,” said Bob Twillman, Ph.D., Executive Director of AIPM. “We have seen policymakers and payers both relying on this concept as if it was based on solid science, and as if individual differences in a number of factors wasn’t important in clinical practice. Doing so can expose patients to significant risks, and we want to help mitigate those risks by encouraging more deliberative practices.”

“I’ve been researching and writing about the problems with equianalgesic dosing for the past several years, so I was pleased to be asked to serve as the primary author on this document,” stated Jeffrey Fudin, Pharm.D. “As I studied this concept, I was shocked by the poor quality of the studies underlying it and by the dramatic clinical effects that could result from an uncritical use of published conversion tables. Add to that the fact that some opioid pain medications just don’t fit the concept because of their mechanisms of action, and you have the potential for some serious negative consequences if policies improperly use this information.”

AIPM encourages policymakers and payers to review the white paper carefully and to consider its implications if they attempt to fashion opioid dosing policies that rely on the concept of equianalgesic dosing. “We hope this will help policymakers and payers develop better, safer policies that protect patients from overdose while also ensuring that people with pain get the treatment they need for their pain,” added Twillman.

The full text of the document can be found here.


If you would like more information about this topic, please call Bob Twillman, Ph.D., at (913) 205-3746, or email