Management of Chronic Non-Cancer Pain: a Framework

Figures & data

Table 1. Approximate dose equivalence of opioids in widespread use^§.

Drug (immediate or sustained release)	Morphine equivalent conversion factor/mg of opioid^†^,^‡
Morphine	1.0
Buprenorphine transdermal	2.4
Codeine	0.15
Fentanyl transdermal	2.4
Hydrocodone	1.0
Hydromorphone	4.0
Meperidine	0.1
Methadone	3.0
Oxycodone	1.5
Oxymorphone	3.0
Tramadol	0.10

† Examples: 30 mg of codeine is equivalent to 4.5 mg of morphine/day; 30 mg of methadone is equivalent to 90 mg of morphine/day; a 10 mcg/h buprenorphine patch is equivalent to 24 mg morphine/day; and a 100 mcg/hour fentanyl patch is equivalent to 240 mg morphine/day.

‡ Equivalencies are based on average data and may vary substantially from patient to patient. Therefore, when converting from one opioid to another, one should err on the side of substantial underdosing. For example, if converting from morphine 90 mg/day to oxycodone; the starting dose of oxycodone should be 30–45 mg/day.

§ Adapted from [135]. (See also dose calculator: https://www.oregonpainguidance.org/opioidmedcalculator/).

Table 2. Demographics of opioid associated mortality^†.

Age group (years)	2012 mortality (per 100,000)	2017 mortality (per 100,000)
15–24	8	18
25–34	7.7	16.8
35–44	9	15
45–54	5.3	10.8
55–64	1.2	2.2
65–74	0.6	0.8
75–84	0.5	0.7

† Data taken from [191].

Von Korff M , SaundersK , RayGTet al. De facto long-term opioid therapy for noncancer pain. Clin. J. Pain24, 521–527 (2008).

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CDC Wonder. https://wonder.cdc.gov/ucd-icd10.html

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