High Dose Opioids for Pain and Overdose Risk

It seems almost everyone is now aware of the huge increase in overdoses on prescription medications, especially opioid pain medications. Studies show that the risk of overdose is highest for patients on the highest doses of opioids. While the dosing differs for each different opioid formulation,it is possible to compare doses for patients on different opioids by converting the dose of the opioid to the equivalent dose for morphine. For example, 30 mg of oxycodone is approximately equivalent to 45 mg of morphine. In particular, patients on doses higher than 100 mg a day morphine equivalent are at especially high risk of overdose-- almost 9 times the risk of overdose compared to patient taking less than 20 mg morphine equivalent a day in a recent study.

There are several free online tools that allow doctors (and patients for that matter) to estimate the equivalent dose in morphine that the patient is taking. We uses these regularly and take particular care with patients who are on doses above 100 mg a day morphine equivalents. While high doses like these may be appropriate, doctors and patients should also be aware of the increased risk of overdose with these high doses. Sometimes these patients have developed tolerance to the opioids and a period of detoxification is needed to allow them to again be effectively treated with lower, safer doses. If you are concerned this may be the case, contact us as we may be able to help.

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Tags: chronic pain, opioids, overdose