These modifications will align with the Centers for Disease Control and Prevention (CDC) 2022 guideline

The Centers for Disease Control and Prevention (CDC) revised its Clinical Practice Guideline for Prescribing Opioids for Pain in November 2022, and Optum is following suit by modifying the morphine equivalent dose, or MED, conversion factors (also referred to as morphine milligram equivalent, or MME, conversion factors by the CDC) for three opioid analgesics in our clinical programs effective in January 2024.

In its publication, the CDC modified the MED conversion factors for only the three opioid analgesics mentioned (hydromorphone, methadone, and tramadol). The MED conversion factors for all other opioid analgesics did not change.

Below are the previous and updated MED conversion factors for these three opioid analgesics per CDC. 

Equianalgesic dose conversions are only estimates and cannot account for individual variability in genetics and pharmacokinetics. Do not use the calculated dose in MED to determine the doses to use when converting one opioid to another. When converting opioids, the new opioid is typically dosed substantially lower than the calculated MED dose (such as 25-50% less) to avoid accidental overdose due to incomplete cross-tolerance and individual variability in opioid pharmacokinetics.

Impact on workers’ compensation and auto no-fault

In recent years, the Optum Pharmacy & Therapeutics (P&T) Committee adopted many CDC MED conversion factors. As the debate in the clinical literature on the conversion factors for these three medications continues, most nationally recognized and state treatment guidelines have not yet modified their MED conversion factors accordingly.

After continued review and discussions, the P&T Committee approved updating the conversion factors for these three medications to fully align with the CDC MED conversion factors. After looking at historical transactional pharmacy data, the P&T Committee determined that this change will have minimal impact to Optum risk identification and clinical review programs.

Our clinical programs and data conversion tables are being modified and are expected to go into effect on January 2, 2024. While medical and clinical information and treatments constantly evolve, our clinical goals will remain constant to help ensure that an injured person’s medication therapy is managed proactively based on recognized medical guidelines, to use evidence-based medicine to promote the safe use of medications, and to assist claims professionals in making the most informed decisions on their claims.

Understanding MED

Opioid analgesics can help manage moderate to severe pain due to trauma, surgery, or nerve damage. These medications may be appropriate for injured persons experiencing pain not adequately relieved by non-opioid analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs). Understanding the risks and benefits of opioid analgesics is therefore crucial to calculating and monitoring an injured person’s MED as well as identifying and mitigating the risk for overdose.

The MED represents an estimate of the analgesic equivalent potency of an opioid analgesic in relation to the potency of morphine. Research demonstrates a higher daily MED is strongly associated with an increased risk of overdose events, including death.

The table below represents the MED conversion factors for commonly prescribed opioid analgesics according to the CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022):

† Tapentadol is a µ-receptor agonist and norepinephrine reuptake inhibitor. MEDs are based on degree of µ-receptor agonist activity; however, it is unknown whether tapentadol is associated with overdose in the same dose-dependent manner as observed with medications that are solely µ-receptor agonists.
§ Tramadol is a µ-receptor agonist and norepinephrine and serotonin reuptake inhibitor. MEDs are based on degree of µ-receptor agonist activity; however, it is unknown whether tramadol is associated with overdose in the same dose-dependent manner as observed with medications that are solely µ-receptor agonists.

*To use the conversion factors, multiply the dose for each opioid analgesic by the conversion factor to determine the daily MED. For example, using the previous conversion factor, hydromorphone 4 mg tablets taken four times a day equates to a total of 16 mg of hydromorphone daily; 16 mg multiplied by 4 would be equivalent to 64 MED daily. Using the updated MED conversion factor, 16 mg of hydromorphone daily multiplied by 5 would be equivalent to 80 MED daily.

If you have any questions, please contact your account manager, clinical liaison, or our Clinical Services team at 1-877-275-7674 ext. 8612.

Source:

1. CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022. MMWR Recomm Rep 2022;71(No. RR-3):1–95. Available at CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022 | MMWR.