Sometimes the best intentions have fatal consequences. Canada and the United States do not have good evidence that they are effective for chronic pain, but they are the two top consumers of prescription opioids. Since there are many different opioids that are used for the same purpose, we use morphine equivalence to compare how strong they are.

AS THE NUMBER OF MORPHINE MILLIGRAM EQUIVALENTS PER DAY (MME/D) INCREASES, THE HARMS ASSOCIATED WITH OPIOID THERAPY ALSO INCREASE.

0-50 MME/D

There is no safe dose of opioids. Harms and complications can happen at any dose, but are less likely at lower MMEs/D.

Codeine Contin 100mg	2 tabs/day	30 MME
Tylenol #3	8 tabs/day	36 MME
50-100 MME/D

There is up to a 5x increase in overdose risk in this range as compared to lower doses. Guidelines recommend that prescribing above 90 MME/D be avoided.

MS Contin 30mg	2 tabs/day	60 MME
Percocet	10 tabs/day	75 MME
Hydromorphone 4mg	4 tabs/day	80 MME
100-200 MME/D

There is up to a 9x increase in overdose risk in this range as compared to lower doses. Overdoses that happen at doses greater than 100 MME/D are more likely to be fatal.

Hydromorphone SR 12mg	2 caps/day	120 MME
OxyNEO 40m	3 tabs/day	180 MME
Fentanyl 50mcg Patch		200 MME
>200 MME/D

People on higher doses tend to have higher rates of complications like sleep apnea, generalized pain, addiction, low testosterone levels and disability from work. Most chronic pain can be managed well below 200 MME/D.

Oxycodone CR 80mg	2 caps/day	240 MME
Hydromorph Contin 30mg	2 caps/day	300 MME
Fentanyl 100mcg Patch		400 MME