Morphine Milligram Equivalents (MME)

When it activates

Scribeable activates a calculator from the encounter. The Morphine Milligram Equivalents (MME) can activate when the transcript or pasted chart context documents any of these:

• Opioid prescribing assessment
• Chronic opioid therapy monitoring
• Opioid rotation/conversion
• CDC guideline compliance review
• Controlled substance risk evaluation

Inputs the note needs

2 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; at this calculator’s tier a missing input is never requested, and a missing required input keeps the score out of the draft.

Scoring

Conversion factors (oral): morphine=1, codeine=0.15, hydrocodone=1, hydromorphone=4, oxycodone=1.5, oxymorphone=3, methadone=variable (4 for <=20mg/d, 8 for 21-40, 10 for 41-60, 12 for >60), fentanyl patch mcg/hr x 2.4, tramadol=0.1, tapentadol=0.4. Total MME/day = sum of (dose x frequency x conversion factor) for each opioid.

Interpretation

<50 MME/day: Standard dosing range. 50-89 MME/day: Increased risk — reassess need, consider dose reduction, naloxone coprescription. >=90 MME/day: High risk for overdose — avoid or carefully justify, implement risk mitigation (naloxone, UDS, PDMP check, frequent follow-up). CDC 2022 emphasizes individualized assessment over rigid thresholds. Methadone conversion is non-linear and requires special caution.

Evidence

Sources carried in Scribeable's citation registry for this calculator; guideline version: CDC 2022.

• CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022 (Morphine Milligram Equivalents)CDC Opioid Guideline (MME) 2022 · 2022 · CDC · Grade A · link last verified 2026-03-28

How Scribeable handles it in the note

When an encounter activates the Morphine Milligram Equivalents (MME) (its highest tier is recommended), Scribeable does not ask you for missing inputs. The score is computed in code from whatever inputs resolve from the transcript, the pasted chart context or charted labs; a computed value is written into the draft only when every required input already resolves.

The score is computed in code from the resolved inputs, not recalled by the language model. If the draft states a Morphine Milligram Equivalents (MME) value that disagrees with the computed one, the disagreement is flagged to the second drafting pass, which is instructed to correct the score and its interpretation before you see the note.

Classified as a deterministic formula: a spare suggestion is easy to ignore, so activation is permissive.

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Can activate in: Internal Medicine, Emergency Medicine, Hospital Medicine, Palliative Care, Pain Management.