Module 2: Basic Pharmacology of Controlled Drugs and Substances
Opioid rotation – Learning activities
Read the following article:
- Smith, H. S., & Peppin, J. F. (2014). Toward a systematic approach to opioid rotation. Journal of Pain Research, 7, 589–608. doi:https://doi.org/10.2147/jpr.s55782
- Review the Opioid Conversion Table in Appendix B-8 of the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (NOUGG, 2017).
Calculate the following opioid dose equivalencies and/or opioid rotations:
- A patient has been prescribed morphine 20 mg orally every 4 hours as needed. What is the maximum daily dose in morphine equivalents that this patient is receiving?
- A patient has been taking Codeine Contin 100 mg BID for management of chronic back pain due to ankylosing spondylitis. They also may take Codeine Contin 50 mg once daily for breakthrough, which they report taking 3 to 4 times per week. This patient’s medication is being changed to oxycodone. What would be the equivalent dose that you would prescribe?
- A patient has been taking hydromorphone 4 mg orally every 6 hours for chronic pain management. You discuss the option of transdermal fentanyl due to gastric irritation the patient is experiencing. What would be the equivalent dose of transdermal fentanyl?