7 Scenarios You Will Use OME

Hey 🎃

Every now and then, I hear debates about how oral morphine equivalent (OME) or morphine milligram equivalent (MME) can be flawed. And I get it.

But there are times you just can’t get away from the concept of OME/ MME, or you’d have no guidance.

Maybe you could still guess the dose right without it. But there’s one principle that will instantly upset a patient:

Start low, go slow.

Here are 7 scenarios that have everything to do with OME/MME:

1. A cancer patient on a stable opioid regimen needs to start a fentanyl patch because of severe nausea or mouth pain.

2. The same cancer patient now needs IV pushes or sublingual morphine to get through the next 12–24 hours until the fentanyl starts to work.

3. If the patient receives a G tube and doesn’t want a fentanyl patch, you have to re-dose the opioid if the previous one was long acting, because you cannot crush long acting opioids.

4. Let’s say the opioid regimen you just built works great for 3 months, but the patient gets worse and you need to consider methadone.

And sometimes patients like that end up in the hospital because of pain and need a PCA. Speaking of PCA, it is all about OME/MME.

5. When you start a PCA for someone who’s opioid tolerant, you need the OME/MME to get the basal rate and adjust the bolus dose.

6. When the patient is more stable, you need to get the OME/MME and switch back to tube administration.

7. You may end up adding IV boluses when you switch to oral. You need that OME/MME to guesstimate the IV boluses.

PS: I listened to The Art of Spending Money last weekend. It’s such an amazing book.

Stay warm,

SP