The Medication Review and Calculating Morphine Equivalent Dose (MEQ)

Calculating Morphine Equivalent Dose (MEQ)

Last updated 2020.03.10
Now available as an online short course with pdf(s)

Keywords:  documentation standards, pain medications, opioid medications, calculating morphine equivalent dose (MED), MEQ, medication review, metrics, pain management, opioids, workers' comp, return-to-work clinic model

Morphine Equivalent Dose Calculation (MEQ)

The morphine equivalent dose is a way of tracking how much opioid-type medication a patient is taking on a daily basis. There are multiple medications that contain morphine, hence the calculation.

MEQ is a useful tool for determining red flags and for tracking (by the individual patient or a general measure of all patients in specific outpatient clinic environment) how much opioid-type pain meds patients are taking before starting EAM treatment vs. when they finish treatment. MEQ data taken at initial and re-evaluations is a useful way to track that info. 

1.    First, do the medication review with the patient.

In a medication review, you take down patient-reported information on prescriptions, over-the-counter meds and supplements.

If the patient is unclear about what they are taking, communicate with the referring provider to get this information. 

[The ACPA has a useful wallet card for patients to track their meds.]

2.    Second, recognize which prescriptions are opioid-based medications.

Names of commonly prescribed opioid medications

Codeine	Fentanyl transdermal
Hydrocodone	Hydromorphone
Methadone	Morphine
Oxycodone	Oxymorphone
Tapentadol	Tramadol

3.    Third, after you have finished the med review, plug the opioid-based prescriptions and daily mg dosages into the online Opioid Conversion calculator to determine the daily morphine equivalent dose (MEQ).  Report/track this number in the MEQ portion in the medication review section of your chart note template.

4.    Fourth, note Red Flags such as MEQs above 50 and medication panels that include opioids plus one or more of the following:  mood drugs, sleep drugs.  For specific medication names and drug classes that warrant red flags, review the WA State Opioid Safety free CEU training.  Know how and when to make appropriate referrals or communication with the referring provider.

Quick double-check: did you remember to ask your patient (who is on an opioid medication), about their pain?  Did you track this on a validated pain scale?  Learn more about pain scales in this post.

Related Resources

• WA State's calculator link (for MEQ) comes with a CEU training for providers about opioid prescriptions 
• Link to more WA State Opioid Safety Resources with some YouTube Videos.
• The CDC Opioid Prescribing Safety Guideline Training, the August 2017 update 
• these guidelines have lowered the red flag MED from 120/day to 50/day
• If you want to dive deeper into this:  The COCA Webinar series with the University of Washington

Primary Care-Specific Resources (Physicians, Nurse Practitioners, PAs)

• All of the above Resources plus
• Moving Beyond Medications: Non-Pharm Approaches to Pain Management and Well-Being, a one-page infographic for PCMs, a collaborative work by several national Integrative Medicine groups.
• Cautious, Evidenced-Based Prescribing Guidelines by the Physicians for Responsible Opioid Prescribing

Related Short Courses Available with download-able pdfs
all revenue generated from these goes toward sustaining the Hospital Handbook Project, a community resource

• How to use a validated Pain Scale in Your Chart Note
• How to Calculate MEQ and the Medication Review Standard for Non-prescribers

Related Blogposts

• Medication Review and ROS:  Opioid medication side effects
• The White Paper:  Acupuncture's Role in Solving the Opioid Epidemic
• The FDA Pain Management Guideline Recommends Acupuncture
• The Joint Commission Pain Management Standard 2017 Clarification on Non-Drug Pain Relief Therapies
• DVPRS, the validated pain scale designed for the patient-centered, biopsychosocial clinic model

copyright Megan Kingsley Gale

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