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

Do not reproduce without the author's written permission

If you found this helpful, contribute $5 or $25 to the Hospital Handbook Project today to support this resource (website and blogposts).

Want to learn more?  Contact me about our related online, self-paced courses.

The author can be reached through the Hospital Practice Handbook's Facebook Page.  Just use the "message" feature on that Facebook Page.

Update on my Workers' Comp Supplement Resource, "Practitioner Perspective"

keywords:  projects, resources, workers' comp, return-to-work model, documentation standards

So, Indiegogo requires me to post monthly updates.  If you didn't follow the spring campaign you can check it and learn more about our project lists and related projected budgets (per project) here.

Today's update is about my more recent volunteer work with creating a supplemental resource for state (Washington) practitioners who have enrolled in the new WA State L&I Acupuncture Pilot.  It is a work-in-progress and I will link to the course when it is more refined.

However, there are some outgoing expenses for the worker's comp Practitioner resource.  If you are interested in supporting this specific project, you can donate to WEAMA, the nonprofit state professional organization that has been spearheading this work the last 5+ years.  To donate, please go to the WEAMA webpage and tag "for Megan's L&I Resource" in the comments section of your online donation.  Donations to WEAMA are tax-deductible.

Here is the update I posted:

Happy Autumn!  Our family is still here in the Pacific Northwest.  Military family life is about "making plans and then making plans again and then going back to plan A or C" someone probably once said.

We are enjoying the cool weather and the transition back to school for my oldest. 

In my last post, I mentioned my volunteer professional work with creating supportive materials for L&I Pilot Project participants was taking up a significant portion of my time.  The work has continued and hope to unveil the link to my first online course, "Practitioner Perspective" at the state professional association meeting (Washington East Asian Medicine Association) on Sunday, October 22nd, at Bastyr University in Kenmore, WA. 

The resource I created is a documentation toolkit to support Practitioners involved in the WA state Workers' Comp Pilot to be successful by reviewing professional documentation standards in our field, with introduction to the return-to-work/rehab model and how Acupuncturists fit into it, and resources, with examples, on how to collect a few specific functional measures. 

There are outgoing expenses associated with creating this Resource. If you know someone, a professional, or a business that would like to donate toward this specific project, donations are accepted through Washington East Asian Medicine Association (WEAMA) at the donation page.  Caveat:  for the money to go toward the project, you must tag "for L&I project" in the comments field of your donation.  

Thank you for sharing this post!
Megan

37 Attorney Generals Push Incentives for prescription of Non-Pharm Pain Management Therapies

key words:  models of care, non-drug pain management, working as a team, research studies, funding/incentives

This September, Dennis Hoey of the Press Herald reported that there are now 37 state attorney generals that are pushing incentives to increase the use of non-pharmaceutical pain relief therapy as imperative to addressing the U.S. Opioid Crisis.

"Mills and her peers said the health care industry needs to promote the use of alternatives such as physical therapy, acupuncture, massage, and chiropractic care to treat patients' chronic pain."

"Mills said health insurers need to reduce any financial incentives to prescribing addictive narcotics and begin to offer greater coverage for alternative therapies."

Update:
As of Jan 2018, there is now a more comprehensive review of this in the winter 2018 issue of Meridians: JAOM, "U.S. Attorneys General Promote Acupuncture Coverage" by Bill Reddy, Dipl.Ac (NCCAOM) of the Integrative Health Policy Consortium (IHPC).  Electronic copies of Meridians are available gratis through your state acupuncture association membership or you can subscribe for e-copy or print copy through the journal's website.  

citation:
Reddy B. U.S. Attorneys General Promote Acupuncture Coverage. MJAOM. 2018; 5(1): 39-40.

Related
The White Paper:  Acupuncture's Role in Solving the Opioid Epidemic
Joint Commission Pain Management Standard is updated
More about a pilot in Vermont looking at Medicaid and acupuncture for chronic pain management 
Research from the NIH, "Acupuncture is effective, safe, and cost-effective for treating several chronic pain conditions when performed by well-trained healthcare professionals."
How to use a Validated Pain Scale in Your Clinical Care

More great resources at The Collaborative.