How does an opioid conversion calculator work. What factors influence narcotic potency. Why is understanding morphine equivalents crucial for pain management. How can healthcare providers ensure safe opioid dosing across different medications.

The Importance of Opioid Conversion in Pain Management

Opioid conversion is a critical aspect of pain management, particularly for patients with chronic pain or those undergoing cancer treatment. Healthcare providers must accurately calculate equivalent doses when switching between different opioid medications to ensure effective pain relief while minimizing the risk of adverse effects.

The concept of morphine equivalents serves as a standardized measure for comparing the potency of various opioids. By understanding the relative strength of different opioid medications in relation to morphine, clinicians can make informed decisions about dosing and medication switches.

Key Considerations for Opioid Conversion

• Patient-specific factors (age, renal function, pain severity)
• Opioid-specific properties (half-life, receptor affinity)
• Cross-tolerance between opioids
• Route of administration

Decoding the Narcotic Potency Chart

A narcotic potency chart provides a visual representation of the relative strengths of various opioid medications compared to morphine. These charts typically display conversion factors that allow healthcare providers to calculate equivalent doses across different opioids.

How do narcotic potency charts work? They present a ratio or multiplier for each opioid, indicating its strength relative to morphine. For example, if a drug has a potency factor of 2, it means that 1 mg of that drug is equivalent to 2 mg of morphine.

Sample Opioid Potency Ratios (Oral Route)

• Morphine: 1 (reference standard)
• Oxycodone: 1.5
• Hydromorphone: 5
• Methadone: Variable (see note below)
• Fentanyl: Not typically given orally, transdermal conversion charts available

It’s crucial to note that these ratios are approximations and may vary based on individual patient factors and specific clinical scenarios.

The Complexities of Methadone Conversion

Methadone presents unique challenges in opioid conversion due to its complex pharmacokinetics and pharmacodynamics. While a single 5 mg dose of methadone is roughly equivalent to 7.5 mg of morphine, this relationship becomes more complicated with regular administration.

Why is methadone conversion so complex? Methadone has a variable long plasma half-life and broad-spectrum receptor affinity, resulting in a much higher-than-expected relative potency when administered regularly. In some cases, the potency can be significantly higher than the initial conversion ratio suggests.

Due to these complexities, guidance from a pain management specialist is strongly recommended when converting to or from methadone. This ensures safe and effective dosing tailored to the individual patient’s needs.

Utilizing Opioid Conversion Calculators

Opioid conversion calculators are valuable tools that help healthcare providers determine equivalent doses when switching between different opioid medications. These calculators typically use established conversion ratios and take into account factors such as the current opioid, its dose, and the target opioid.

Steps in Using an Opioid Conversion Calculator

1. Enter the current opioid medication and its daily dose
2. Select the route of administration (oral, intravenous, etc.)
3. Choose the target opioid medication
4. Review the calculated equivalent dose
5. Apply clinical judgment to adjust the dose as needed

While opioid conversion calculators provide a useful starting point, it’s essential to remember that they are not a substitute for clinical expertise. Healthcare providers must always consider individual patient factors and use their judgment when determining final dosages.

Safety Considerations in Opioid Conversion

Opioid conversion carries inherent risks, and healthcare providers must prioritize patient safety throughout the process. Careful monitoring and dose adjustments are crucial to prevent adverse effects and ensure optimal pain management.

Key Safety Practices in Opioid Conversion

• Start with conservative dose estimates
• Implement a dose reduction (typically 25-50%) when switching opioids to account for incomplete cross-tolerance
• Monitor patients closely for signs of under- or over-dosing
• Educate patients and caregivers about potential side effects and proper medication use
• Have a plan in place for breakthrough pain management during the conversion process

How can healthcare providers ensure safe opioid dosing across different medications? By combining the use of conversion tools with clinical expertise, patient-specific considerations, and ongoing monitoring, clinicians can optimize pain management while minimizing risks.

Special Considerations for Different Patient Populations

Opioid conversion and dosing must be tailored to specific patient populations to ensure safe and effective pain management. Factors such as age, organ function, and comorbidities can significantly impact opioid metabolism and effectiveness.

Elderly Patients

Older adults may be more sensitive to opioid effects and have altered pharmacokinetics. How should opioid conversion be approached in elderly patients? Consider starting with lower doses, using longer dosing intervals, and monitoring closely for side effects such as confusion, sedation, and respiratory depression.

Patients with Renal Impairment

Kidney function plays a crucial role in the metabolism and excretion of many opioids. For patients with renal impairment, dose adjustments may be necessary, and certain opioids may be preferred over others. Consulting with a pharmacist or pain specialist can help guide appropriate opioid selection and dosing in these cases.

Patients with Hepatic Impairment

Liver function affects the metabolism of many opioids. In patients with hepatic impairment, dose reductions and careful titration are often necessary. Some opioids, such as fentanyl, may be preferred due to their minimal hepatic metabolism.

The Role of Adjunct Medications in Pain Management

While opioids are powerful pain relievers, they are often used in combination with other medications to enhance pain control and reduce opioid requirements. This multimodal approach to pain management can improve outcomes and minimize opioid-related side effects.

Common Adjunct Medications in Pain Management

• Acetaminophen (paracetamol)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Gabapentinoids (e.g., gabapentin, pregabalin)
• Antidepressants (e.g., tricyclic antidepressants, SNRIs)
• Topical agents (e.g., lidocaine patches, capsaicin)

How do adjunct medications impact opioid conversion? When incorporating adjunct medications into a pain management regimen, healthcare providers may be able to reduce opioid doses while maintaining or improving pain control. This can simplify opioid conversion calculations and potentially reduce the risk of opioid-related adverse effects.

Emerging Trends in Opioid Conversion and Pain Management

The field of pain management is continually evolving, with new research and technologies shaping approaches to opioid use and conversion. Understanding these emerging trends can help healthcare providers stay at the forefront of best practices in pain management.

Precision Medicine in Pain Management

Advances in pharmacogenomics are enabling more personalized approaches to opioid therapy. Genetic testing can help identify patients who may metabolize certain opioids differently, allowing for more tailored medication selection and dosing.

Novel Opioid Formulations

Researchers are developing new opioid formulations designed to minimize abuse potential and reduce side effects. These innovations may impact future opioid conversion practices and pain management strategies.

Integration of Technology

Digital health tools, such as smartphone apps and wearable devices, are increasingly being used to monitor pain levels, track medication use, and provide real-time feedback to healthcare providers. These technologies have the potential to improve the accuracy and safety of opioid conversion and ongoing pain management.

As the landscape of pain management continues to evolve, healthcare providers must stay informed about new developments and incorporate evidence-based practices into their opioid conversion and pain management strategies. By combining traditional conversion methods with emerging technologies and personalized approaches, clinicians can optimize pain control while prioritizing patient safety.

Table A6.2, Approximate potency of opioids relative to morphine; PO and immediate-release formulations unless stated otherwisea – WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents

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WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents. Geneva: World Health Organization; 2018.

WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents.

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Table A6.2Approximate potency of opioids relative to morphine; PO and immediate-release formulations unless stated otherwise

^a

Source: Adapted with permission from Twycross et al. 2017:371 (Table 4) (3).

a

Multiply dose of opioid in the first column by relative potency in the second column to determine the equivalent dose of morphine sulfate/hydrochloride; conversely, divide morphine dose by the relative potency to determine the equivalent dose of another opioid.

b

Dependent in part on severity of pain and on dose; often longer-lasting in very elderly and those with renal impairment.

c

The numbers in parenthesis are the manufacturers’ preferred relative potencies.

d

A single 5 mg dose of methadone is equivalent to morphine 7.5 mg, but a variable long plasma half-life and broad-spectrum receptor affinity result in a much higher-than-expected relative potency when administered regularly – sometimes much higher than the range given above. Therefore, guidance from a specialist is recommended for conversions to regularly administered methadone.

From: ANNEX 6, Pharmacological Profiles and Opioid Conversion Tables

© World Health Organization 2018.

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3201-Opioid Conversion Calculator | eviQ

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• All calculations must be confirmed before use. Significant inter/intra patient variability exists in the response to different opioid drugs and the dose of these agents. After changing an opioid drug or its dose, patients should be closely assessed and the dose or drug altered as necessary.
• Calculations used for opioid switching should be documented in the patients record.
• All conversions are made by first calculating the daily oral morphine equivalent of the opioid being converted from, and then calculating the specific dose of the opioid being converted to. For conversion factors used in the calculator select here.
• It is the responsibility of the user to round up or down calculated results if required, to align with preparations available at individual workplaces.
• The eviQ opioid conversion calculator is only to be used for patients greater than 12 years old. For this reason the Date of Birth field is mandatory. For patients under this age consult with a pain or palliative care specialist

• Combination products: There is no conclusive evidence that combination analgesics containing lower doses of codeine with paracetamol, aspirin or ibuprofen have any benefits over these non-opioids alone.
• Buprenorphine transdermal patches: Calculator will only allow conversion FROM a buprenorphine patch and not TO a patch as there is limited evidence about, and experience of it’s use compared to other opioids.
• Methadone: Dose conversion to: from other opioids and methadone is complex; consultation with pain management specialists familiar with methadone use is recommended
• Fentanyl Lozenges: There is no dose equivalence between fentanyl lozenges and other opioid formulations. The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid. It should be individually titrated by starting at the lowest dose (200 micrograms)

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Disclaimer: The Cancer Institute NSW does not warrant or represent that the information is free from errors or omission. Furthermore, changes in circumstances after the time of publication of the information may impact on the accuracy of the information. The user agrees not to hold the Cancer Institute NSW or any of its officers, employees or contractors liable in any way for use and/or outcomes brought about through the use of any information obtained from the opioid calculator. The doses are calculated as a guideline only, based on currently published conversion factors and may differ from those used in your institution. Clinical application of any information obtained from the opioid calculator is the sole responsibility of the user.

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how to achieve the desired and lasting result

• Date: June 12, 2021

• Author: Yuliana Borisovna Ivashchenko

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9000 4 According to the latest statistics, 3% of the people on earth, which is approximately 200 million people, are drug addicts. With the advent of the Internet in our lives, the number of cases of distribution of drugs through the worldwide network has increased, about 600 sites that sell drugs have been recorded. The mass distribution of drugs and, accordingly, their use destroys not only moral and ethical principles, but also endangers the lives and health of countless people.

This situation and the results of research make the issue of prevention, which will be aimed at the younger generation, as well as the treatment of drug addicts, relevant.

You need to start with medication support – that’s where any drug addiction treatment begins.

Effective drug addiction treatment is a comprehensive approach using different types of methods, including: the use of medications, various rehabilitation centers and drug treatment dispensaries (labor centers, centers operating under the 12 step program, spiritual and Orthodox centers, the community of anonymous drug addicts , monasteries and church churches), coding, substitution therapy (replacement of a drug familiar to the patient with another drug – methadone, bublemorphine, methadol). It is also believed that Effective drug addiction treatment can be achieved with strict therapy in several stages. The first stage is the relief of acute withdrawal disorders. As part of this stage, detoxification agents are used that are aimed at relieving pain, autonomic disorders, somatic disorders (clophelin, cholecystokinin or pancreozymin). A similar effect of drugs was revealed – tacus-decapeptide and deltoran-peptide, which also normalize the level of dopamine.

The results of studies have shown that the problem of vegetative disorders copes with the inhibitor – aprotinin, which largely removes such disorders. In general, this type of treatment is successful, as it normalizes the psychological state of the patient, eliminates metabolic disorders, and normalizes sleep. To stop the craving for drugs, it is preferable to use antipsychotics and anticonvulsants, after which antidepressants (melipramine, lyudiomil and amitriptyline) are prescribed in case of apathetic and anxious mood of the patient. Also in therapeutic practice, to normalize the functioning of the central nervous system and form long-term remissions, nootropic drugs (phenibut, picamilon, pantogam) are used. An important drug in the treatment of dependence on psychostimulants is the dopamine agonist bromocriptine.

Medical treatment is only a stage. Psychological help is also important!

But an important condition for getting rid of drug addiction is not only drug treatment, but also the stage of anti-relapse therapy, which is the patient’s work with psychologists and psychotherapists in combination with psychotherapy and supportive pharmacotherapy (drug therapy). During this period, an antagonist, naltrexone, is used to prevent relapse in drug addicts. The stage is aimed at correcting the psychological state of the patient and is an indicator of whether effective drug addiction treatment during rehabilitation. A prerequisite for therapy is the resocialization of patients, during which the skills of preventing breakdowns are mastered, the process of transition to a society where there is no place for drug addiction.

Unfortunately, drug has not yet been created to cure this disease in a matter of minutes. Drug addiction treatment is a complex and multi-stage process that requires a full course of treatment, including the stage of resocialization. The formation of a patient’s motivation for recovery is an important task for a possible long-term remission. For a drug-free society, not only the treatment of drug addiction is important, but also its prevention is the work of all members of society.

Diagram of addiction to drugs

Author: Ivashchenko Yuliana Borisovna

Specialist in working with addictions

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How the “diagram of life” works ? An excerpt from the book of psychotherapist Irina Gibermann “I live as I want”

An excerpt from the book of psychotherapist Irina Gibermann “I live as I want”.

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I live as I want. Accept the past and find yourself in the present, Irina Gibermann

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The Life Chart is a very powerful tool for exploring the psyche. I love giving this exercise to my patients in both personal and group work. Its goal is to understand what patterns certain life scenarios repeat. You can often see how decisions are made not logically, but unconsciously, based on the “old” method laid down in the psyche, and then, like a stencil, are superimposed on seemingly new phases of life.

I do not know the author of this exercise. It was taught to me in a clinic where I worked for over ten years, and it has been passed down by word of mouth for decades. Each therapist made his own adjustments, integrated his ideas and set his own trajectories for the movement of thought, but it was carried out by all patients undergoing treatment.

And this is the strength of the concept: for the same task in each case, an absolutely individual interpretation. Over the years, I have collected a huge number of questions that I like and that I pay attention to when my patients draw their life chart.

These questions, in my experience, play the role of important landmarks in self-exploration. You can make notes for yourself and later transfer them to a separate sheet.

1. Do you know your biological parents?
2. Are you a desirable child? What and who told you about it and how old were you then?
3. What family situation have you come to? How many family members live with you under the same roof?
4. What is the atmosphere like at home? Did important events in family history take place before your birth: funeral of relatives, war, emigration, loss of all property during persecution, persecution, fire?
5. Mom and dad together or not?
6. Were there any abortions, miscarriages, missed pregnancies, children who died at an early age before or after your birth that you know about? When did you find out about this? Who told you about this? How did you find the information?
7. What are the relationships within the family with other generations: mother with father’s parents, father with mother’s parents, you with grandparents?
8. What is your relationship with older brothers or sisters?
9. What is your relationship with the children after you? How did you know that mom was pregnant, and how old were you? How did you react to the appearance of the baby? What important events took place during that period?
10. Divorce of parents. At what age and how were you informed about it? What was your involvement in making the decision? On which side were you emotionally, who were you worried about? With whom did you stay after the divorce, with whom did the other children stay? Do you know the true reason for divorce (infidelity, betrayal, alcohol, drugs, conflicts, violence, etc.) and how do you live with it?
11. The appearance of other family members after the parents divorce: mom, dad, new children from one of the parents, patchwork-family (the so-called patchwork family, with children from different marriages), your place in this system.
12. What was your childhood like before kindergarten? Did you go to nursery? Who was there as a resource? Did you have friends?
13. What was the time like in kindergarten? What were you into? Did you have a hobby?
14. What was the mood like before school? Did you want to go there? Were your relatives or family members at this school? Were there connections with teachers, did your parents work there?
15. What were your expectations for your future profession? When did you form your idea of ​​it?
16. Highlights during high school: studying abroad on exchange, moving, losing friends, changing schools, bullying (you bullied others or experienced bullying), first experience with boundary testing: sex, leaving home, rebellious behavior, showdown with police or prison, etc.
17. First experience with alcohol or drugs. Each of them has its own color. In what situations did you repeat this experience? Were there any pauses? Or perhaps one drug replaced another? When it was not possible to consume, what did you compensate for (work, sports, food, etc.), what relapses happened, how many times did you try to be cured, who taught you to use, what is happening with these people now, when a frank conversation with the family took place, there are Are there family members with whom you can openly do this?
18. Transition from school to new system. Where did you go after school? Why? What were the motives?
19. When did you leave your parents’ house? Where and with whom did you move? How did you leave or how were you kicked out? How did you communicate with your parents after leaving?
20. Did you create your own family? How many times? How did you choose your partners?
21. Do your parents know your partners? Do they know about your sexual orientation?
22. Do you have any history of abortions, miscarriages, loss of children (if you are a man: did your girlfriend have abortions, did she blackmail you with this, did you deliberately get pregnant for the sake of your genes, and not for the sake of relationships)?
23. When did your grandparents die? Are your parents still alive? When were important family members buried? Were you able to say goodbye and survive the grief?
24. What were the basic career or job decisions you made? Where were they cowardly? Where did you take on too much?
25. What losses affected you? How did you live grief?
26. Your most important successes. How did you celebrate them? How were you awarded? Were you able to appropriate your own victories?
27. Your failures. Have you forgiven yourself for them? Do you still feel guilty? Shame? To sweep?

Next, take a sheet of paper and transfer your notes and answers to it. This is a very important point that requires attention and concentration.

Draw two lines: X and Y. The scale goes up to +100, down to -100. This is the emotional scale. The life line starts from 0 right at the intersection of X and Y. This is the base: what kind of family did you come to, whether you wanted a child, were there abortions and deaths before and after your birth, what happened to your parents and mother during pregnancy, artificial or natural was the conception.

Then draw the stages of life on the line: 0-3, 3-6, 6-12, 12-21, 21-30, 30-40, 40-55, 55-65, 65-75 years. For each phase of life, we prescribe two important points.

1. What were the important events in your life and family that changed you?
2. What happened to your emotions, what did you feel and experience?

With all the individuality of the life of each of us, I love this exercise very much.