ArticleThe Clinical journal of pain2021
Inches, Centimeters, and Yards: Overlooked Definition Choices Inhibit Interpretation of Morphine Equivalence.
Article in The Clinical journal of pain, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2022Guideline
- Impact of Prescription Drug Monitoring Programs on Postpartum Opioid Prescribing Practices.Health services research · 2026Article
- Opioid dose, duration, and risk of use disorder in Medicaid patients with musculoskeletal pain.Pain medicine (Malden, Mass.) · 2026Article
- The Association Between Rapid Opioid Dose Tapering and Polydrug Overdose Deaths Among High-Dose, Long-Term Opioid Therapy Recipients.Journal of general internal medicine · 2025Article
- Opioid prescribing trends and pain scores among adult patients with cancer in a large health system.Cancer · 2025Article
- Article
- Impact of State Policies on Opioid Prescribing Among Surgery and Injury Patients: Controlled Interrupted Time-Series Study, North Carolina, 2014-2019.Pharmacoepidemiology and drug safety · 2025Article
- The role of prescription opioid and cannabis supply policies on opioid overdose deaths.American journal of epidemiology · 2025Article
- Abuse-deterrent formulations and opioid-related harms in North Carolina, 2010-2018.American journal of epidemiology · 2025Article
- Prediction model for delirium in advanced cancer patients receiving palliative care: development and validation.BMC palliative care · 2025Observational
- Article
- The association of state policies and opioid analgesic amount dispensed from retail pharmacies.Drug and alcohol dependence · 2025Article
- Differences in opioid prescriptions by race among U.S. older adults with a hip fracture transitioning to community care.Journal of the American Geriatrics Society · 2024Article
- Cholinesterase Inhibitor Initiation Does Not Increase the Risk of Fall-Related Injury in Older Adults Treated With Beta-Blockers: A Self-Controlled Case Series Design.The journals of gerontology. Series A, Biological sciences and medical sciences · 2024Article
- Association of Opioid Use Disorder Diagnosis with Management of Acute Low Back Pain: A Medicare Retrospective Cohort Analysis.Journal of general internal medicine · 2024Article
- Detroit Interventional Pain Assessment Scale: A Pain Score and Method for Measuring and Evaluating Post-Operative Pain Management-A Prospective Study.Medicina (Kaunas, Lithuania) · 2023Article
- Post-Acute Care Setting After Hip Fracture Hospitalization and Subsequent Opioid Use in Older Adults.Journal of the American Medical Directors Association · 2023Article
- Concordance between controlled substance receipt and post-mortem toxicology in opioid-detected overdose deaths: A statewide analysis.Drug and alcohol dependence · 2023Article
- Accuracy and validity of reported opioid prescription days' supply.Pharmacoepidemiology and drug safety · 2022Article
- Evaluating opioid analgesic prescribing limits: A narrative review.Pharmacoepidemiology and drug safety · 2022Review
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveMorphine-standardized doses are used in clinical practice and research to account for molecular potency. Ninety milligrams of morphine equivalents (MME) per day are considered a "high dose" risk threshold in guidelines, laws, and by payers. Although ubiquitously cited, the "CDC definition" of daily MME lacks a clearly defined denominator. Our objective was to assess denominator-dependency on "high dose" classification across competing definitions.
methodsTo identify definitional variants, we reviewed literature and electronic prescribing tools, yielding 4 unique definitions. Using Prescription Drug Monitoring Programs data (July to September 2018), we conducted a population-based cohort study of 3,916,461 patients receiving outpatient opioid analgesics in California (CA) and Florida (FL). The binary outcome was whether patients were deemed "high dose" (>90 MME/d) compared across 4 definitions. We calculated I2 for heterogeneity attributable to the definition.
resultsAmong 9,436,640 prescriptions, 42% overlapped, which led denominator definitions to impact daily MME values. Across definitions, average daily MME varied 3-fold (range: 17 to 52 [CA] and 23 to 65 mg [FL]). Across definitions, prevalence of "high dose" individuals ranged 5.9% to 14.2% (FL) and 3.5% to 10.3% (CA). Definitional variation alone would impact a hypothetical surveillance study trying to establish how much more "high dose" prescribing was present in FL than CA: from 39% to 84% more. Meta-analyses revealed strong heterogeneity (I2 range: 86% to 99%). In sensitivity analysis, including unit interval 90.0 to 90.9 increased "high dose" population fraction by 15%. DISCUSSION: While 90 MME may have cautionary mnemonic benefits, without harmonization of calculation, its utility is limited. Comparison between studies using daily MME requires explicit attention to definitional variation.
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