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Quick answer
MME/day = daily dose × CDC conversion factor, added up across every opioid. Oxycodone 10 mg twice daily = 20 mg × 1.5 = 30 MME/day; a 25 mcg/hr fentanyl patch = 25 × 2.4 = 60 MME/day. CDC advises pausing to reassess before reaching 50 MME/day, and says MME totals should not be used to choose a dose when switching opioids.
For education and dose review only. MME estimates population risk; it can't account for genetics, kidney or liver function, sleep apnea, benzodiazepines, or alcohol. Opioid changes and tapers belong with a licensed prescriber. Suspected overdose: call 911 and give naloxone.
Last updated: September 30, 2026. Factors from the CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022). Guides: how to calculate MME · fentanyl patch MME.
Count only the oxycodone mg in combination tablets (e.g., Percocet 5/325 = 5 mg)
For as-needed (PRN) use, enter the average number of doses actually taken per day.
Total daily dose
30 MME/day
Below 50 MME/day
CDC: use caution at any dosage and prescribe the lowest effective dose. Overdose risk still rises with dose and with benzodiazepines, alcohol, or sleep apnea.
How the total was calculated
Oxycodone
10 mg × 2/day = 20 mg/day × 1.5 = 30 MME/day
Same MME as another oral opioid (estimate)
CDC: do not use MME totals to choose a dose when switching opioids. The new opioid is usually started substantially lower and titrated by the prescriber using the product label.
Educational estimate, not medical advice. Don't change, stop, or combine opioids without your prescriber. Suspected overdose: call 911 and give naloxone if available.
This is the table CDC now calls its sole MME conversion resource; it covers more than 99% of opioid pain prescriptions filled at U.S. retail pharmacies in 2018–2021. Multiply the total daily mg (or the patch’s mcg/hr) by the factor.
| Opioid | Common brands | Factor | Dose unit | Notes |
|---|---|---|---|---|
| Oxycodone | OxyContin, Roxicodone, Percocet, Endocet | 1.5 | mg/day | Count only the oxycodone mg in combination tablets (e.g., Percocet 5/325 = 5 mg) |
| Hydrocodone | Norco, Vicodin, Lortab, Hysingla ER | 1 | mg/day | Count only the hydrocodone mg (Norco 10/325 = 10 mg) |
| Morphine (oral) | MS Contin, morphine IR tablets/solution | 1 | mg/day | Reference drug — 1 mg oral morphine = 1 MME |
| Hydromorphone | Dilaudid, Exalgo | 5 | mg/day | CDC raised this factor from 4 to 5 in the 2022 guideline |
| Oxymorphone | Opana (generic oxymorphone) | 3 | mg/day | Oral tablets only |
| Codeine | Tylenol with Codeine #3 (30 mg), #4 (60 mg) | 0.15 | mg/day | Prodrug activated by CYP2D6 — effect varies widely between people |
| Tramadol | Ultram, Ultracet | 0.2 | mg/day | CDC 2022 factor is 0.2 (older data files used 0.1); also a serotonin/norepinephrine reuptake inhibitor |
| Tapentadol | Nucynta, Nucynta ER | 0.4 | mg/day | Also a norepinephrine reuptake inhibitor |
| Methadone | Dolophine, Methadose (for pain) | 4.7 | mg/day | Single 4.7 factor replaced the 2016 tiered factors (4–12); long, variable half-life |
| Fentanyl patch (transdermal) | Duragesic and generic fentanyl patches | 2.4 | mcg/hr | Enter the patch strength in mcg/hr — MME/day = mcg/hr × 2.4 |
| Buprenorphine | Butrans, Belbuca, Suboxone, Subutex, Sublocade | None | mg/day | No CDC factor — partial agonist with a ceiling effect; excluded from MME totals |
What changed from the 2016 guideline
MME/day (oral) = mg per dose × doses per day × factorMME/day (fentanyl patch) = mcg/hr × 2.4Total MME/day = sum of every opioid’s MME/dayCDC’s own examples: hydrocodone 5 mg (with acetaminophen 325 mg) four times a day = 20 mg = 20 MME/day; extended-release oxycodone 10 mg twice a day = 20 mg × 1.5 = 30 MME/day. For as-needed prescriptions, use the average number of doses actually taken.
MME per tablet and per day at a typical schedule. Combination products count only the opioid milligrams.
| Product | MME per dose | Schedule | MME/day |
|---|---|---|---|
| Oxycodone 5 mg (Percocet 5/325) | 7.5 | 4× daily | 30 |
| Oxycodone 10 mg (Percocet 10/325) | 15 | 4× daily | 60 |
| Oxycodone 15 mg | 22.5 | 4× daily | 90 |
| OxyContin 20 mg ER | 30 | 2× daily | 60 |
| Hydrocodone 5 mg (Norco 5/325) | 5 | 4× daily | 20 |
| Hydrocodone 10 mg (Norco 10/325) | 10 | 4× daily | 40 |
| Morphine IR 15 mg | 15 | 4× daily | 60 |
| MS Contin 30 mg ER | 30 | 2× daily | 60 |
| Hydromorphone 2 mg (Dilaudid) | 10 | 4× daily | 40 |
| Hydromorphone 4 mg (Dilaudid) | 20 | 4× daily | 80 |
| Oxymorphone 10 mg | 30 | 2× daily | 60 |
| Codeine 30 mg (Tylenol #3) | 4.5 | 4× daily | 18 |
| Codeine 60 mg (Tylenol #4) | 9 | 4× daily | 36 |
| Tramadol 50 mg | 10 | 4× daily | 40 |
| Tramadol 100 mg | 20 | 4× daily | 80 |
| Tapentadol 50 mg (Nucynta) | 20 | 4× daily | 80 |
| Tapentadol 100 mg (Nucynta) | 40 | 4× daily | 160 |
| Methadone 5 mg | 23.5 | 3× daily | 70.5 |
| Methadone 10 mg | 47 | 3× daily | 141 |
Methadone rows show exposure for comparison only; methadone accumulates over several days.
MME/day = patch mcg/hr × 2.4. The oral columns show the same MME, before any switching reduction.
| Patch | MME/day | Oral morphine | Oral oxycodone |
|---|---|---|---|
| 12 mcg/hr | 28.8 | 28.8 mg | 19.2 mg |
| 25 mcg/hr | 60 | 60 mg | 40 mg |
| 37.5 mcg/hr | 90 | 90 mg | 60 mg |
| 50 mcg/hr | 120 | 120 mg | 80 mg |
| 62.5 mcg/hr | 150 | 150 mg | 100 mg |
| 75 mcg/hr | 180 | 180 mg | 120 mg |
| 87.5 mcg/hr | 210 | 210 mg | 140 mg |
| 100 mcg/hr | 240 | 240 mg | 160 mg |
Total mg/day of each oral opioid that equals 20, 30, 50, or 90 MME. An asterisk marks amounts above the labeled daily maximum.
| Opioid | 20 MME | 30 MME | 50 MME | 90 MME |
|---|---|---|---|---|
| Oxycodone | 13.3 mg | 20 mg | 33.3 mg | 60 mg |
| Hydrocodone | 20 mg | 30 mg | 50 mg | 90 mg |
| Morphine (oral) | 20 mg | 30 mg | 50 mg | 90 mg |
| Hydromorphone | 4 mg | 6 mg | 10 mg | 18 mg |
| Oxymorphone | 6.7 mg | 10 mg | 16.7 mg | 30 mg |
| Codeine | 133.3 mg | 200 mg | 333.3 mg | 600 mg* |
| Tramadol | 100 mg | 150 mg | 250 mg | 450 mg* |
| Tapentadol | 50 mg | 75 mg | 125 mg | 225 mg |
*Labeled maximums: codeine 360 mg/day, tramadol 400 mg/day, tapentadol IR 600 mg/day.
The 2022 guideline treats these as points to slow down and reassess, not hard ceilings, and warns that using them to force rapid tapers harms patients.
< 50 MME/day
CDC: use caution at any dosage and prescribe the lowest effective dose. Overdose risk still rises with dose and with benzodiazepines, alcohol, or sleep apnea.
50–89 MME/day
CDC: pause and carefully reassess benefits and risks before increasing; offer naloxone; follow up more often. Overdose risk is about double at 50 to <100 MME/day versus <20 MME/day.
90–199 MME/day
Few trials studied doses ≥90 MME/day and added benefit is not established. Medicare Part D plans run a pharmacist care-coordination edit at 90 MME/day. Do not taper abruptly.
≥ 200 MME/day
Medicare Part D plans may apply an optional hard edit at 200 MME/day. CDC warns against rapid tapers or abrupt discontinuation unless there are warning signs of impending overdose.
The calculator shows how much of another oral opioid carries the same MME, then applies the 25–50% reduction that an expert panel recommends for most switches because tolerance to one opioid doesn't fully carry over to another. CDC is explicit that the MME number itself must not be used to choose the new dose.
No. CDC’s 2022 table leaves buprenorphine out because it is a partial µ-agonist with a ceiling effect, so its risk doesn't rise with dose the way full agonists’ does. Medicare Part D likewise excludes all buprenorphine products from average daily MME. That applies to sublingual tablets and films (such as 8 mg or 16 mg Suboxone), Belbuca, and Butrans patches. Tools that still show a buprenorphine MME use older or payer-specific tables, and their results vary widely.
| Situation | Approach |
|---|---|
| Opioids taken for a year or longer | About 10% per month or slower is likely to be better tolerated (CDC 2022). |
| Opioids taken for weeks to months | About 10% of the original dose per week or slower until ~30% remains, then ~10% of the remaining dose weekly (CDC 2022). |
| Withdrawal or pain flare during a taper | Pause the taper, maximize non-opioid treatment, and adjust the pace with the patient — tapers can take months to years. |
| After any dose reduction | Tolerance drops; returning to the old dose can cause overdose. Offer naloxone and overdose education. |
Total: 30 MME/day — below 50 mme/day
Same MME as 30 mg/day of morphine (oral); after a 25–50% cross-tolerance reduction, 15–22.5 mg/day (7.5–11.3 mg × 2).
Total: 60 MME/day — 50 mme/day or more
Total: 120 MME/day — 90 mme/day or more
Same MME as 80 mg/day of oxycodone; after a 25–50% cross-tolerance reduction, 40–60 mg/day (20–30 mg × 2).
Total: 80 MME/day — 50 mme/day or more
Same MME as 53.3 mg/day of oxycodone; after a 25–50% cross-tolerance reduction, 26.7–40 mg/day (6.7–10 mg × 4).
Combination tablets also count toward acetaminophen limits — check them with the Tylenol dosage calculator.
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