Editorial Highlights Shortcomings of Morphine-Equivalent Daily Dose (MEDD)

In an editorial published last week in the Journal of Pain Research, Editor-in-Chief Michael Schatman, PhD, CPE; Jeffrey Fudin, PharmD, FCCP; and Jacqueline Cleary, PharmD, offer a critique of the various yardsticks in current use to assess relative risk associated with opioid therapy for chronic noncancer pain. The article, entitled “The MEDD myth: the impact of pseudoscience on pain research and prescribing-guideline development” focuses in particular on the use of morphine-equivalent daily dose (MEDD) in the professional literature as a measurement of daily opioid dose reduction to avert opioid induced respiratory depression. The authors write: “Considering the plethora of literature that relies on MEDD to assign opioid and public health risks, as well as to study various opioid-prescribing trends, we question the validity of MEDD as a justifiable parameter on which to rely so heavily.”

To test their reservations, the authors conducted a search of the literature dealing with daily morphine equivalency and its establishment via MEDD as well as OMEQ (oral morphine equivalent), MEQs (morphine equivalents), and “equianalgesic opioid dose.” This last was defined as a dose at which 2 opioids, at a steady state, provided approximately the same pain relief. After highlighting some of the deficiencies of MEDD as a means to risk assessment, and in consideration of a variety of patient-specific attributes that should be, but are not generally factored in, the authors conclude that, “The bottom line is that as the scientific concepts upon which prescribing guideline authors depend are flawed and invalid, so are the guidelines themselves.” Authors Schatman and Fudin are longtime members of the PAINWeek faculty. When contacted for comment about their article, Dr. Schatman remarked, “The recently released CDC Guideline for Prescribing Opioids for Chronic Pain has received much attention, and no small degree of praise. But reliance on the flawed concept of MEDD may well lead to adverse outcomes for legitimate pain patients. We think it’s an article that practitioners, researchers, and patients need to see.“

A link to the article may be found here.


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