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. 2022 Oct;25(10):1557-1562.
doi: 10.1089/jpm.2022.0266. Epub 2022 Aug 5.

Opioid Rotation and Conversion Ratios Used by Palliative Care Professionals: An International Survey

Akhila Reddy  1 , Christian Sinclair  2 , Gregory B Crawford  3   4 , Mary Lynn McPherson  5 , Sebastiano Mercadante  6 , David Hui  1 , Ali Haider  1 , Joseph Arthur  1 , Kimberson Tanco  1 , Shalini Dalal  1 , Rony Dev  1 , Jaya Amaram-Davila  1 , Claudio Adile  6 , Diane Liu  7 , Ulrich Schuler  8 , Sheetal Jammi  9 , Zeena Shelal  1 , Egidio Del Fabbro  10 , Mellar Davis  11 , Eduardo Bruera  1
Affiliations

Opioid Rotation and Conversion Ratios Used by Palliative Care Professionals: An International Survey

Akhila Reddy et al. J Palliat Med. 2022 Oct.

Abstract

Background: The opioid rotation ratios (ORRs) and conversion ratios (CRs) used worldwide among palliative care (PC) professionals to perform opioid rotations (ORs) and route conversions may have a wide variation. Methods: We surveyed PC professionals on opioid ratios used through email to the Multinational Association of Supportive Care in Cancer's PC study group and Twitter and Facebook posts between September and November 2020. Results: We received 370 responses from respondents from 53 countries: 276 (76%) were physicians, 46 (13%) advanced practice providers, 39 (11%) pharmacists, and 9 respondents did not report their profession. There were statistically significant variations in median CR from intravenous (IV) to oral morphine (2-3), IV to oral hydromorphone (2-4.5), ORR from IV hydromorphone to oral morphine (10-20), and ORR from transdermal fentanyl mcg/hour to oral morphine (2-3.5) across various groups. Conclusion: This survey highlights the wide variation in ORRs and CRs among PC clinicians worldwide and the need for further research to standardize practice.

Keywords: cancer pain; conversion ratio; morphine equivalent daily dose; opioid rotation; opioid rotation ratio; palliative care.

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Conflict of interest statement

No competing financial interests exist.

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