AMDG Implements Updated Opioid Dose Calculator to Align with Best Practices and Evidence-Based Guidelines

On February 1, 2024, the AMDG (Agency Medical Directors' Group) updated the Opioid Dose Calculator to reflect evolving best practices and evidence-based guidelines for opioid prescribing. The following changes were made:

• Updated hydromorphone conversion factor to 5
• Updated tramadol conversion factor to 0.2
• Added buprenorphine transdermal product with a conversion factor of 2.2

The WMC has received concerns about these changes, which increased the MED conversion rates for Tramadol, Hydromorphone, and Methadone. The primary worry is that stable patients might be unnecessarily tapered off their medications because prescribers may not be aware of the change in conversion calculations. This lack of awareness could lead to misunderstandings about the actual dosage patients are receiving, potentially resulting in inappropriate dose reductions and destabilization of patients who have been effectively managing their pain with their current medication regimen.

Actions Prescribers Should Consider:

• Familiarize themselves with these updates and carefully consider the implications for their patients.
• Communicate clearly with patients about any changes in their treatment plan is essential to avoid unintended consequences.
• Exercise caution when using these new conversion factors, as they reflect the latest clinical evidence and may result in different dosing recommendations compared to previous versions.
• Closely monitor patients for efficacy and safety, particularly during the transition to the updated calculator.

With this change, prescribers should be aware of the following:

• Drugs count for more MED: This means assigning a higher MED value to certain drugs, making them appear more potent or risky when calculating total opioid dosage.
• Trigger a threshold response: In many monitoring systems, there are thresholds of total MED that, when exceeded, prompt specific actions, such as increased monitoring, a warning to the prescriber, or an intervention to prevent potential overdose or misuse.

Conditions for an allopathic physician (MD) or physician assistant (PA) to consider tapering or referring the patient for a substance use disorder evaluation:

• Patient requests tapering.
• Deterioration in patient's function or pain.
• Noncompliance with the written agreement.
• Indication of other treatment modalities.
• Evidence of misuse, abuse, substance use disorder, or diversion.
• Severe adverse event or overdose.
• Unauthorized escalation of doses.
• Escalation in opioid dosage without improvement in pain or function.

Refer to WAC 246-919-950 for MDs and WAC 246-918-900 for PAs for detailed guidance.