Opioid analgesic misuse and overdose constitute a national epidemic.1 In 2011, nearly 17,000 individuals died from opioid analgesic–related overdose deaths in the United States.2 Overdose and overdose deaths have been correlated with opioid prescribing patterns.1,3–5 Among other risky prescribing practices, higher opioid dosages are associated with increased risk of overdose. Opioid dosages that are greater than or equal to 100 morphine milligram equivalents (MME) per day increase overdose risk by nine times compared with dosages between 0 and 20 MME.3
New York City, like many other jurisdictions, has been impacted by the public health crisis related to opioid analgesics. During 2000–13, the rate of opioid analgesic overdose deaths increased by 256%. In 2013, a total of 215 New Yorkers died from opioid analgesic overdoses—more than one person every other day.6 These deaths are preventable.
The New York City Department of Health and Mental Hygiene (DOHMH) has used a multipronged approach to address the problem, including developing an innovative public health drug surveillance system, promoting overdose prevention with naloxone, improving access to addiction treatment, conducting public education media campaigns, and promoting safe and judicious opioid prescribing.
DOHMH has published opioid prescribing guidelines that outline key principles of safe and judicious prescribing practices, one of which is to avoid high-dose prescriptions (≥100 MME/d).7 Because prescribers might lack familiarity with calculating MME per day, DOHMH—with support from CDC and expertise from information technology specialists, epidemiologists, physicians, and pharmacists—developed OpioidCalc, a user-friendly tool that performs this calculation.
OpioidCalc is a free mobile app for smartphones (iOS and Android) that allows users to quickly and easily calculate the total daily MME a patient is taking, based on type of opioid analgesic, strength, and quantity. Multiple types of opioid analgesics can be included in the total daily MME calculation. An alert is displayed for total daily MME greater than or equal to 100, indicating an increased risk for overdose. This alert also suggests reassessing the patient’s pain status and treatment plan and provides a link to the DOHMH opioid-prescribing guidelines for additional information.
OpioidCalc is distinctive in that its purpose is to help assess overdose risk in patients taking opioid analgesics, not to convert from one opioid to another. The tool is for use by prescribing clinicians and also might be of use to pharmacists. It is intended for ambulatory care settings and does not include I.V. formulations of medications.
OpioidCalc supports safe and judicious, evidence-based prescribing practices, with the ultimate goal of reducing overdose deaths from opioid analgesics. Pharmacists can use this app collaboratively with prescribers to develop prudent pain management regimens, reduce patient risk, and help reverse the opioid analgesic epidemic. Overdose deaths are preventable. Be part of the solution by downloading OpioidCalc today from iTunes or Google Play.
Hyattsville, MD: National Center for Health Statistics; 2014. NCHS data brief 166
Ann Intern Med. 2010;152(2):85–92
J Am Board Fam Med. 2014;27(3):329–38
NYC Department of Health and Mental Hygiene; August 2014. Epi data brief 50
City Health Information. 2011;30(4):23–30