How to Safely Convert Opioids in the Clinical Setting

May 13, 2011

Clinical pharmacist gives step-by-step demonstration of how to convert a patient from hydromorphone to extended-release morphine.

Karen Shapiro, PharmD, BCPS, discusses how to safely convert opioids in the clinical setting. By way of example, she discusses the case of a hospice patient who has been receiving 12 mg/d of IV hydromorphone but who now is to be converted to morphine extended-release Q12. In this example, the hospice policy is to reduce the new dose by 50% and to use 5-15% of the total daily dose for breakthrough pain. Topics discussed include the justification for reducing the new opioid dose and the need for breakthrough pain medication. Shapiro also cautions viewers that this conversion method does not work with fentanyl or methadone, as those medications “do not use straight-forward conversions.”