Opioid prescribing is rarely straightforward. The well respected Opioid Calculator from colleagues "down under" has simplification and safety built in.
Opioid use and abuse has reached epidemic status in the United States with $55 billion in health and social costs related to prescription opioid abuse each year, including $20 billion in emergency department and inpatient care for opioid poisonings (hhs.gov). It is now considered a feature of regular medical practice that a significant number of patients will be taking opioid medications. We all have a role to play in pushing back against the powerful tide of misuse, abuse, addiction, and overdose by prescribing as knowledgeably as we can.And, yes; there is an app for that.The Opioid Calculator is a mobile application designed by the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists (FPM ANZCA), the organization responsible for development, training, and continuing education of pain medicine specialists in Australia and New Zealand. Developed for both iOS and Android platforms, the Opioid Calculator is a unique tool that supports safe opoioid prescribing by calculating an oral morphine equivalent daily dose and converting it to equianalgesic doses of alternative opioid medications.How it works After completing the onboarding tutorial, the home screen displays basic information about the app and the developer. The conversion tool runs along the top of the screen.Â The user can enter drug quantities using the keyboard or use the plus or minus button to add up the total current daily dose of a specific opioid a patient is taking [Slide 1]. Importantly, since many patients with severe or long-standing pain are taking multiple opioids in different formulations (eg, long- and short-acting) the app simplifies calculation of the morphine equivalent daily dose for combinations of opioids. Routes other than oral administration also can be selected, ie, transdermal, sublingual, parenteral, etc. After the patient’s daily opioid medications have been entered, the app displays the Total Morphine Equivalent at the top of the screen.Pressing the “Convert” button produces the equianalgesic dose of alternate opioids [Slide 2]. This list of alternatives utilizes a “traffic light” Dose-Warning System:Â Green: “Low Risk of Dose Related Harm if used in accordance with clinical guidelines.”Â Amber: “CAUTION: Increased Risk of Dose Related Harm.”Â Red: “ALERT: High risk of harm due to predictable adverse effects, dependence, or inadvertent overdose.”The app also provides a harm reduction tool by calculating an interval decrease in the medication if the physician and patient agree that it is appropriate to either down-titrate or taper the opioid. [Slide 3]The “Preference Settings” page lets users select the combination of opioids most suited to their practice. You can choose “All” opioids or one of the lists for “Hospital” practice or for primary care practice in Australia, New Zealand or the United States. Users can also create a custom list of the opioids they prescribe most frequently.In the information sections, find detailed information about:Â âº Patient evaluationÂ âº Evidence for/against opioids for non-cancer painÂ âº A demo for the appÂ âº A link to the FPM ANZCA online curriculum for providers.The user interface for both versions of the app, iOS and Android, is attractive and easy to use. The android app uses Google’s Material Design aesthetic, and the iPhone and iPad versions are contemporary with Apple’s iOS 10 design guidelines.The Opioid Calculator by FPM ANZCA is a helpful resource for all clinicians who prescribe opioid medications. It provides evidence-based advice on converting between drugs as well as information on decreasing a patient’s dose. I recommend this tool for all physicians and midlevel providers.