Appendix B-8.1 Oral Opioid Analgesic Conversion Table

• The table is based on oral dosing for chronic non-cancer pain.
• The figures are based on the Compendium of Pharmaceutical & Specialties (Canadian Pharmacists Association 2008) and a systematic review by Pereira (2001). Wide ranges have been reported in the literature.
• These equivalences refer to analgesic strength of oral opioids, and not psychoactive effects or effectiveness in relieving withdrawal symptoms.

1. Equivalence to oral morphine 30 mg:

Table B Appendix 8.1 Oral Opioid Analgesic Conversion Table

	Equivalence to oral morphine 30 mg:	To convert to oral morphine equivalent, multiply by:	To convert from oralmorphine, multiply by:
Morphine	30 mg	1	1
Codeine	200 mg	0.15	6.67
Oxycodone	20 mg	1.5	0.667
Hydromorphone	6 mg	5	0.2
Meperidine	300 mg	0.1	10
Methadone and tramadol	Morphine dose equivalence not reliably established.

2. Equivalence between oral morphine and transdermal fentanyl:

Transdermal fentanyl*	60–134 mg morphine = 25mcg/h
	135–179 mg = 37 mcg/h
	180–224 mg = 50 mcg/h
	225–269 mg = 62 mcg/h
	270–314 mg = 75 mcg/h
	315–359 mg = 87 mcg/h
	360–404 mg = 100 mcg/h

* Formulations include 12, 25, 50, 75 and 100 ucg/hour patches, but the 12 ucg/hour patch is generally used for dose adjustment rather than initiation of fentanyl treatment.

Appendix B-8.2 Opioids: Generic and Brand Names Available in Canada

(Canadian Pharmacists Association 2008)

Strong Opioids

Drug (generic name)	Brand names
Fentanyl (transdermal)	Duragesic®
Hydromorphone HCL	Dilaudid®, Hydromorph Contin®, Hydromorphone HCL, Hydromorphone HP® (10, 20, 50, Forte), Jurnista®, PMS-Hydromorphone®
Methadone HCL	Metadol®
Morphine sulfate	Statex®, Kadian®, M-Eslon®, M.O.S.-Sulfate®, Morphine HP, Morphine sulphate, MS Contin®, MS-IR®, PMS-Morphine®, Morphine Sulfate SR®, ratio-Morphine SR®
Oxycodone HCL	OxyContin®, Oxy-IR®, Supeudol®
Oxycodone HCL with acetaminophen	Endocet®, Percocet®, Percocet-Demi®, ratio-Oxycocet®, PMS- Oxycodone- Acetaminophen®
Oxycodone HCL/ ASA	Endodan®, Percodan®, Percodan-Demi®, ratio-Oxycodan®

Weak Opioids

Drug (generic name)	Brand names
Codeine monohydrate/ sulphate trihydrate	Codeine, Codeine Contin®
Codeine phosphate / acetaminophen / caffeine	Tylenol® (No. 1, 2, 3); Atasol® (No. 8, 15, 30); Lenoltec®
Codeine phosphate / acetaminophen without caffeine	Empracet®
Propoxyphene Napsylate	Darvon-N®
Pentazocine HCL	*Talwin®
Pethidine HCL (meperidine)	Demerol®
**Tramadol	Ralivia™, Zytram XL®, Tridural™
**Tramadol/ Acetaminophen	Tramacet®

Cannabinoids

Drug (generic name)	Brand names
Nabilone	Cesamet®
Dronabinol	Marinol®
	***Sativex®

* Opioid agonist/antagonist

** Tramadol is a weak opioid and serotonin/norepinephrine reuptake inhibitor

*** Orobuccal spray containing extracts of natural cannabis

Note: Reference throughout this document to specific pharmaceutical products as examples does not imply endorsement of any of these products.