Opioid Equianalgesic Tables are Broken

by Drew Rosielle (@drosielle)I am proposing we do away with equianalgesic table (EAT) as a tool to inform clinical decisions about opioid rotations/conversions. Fundamentally, EATs create too many problems, and there are simpler and safer ways to teach clinicians how to convert between different opioids.Part 1: New Data Can ' t Fix the EATA couple HPM fellows every year ask me which table do I prefer to use —the old EAT or the new one? By the old one, they refer to the table most of us used or were at least deeply familiar with for the last 10-20 years. By the new one, they mean the one created by Dr. Mary Lynn McPherson, PharmD in herlandmark bookDemystifying Opioid Conversions, 2nd Ed. If you haven ’t read the book, please do, it’s really one of the best things ever written about opioid conversions. My disagreement with the book, which is admittedly a big one, is that the book promulgates the use of EATs, and my entire argument today is really in some ways inspired by the conversations I’ ve had with my fellows and others as we grapple with the new EAT in her book. (From here, I’ll refer to the tables as ‘Classic’ and ‘DOC2’.)Fundamentally, my argument is EATs themselves are intrinsically flawed: they ‘force errors’ in a way that’s entirely unnecessary and avoidable if one just doesn’t use EATs as clinical decision aides (I’ll elaborate on that statement below). Dr. McPherson’s curating and teaching new, reliable clinical data is critically imp...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: opioid pain rosielle Source Type: blogs