Opioid Rotation and Conversion Ratios Used by Palliative Care Professionals: An International Survey

Akhila Reddy, Christian Sinclair, Gregory B. Crawford, Mary Lynn Mcpherson, Sebastiano Mercadante, David Hui, Ali Haider, Joseph Arthur, Kimberson Tanco, Shalini Dalal, Rony Dev, Jaya Amaram-Davila, Claudio Adile, Diane Liu, Ulrich Schuler, Sheetal Jammi, Zeena Shelal, Egidio Del Fabbro, Mellar Davis, Eduardo Bruera

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: The opioid rotation ratios (ORRs) and conversion ratios (CRs) used worldwide among palliative care (PC) professionals to perform opioid rotations (ORs) and route conversions may have a wide variation. Methods: We surveyed PC professionals on opioid ratios used through email to the Multinational Association of Supportive Care in Cancer's PC study group and Twitter and Facebook posts between September and November 2020. Results: We received 370 responses from respondents from 53 countries: 276 (76%) were physicians, 46 (13%) advanced practice providers, 39 (11%) pharmacists, and 9 respondents did not report their profession. There were statistically significant variations in median CR from intravenous (IV) to oral morphine (2-3), IV to oral hydromorphone (2-4.5), ORR from IV hydromorphone to oral morphine (10-20), and ORR from transdermal fentanyl mcg/hour to oral morphine (2-3.5) across various groups. Conclusion: This survey highlights the wide variation in ORRs and CRs among PC clinicians worldwide and the need for further research to standardize practice.

Original languageEnglish (US)
Pages (from-to)1557-1562
Number of pages6
JournalJournal of Palliative Medicine
Issue number10
StatePublished - Oct 1 2022


  • cancer pain
  • conversion ratio
  • morphine equivalent daily dose
  • opioid rotation
  • opioid rotation ratio
  • palliative care

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine


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