Alchemy and Arithmetic: The Art and Science of Opioid Rotation

Patients receiving opioids, particularly those with a serious illness, often need to switch from one opioid regimen to a different regimen. Reasons for this include lack of therapeutic response, development of adverse effects, change in the patient’s status, opioid or formulation availability, formulary considerations, and patient or family health care beliefs. Participants in this presentation will learn the science that supports doing calculations to switch a patient from one opioid regimen to a different one, using strategies to maximize pain management, and minimize adverse outcomes. A position paper published by Multinational Association of Supportive Care will be presented, covering pre-conversion assessments, how to perform the opioid conversion, and post-conversion assessments. Multiple examples will be provided to illustrate this process.