Slow-release oral morphine

Dosing

BC OUD Guidelines

• Increase doses q48h
• When transitioning from methadone, the eventual dose will usually be 6- to 8-times higher, but generally should start with a 4-times higher dose to be safe
• For other opioids, start with dose of 30 to 60 mg
• Average stable doses are 60 to 1200 mg daily

Missed doses

Number missed	Action
1	no change
2	40% reduction
3	60% reduction
4	40 mg or starting dose
5	re-initiate

St. Michael's Protocol

Day	Slow-release morphine	Instant-release morphine
1	200-300 mg	30-50 mg po q2h while awake + 30-50 mg po q3h prn
2	SR dose from Day 1 + 50% of IR dose from Day 3	30-50 mg po q2h while awake + 30-50 mg po q3h prn
3	SR dose from Day 2	30-50 mg po q3h prn
4	SR dose from Day 3 + 50% of IR dose from Day 3	30-50 mg po q3h prn
5	SR dose from Day 4	30-50 mg po q3h prn
6	SR dose from Day 5 + 50% of IR dose from Day 5	30-50 mg po q3h prn