Update opioidome.json

[richiecroker]

reinstate measure, using DM+D to automatically create OMEs using strengths.

[richiecroker]

In brief:

I have created a new table (richard.opioid_class) which contains chemical level and simple formulation (at DM+D ING level) with an OME for each.

	vpi	nm	form	ome	ref
1	96184001	Alfentanil hydrochloride	nasal	30.0	PCD
2	395822005	Papaveretum	injection	7.7	OA
3	387173000	Buprenorphine	transdermal	100.0	OA
4	21066009	Buprenorphine hydrochloride	injection	100.0	OA
5	373492002	Fentanyl	transdermal	100.0	BNF
6	60886004	Morphine sulfate	rectal	1.0	BNF
7	60886004	Morphine sulfate	oral	1.0	BNF
8	60886004	Morphine sulfate	injection	2.0	BNF
9	261000	Codeine phosphate	oral	0.1	BNF
10	261000	Codeine phosphate	injection	0.1	BNF
11	261000	Codeine phosphate	rectal	0.1	BNF
12	442424007	Morphine tartrate	injection	2.0	BNF
13	4369111000001100	Morphine anhydrous	oral	1.0	BNF
14	17632411000001100	Oxycodone pectinate	rectal	1.5	BNF
15	395804007	Morphine hydrochloride	rectal	1.0	BNF
16	395804007	Morphine hydrochloride	injection	2.0	BNF
17	395804007	Morphine hydrochloride	oral	1.0	BNF
18	108505002	Tramadol hydrochloride	injection	0.1	BNF
19	108505002	Tramadol hydrochloride	oral	0.1	BNF
20	322538006	Dihydrocodeine tartrate	oral	0.1	BNF
21	387024006	Oxycodone hydrochloride	injection	3.0	BNF
22	387024006	Oxycodone hydrochloride	rectal	1.5	BNF
23	387024006	Oxycodone hydrochloride	oral	1.5	BNF
24	111123003	Nalbuphine hydrochloride	injection	1.0	BNF
25	387485001	Hydromorphone hydrochloride	oral	5.0	BNF
26	387485001	Hydromorphone hydrochloride	injection	5.0	BNF
27	29190006	Fentanyl citrate	oromucosal	130.0	CMS
28	29190006	Fentanyl citrate	nasal	160.0	CMS
29	29190006	Fentanyl citrate	buccal	130.0	CMS
30	71533000	Pentazocine lactate	rectal	0.37	CMS
31	71533000	Pentazocine lactate	injection	0.37	CMS
32	23883005	Methadone hydrochloride	inhalation	3.0	CMS
33	23883005	Methadone hydrochloride	injection	3.0	CMS
34	23883005	Methadone hydrochloride	oral	3.0	CMS
35	442699004	Tapentadol hydrochloride	oral	0.4	CMS
36	91013003	Pentazocine hydrochloride	oral	0.37	CMS
37	322508000	Dextromoramide tartrate	oral	4.0	GPN
38	322538006	Dihydrocodeine tartrate	injection	0.1	GPN
39	396019002	Diamorphine hydrochloride	oral	1.0	GPN
40	396019002	Diamorphine hydrochloride	injection	3.0	GPN
41	396019002	Diamorphine hydrochloride	inhalation	1.0	GPN
42	396019002	Diamorphine hydrochloride	rectal	1.0	GPN
43	6837005	Dextropropoxyphene napsylate	oral	0.1	GPN
44	56297001	Dextropropoxyphene hydrochloride	oral	0.1	GPN
45	2878005	Pethidine hydrochloride	oral	0.1	ABHB
46	2878005	Pethidine hydrochloride	injection	0.24	ABHB
47	322554009	Dipipanone hydrochloride	oral	0.5	ABHB
48	3568811000001100	Meptazinol hydrochloride	injection	0.03	ABHB
49	3568811000001100	Meptazinol hydrochloride	oral	0.03	ABHB
50	21066009	Buprenorphine hydrochloride	oromucosal	60.0	MIMS
51	96184001	Alfentanil hydrochloride	injection	30.0	PCD

This table then feeds into a new view, which calculates the OME using the DM+D strength details, prescribing data, and the OME table above:

#subquery to create a "simple" administration route. 
WITH 
simp_form AS ( 
SELECT DISTINCT vmp, #vmp code
                CASE 
                    WHEN descr LIKE '%injection%' THEN 'injection' #creates "injection" as route, regardless of whether injection or infusion. this also removes injection routes, e.g.
                    WHEN descr LIKE '%infusion%' THEN 'injection'  #s/c, i/v etc, AS often injections have many licensed routes, which would multiply the row
                    ELSE SUBSTR(form.descr, STRPOS(form.descr,".")+1) #takes the dosage form out of the string (e.g. tablet.oral) TO leave route.
                END AS simple_form 
FROM dmd.ont AS ont #the coded route for dosage form, includes vmp code 
INNER JOIN dmd.ontformroute AS form ON form.cd=ont.form #text description of route 
  )

#subquery to normalise strength to mg
,norm_vpi AS (
SELECT vmp, #vmp code
       ing, #ing code
       strnt_nmrtr_val, #numerator strength value
       strnt_nmrtr_uom, #numerator unit of measurement
       unit_num.descr AS unit_num, #numerator unit 
       unit_den.descr AS unit_den, #denominator unit
       CASE
           WHEN unit_num.descr = 'microgram' THEN vpi.strnt_nmrtr_val / 1000 #creates miligram value from mcg value
           WHEN unit_num.descr = 'gram' THEN vpi.strnt_nmrtr_val * 1000 #creates miligram value from gram value
           ELSE vpi.strnt_nmrtr_val
       END AS strnt_nmrtr_val_mg, #all listed drugs now in miligram rather than g or mcg
       CASE
           WHEN unit_den.descr = 'litre' THEN vpi.strnt_dnmtr_val * 1000 #some denominators listed as litre, so create mililitre value
           ELSE vpi.strnt_dnmtr_val
       END AS strnt_dnmtr_val_ml #denominator now in ml
FROM dmd.vpi AS vpi
LEFT JOIN dmd.unitofmeasure AS unit_num ON vpi.strnt_nmrtr_uom = unit_num.cd #join to create text value for numerator unit
LEFT JOIN dmd.unitofmeasure AS unit_den ON vpi.strnt_dnmtr_uom = unit_den.cd) #join to create text value for denominator unit

#subquery to create single BNF table for AMPs and VMPs
,vmp_amp AS 
(SELECT DISTINCT id,
                 nm,
                 bnf_code
FROM dmd.vmp #vmp table
WHERE bnf_code IS NOT NULL
UNION DISTINCT
SELECT DISTINCT vmp,
                nm,
                bnf_code
FROM dmd.amp #amp table
WHERE bnf_code IS NOT NULL)
    
#main query to calculate the OME
SELECT rx.month, 
       rx.practice, 
       rx.pct, 
       vpi.strnt_dnmtr_val_ml,
       sum(rx.quantity) as quantity,
       ing.id, #ingredient DM+D code. Combination products will have more than one ing code per VMP, e.g. co-codamol will have ing for paracetamoland codeine
       ing.nm, #ingredient name vmp.bnf_code AS bnf_code,
       vmp.nm AS vmp_nm, #VMP code
       vmp.bnf_code as bnf_code, #BNF code to link to prescribing data
       vpi.strnt_nmrtr_val_mg, #strength numerator in mg
       SUM(quantity*ome*(CASE
           WHEN ing.id=373492002 AND form.simple_form = 'transdermal' THEN (vpi.strnt_nmrtr_val_mg*72)/coalesce(vpi.strnt_dnmtr_val_ml, 1) # creates 72 hour dose for fentanyl transdermal patches, as doses are per hour on DM+D)
           WHEN ing.id=387173000 AND form.simple_form = 'transdermal' AND vpi.strnt_nmrtr_val IN (5, 10, 15, 20) THEN (vpi.strnt_nmrtr_val_mg*168)/coalesce(vpi.strnt_dnmtr_val_ml, 1) # creates 168 hour (7 day) dose for low-dose buprenorphine patch
           WHEN ing.id=387173000 AND form.simple_form = 'transdermal' AND vpi.strnt_nmrtr_val IN (35, 52.5, 70) THEN (vpi.strnt_nmrtr_val_mg*96)/coalesce(vpi.strnt_dnmtr_val_ml, 1) # creates 96 hour dose for higher-dose buprenorphine patch
           ELSE strnt_nmrtr_val_mg/coalesce(vpi.strnt_dnmtr_val_ml, 1) #all other products have usual dose - coalesce as solid dose forms do not have a denominator
       END)) AS ome_dose, 
       opioid.ome AS ome
FROM norm_vpi AS vpi #VPI has both ING and VMP codes in the table
INNER JOIN dmd.ing AS ing ON vpi.ing=ing.id #join to ING to get ING codes and name
INNER JOIN vmp_amp AS vmp ON vpi.vmp=vmp.id #join to get BNF codes for both VMPs and AMPs joined indirectly TO ING. 
INNER JOIN simp_form AS form ON vmp.id=form.vmp #join to subquery for simplified administration route
INNER JOIN richard.opioid_class AS opioid ON opioid.id=ing.id AND opioid.form=form.simple_form #join to OME table, which has OME value for ING/route pairs
INNER JOIN hscic.normalised_prescribing AS rx ON rx.bnf_code = vmp.bnf_code
WHERE rx.bnf_code NOT LIKE '0410%' #remove drugs used in opiate dependence
GROUP BY rx.month, 
         rx.practice, 
         rx.pct,
         id,
         ing.nm,
         vmp.bnf_code,
         vmp.nm,
         vpi.strnt_nmrtr_val,
         strnt_nmrtr_val_mg,
         vpi.strnt_dnmtr_val_ml,
         opioid.ome

I have compared the output of the table above with the previous one. The main differences are:

• there are a few extra presentations which were not previously considered (e.g. codeine linctus)
• oxycodone OMEs are reduced, as per the new OA guidance
• there appears to have been a typo in the old calculation sheet, meaning that fentanyl transdermal patches were not showing the correct OME. This shows the benefit of the new methodology

The vast majority of the OMEs were the same for both methods.

[madwort]

nb. CI fails due to an unrelated issue which we're fixing in another PR

[madwort]

@richiecroker CI fix now merged, I think if you rebase/merge on the master branch and re-push it here, it should look better

[inglesp]

Please could you:

• put the SQL for vw__opioids_total_ome and vw__opioids_total_dmd in the measure_sql directory, including the comment like one that's at the top of opioid_total_ome.sql in the same directory
• delete opioid_total_ome.sql
• update the list of tables here

[richiecroker]

@inglesp done

[inglesp]

This is an impressive piece of work -- for this much SQL it was very easy to review! But unfortunately it's not quite right, because vw__opioid_measure_dmd is going to contain duplicate rows, which means that some prescribing will be double-counted in the measure.

I think the fix will be to create a subquery (or a view if that's easier) that contains one row per BNF code, with column for ome_dose. Then, in your main query, you can join against this subquery/view, and sum over the ome_dose column.

If any of this is unclear, let me know.

[richiecroker]

Thanks for the review @inglesp - although strangely when i've checked against the existing measure there didn't appear to be an differences in total_ome apart from where i'd expected them to be, which if we're getting duplication I don't understand. Also, re the single bnf_code and ome_dose there will be some occasions (although not in the current opioid dataset) where there are multiple ing that we may want to calculate e.g. ADQ on. How will this affect this? I'll take a closer look next week. Thanks again!

[inglesp]

when i've checked against the existing measure there didn't appear to be an differences in total_ome apart from where i'd expected them to be, which if we're getting duplication I don't understand

How did you check this?

Also, re the single bnf_code and ome_dose there will be some occasions (although not in the current opioid dataset) where there are multiple ing that we may want to calculate e.g. ADQ on. How will this affect this?

If we've worked out the ADQ per ingredient, is it valid to sum the ADQs over a VMP's ingredients to get a VMP's ADQ? If so, that's in the fiddly/doable quadrant.

[brianmackenna]

I've had a brief look and I estimate this is going to be at least a half day work to review this measure. It's on my longer TODO list but likely to be awhile before I get to it.

[richiecroker]

Latest version of opiate equivalence data, including updated links and some brief notes:

vpi	nm	form	ome	ref	link	notes
96184001	Alfentanil hydrochloride	nasal	30	ScotPCG	https://www.palliativecareguidelines.scot.nhs.uk/guidelines/pain/choosing-and-changing-opioids.aspx
395822005	Papaveretum	injection	1.5	Loan	https://academic.oup.com/bja/article/38/11/891/241933
387173000	Buprenorphine	transdermal	100	OA	https://fpm.ac.uk/opioids-aware-structured-approach-opioid-prescribing/dose-equivalents-and-changing-opioids	calculation based on buprenorphine mcg/hr to morphine mg per day
21066009	Buprenorphine hydrochloride	injection	100	OA	https://fpm.ac.uk/opioids-aware-structured-approach-opioid-prescribing/dose-equivalents-and-changing-opioids	assumed from oral dose
373492002	Fentanyl	transdermal	100	BNF	https://fpm.ac.uk/opioids-aware-structured-approach-opioid-prescribing/dose-equivalents-and-changing-opioids
60886004	Morphine sulfate	rectal	1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
60886004	Morphine sulfate	oral	1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
60886004	Morphine sulfate	injection	2	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
261000	Codeine phosphate	oral	0.1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
261000	Codeine phosphate	injection	0.1	GPN	https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20041106080748159860
261000	Codeine phosphate	rectal	0.1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
442424007	Morphine tartrate	injection	2	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
4369111000001103	Morphine anhydrous	oral	1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
17632411000001105	Oxycodone pectinate	rectal	1.5	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
395804007	Morphine hydrochloride	rectal	1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
395804007	Morphine hydrochloride	injection	2	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
395804007	Morphine hydrochloride	oral	1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html	assumed from oral dose
108505002	Tramadol hydrochloride	injection	0.1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
108505002	Tramadol hydrochloride	oral	0.1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
322538006	Dihydrocodeine tartrate	oral	0.1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
387024006	Oxycodone hydrochloride	injection	3	BNF	https://bnf.nice.org.uk/drug/oxycodone-hydrochloride.html#indicationsAndDoses
387024006	Oxycodone hydrochloride	rectal	1.5	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
387024006	Oxycodone hydrochloride	oral	1.5	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
111123003	Nalbuphine hydrochloride	injection	1	Sedation	https://www.sciencedirect.com/topics/medicine-and-dentistry/nalbuphine
387485001	Hydromorphone hydrochloride	oral	5	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
387485001	Hydromorphone hydrochloride	injection	5	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
29190006	Fentanyl citrate	oromucosal	130	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
29190006	Fentanyl citrate	nasal	160	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
29190006	Fentanyl citrate	buccal	130	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
71533000	Pentazocine lactate	rectal	0.37	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
71533000	Pentazocine lactate	injection	0.37	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
23883005	Methadone hydrochloride	inhalation	3	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
23883005	Methadone hydrochloride	injection	3	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
23883005	Methadone hydrochloride	oral	3	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
442699004	Tapentadol hydrochloride	oral	0.4	OA	https://fpm.ac.uk/opioids-aware-structured-approach-opioid-prescribing/dose-equivalents-and-changing-opioids
91013003	Pentazocine hydrochloride	oral	0.37	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
322508000	Dextromoramide tartrate	oral	2	Barnett	https://pmj.bmj.com/content/postgradmedj/77/908/371.full.pdf
322538006	Dihydrocodeine tartrate	injection	0.1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
396019002	Diamorphine hydrochloride	oral	1	GPN	https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20041106080748159860
396019002	Diamorphine hydrochloride	injection	3.3	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
396019002	Diamorphine hydrochloride	inhalation	1	GPN	https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20041106080748159860
396019002	Diamorphine hydrochloride	rectal	1	GPN	https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20041106080748159860	assumed from oral dose
6837005	Dextropropoxyphene napsylate	oral	0.1	GPN	https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20041106080748159860
56297001	Dextropropoxyphene hydrochloride	oral	0.1	GPN	https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20041106080748159860
2878005	Pethidine hydrochloride	oral	0.1	ABHB	https://www.drjcope.com/uploads/1/3/1/4/13140168/palliative_care_drug_converter_1.pdf
2878005	Pethidine hydrochloride	injection	0.24	ABHB	https://www.drjcope.com/uploads/1/3/1/4/13140168/palliative_care_drug_converter_1.pdf
322554009	Dipipanone hydrochloride	oral	0.5	Barnett	https://pmj.bmj.com/content/postgradmedj/77/908/371.full.pdf
768496009	Meptazinol hydrochloride	injection	0.03	ABHB	https://www.drjcope.com/uploads/1/3/1/4/13140168/palliative_care_drug_converter_1.pdf
768496009	Meptazinol hydrochloride	oral	0.03	ABHB	https://www.drjcope.com/uploads/1/3/1/4/13140168/palliative_care_drug_converter_1.pdf
21066009	Buprenorphine hydrochloride	oromucosal	60	GPN	https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20041106080748159860	assumed from oral dose
96184001	Alfentanil hydrochloride	injection	30	ScotPCG	https://www.palliativecareguidelines.scot.nhs.uk/guidelines/pain/choosing-and-changing-opioids.aspx

[charliedthomas]

Agree with the opioid equivalence in the main. A couple of comments:

• There is no fentanyl injection listed. This page suggests 0.067mg is roughly equivalent to 10mg oral morphine (ome = 150).
• Papaveretum 20mg roughly equivalent to 13.3mg morphine, so ome should be 2/3, not 1.5
• Tramadol injection - Zydol SPC states 1/10 - 1/6th as potent as morphine. Would seem sensible to relate this to morphine injection, not oral (i.e ome = 0.2, not 0.1). This may be worth considering for all injectables.
• Study suggests IV hydromorphone 1mg is equivalent to 2.5mg oral hydromorphine. It would be expected that parenteral more potent, so ome = 12.5, not 5.

Otherwise, in general agreement with latest equivalence data, particularly as this should be viewed as an estimate of total ome.

[richiecroker]

Thanks to @charliedthomas for the review, I have made changes as recommended, and final table below:

vpi	nm	form	ome	ref	link	notes
96184001	Alfentanil hydrochloride	nasal	30	ScotPCG	https://www.palliativecareguidelines.scot.nhs.uk/guidelines/pain/choosing-and-changing-opioids.aspx
395822005	Papaveretum	injection	0.67	Loan	https://academic.oup.com/bja/article/38/11/891/241933
387173000	Buprenorphine	transdermal	100	OA	https://fpm.ac.uk/opioids-aware-structured-approach-opioid-prescribing/dose-equivalents-and-changing-opioids	calculation based on buprenorphine mcg/hr to morphine mg per day
21066009	Buprenorphine hydrochloride	injection	100	OA	https://fpm.ac.uk/opioids-aware-structured-approach-opioid-prescribing/dose-equivalents-and-changing-opioids	assumed from oral dose
373492002	Fentanyl	transdermal	100	BNF	https://fpm.ac.uk/opioids-aware-structured-approach-opioid-prescribing/dose-equivalents-and-changing-opioids
60886004	Morphine sulfate	rectal	1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
60886004	Morphine sulfate	oral	1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
60886004	Morphine sulfate	injection	2	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
261000	Codeine phosphate	oral	0.1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
261000	Codeine phosphate	injection	0.1	GPN	https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20041106080748159860
261000	Codeine phosphate	rectal	0.1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
442424007	Morphine tartrate	injection	2	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
4369111000001103	Morphine anhydrous	oral	1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
17632411000001105	Oxycodone pectinate	rectal	1.5	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
395804007	Morphine hydrochloride	rectal	1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
395804007	Morphine hydrochloride	injection	2	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
395804007	Morphine hydrochloride	oral	1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html	assumed from oral dose
108505002	Tramadol hydrochloride	injection	0.2	SPC	https://www.medicines.org.uk/emc/product/82/smpc#gref
108505002	Tramadol hydrochloride	oral	0.1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
322538006	Dihydrocodeine tartrate	oral	0.1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
387024006	Oxycodone hydrochloride	injection	3	BNF	https://bnf.nice.org.uk/drug/oxycodone-hydrochloride.html#indicationsAndDoses
387024006	Oxycodone hydrochloride	rectal	1.5	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
387024006	Oxycodone hydrochloride	oral	1.5	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
111123003	Nalbuphine hydrochloride	injection	1	Sedation	https://www.sciencedirect.com/topics/medicine-and-dentistry/nalbuphine
387485001	Hydromorphone hydrochloride	oral	5	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
387485001	Hydromorphone hydrochloride	injection	12.5	Reddy	https://pubmed.ncbi.nlm.nih.gov/28711751/
29190006	Fentanyl citrate	injection	150	Glos	https://www.gloshospitals.nhs.uk/gps/treatment-guidelines/opioid-equivalence-chart/
29190006	Fentanyl citrate	oromucosal	130	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
29190006	Fentanyl citrate	nasal	160	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
29190006	Fentanyl citrate	buccal	130	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
71533000	Pentazocine lactate	rectal	0.37	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
71533000	Pentazocine lactate	injection	0.37	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
23883005	Methadone hydrochloride	inhalation	3	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
23883005	Methadone hydrochloride	injection	3	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
23883005	Methadone hydrochloride	oral	3	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
442699004	Tapentadol hydrochloride	oral	0.4	OA	https://fpm.ac.uk/opioids-aware-structured-approach-opioid-prescribing/dose-equivalents-and-changing-opioids
91013003	Pentazocine hydrochloride	oral	0.37	CMS	https://medicaid.utah.gov/Documents/files/Opioid-Morphine-EQ-Conversion-Factors.pdf
322508000	Dextromoramide tartrate	oral	2	Barnett	https://pmj.bmj.com/content/postgradmedj/77/908/371.full.pdf
322538006	Dihydrocodeine tartrate	injection	0.1	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
396019002	Diamorphine hydrochloride	oral	1	GPN	https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20041106080748159860
396019002	Diamorphine hydrochloride	injection	3.3	BNF	https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html
396019002	Diamorphine hydrochloride	inhalation	1	GPN	https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20041106080748159860
396019002	Diamorphine hydrochloride	rectal	1	GPN	https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20041106080748159860	assumed from oral dose
6837005	Dextropropoxyphene napsylate	oral	0.1	GPN	https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20041106080748159860
56297001	Dextropropoxyphene hydrochloride	oral	0.1	GPN	https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20041106080748159860
2878005	Pethidine hydrochloride	oral	0.1	ABHB	https://www.drjcope.com/uploads/1/3/1/4/13140168/palliative_care_drug_converter_1.pdf
2878005	Pethidine hydrochloride	injection	0.24	ABHB	https://www.drjcope.com/uploads/1/3/1/4/13140168/palliative_care_drug_converter_1.pdf
322554009	Dipipanone hydrochloride	oral	0.5	Barnett	https://pmj.bmj.com/content/postgradmedj/77/908/371.full.pdf
768496009	Meptazinol hydrochloride	injection	0.03	ABHB	https://www.drjcope.com/uploads/1/3/1/4/13140168/palliative_care_drug_converter_1.pdf
768496009	Meptazinol hydrochloride	oral	0.03	ABHB	https://www.drjcope.com/uploads/1/3/1/4/13140168/palliative_care_drug_converter_1.pdf
21066009	Buprenorphine hydrochloride	oromucosal	60	GPN	https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20041106080748159860	assumed from oral dose
96184001	Alfentanil hydrochloride	injection	30	ScotPCG	https://www.palliativecareguidelines.scot.nhs.uk/guidelines/pain/choosing-and-changing-opioids.aspx

code completely rewritten to take account of VMP/AMP duplication

[richiecroker]

Updated methodology notebook can be found here.

• Clinical OME values have been checked by @charliedthomas

• Methodology for calculation appears consistent with previous methodology

• Preview version has been deployed to site, and seems to give correct items, quantity and OME.

• "Why it matters" has been updated and blog written to explain changes.

@CarolineMorton are you able to check and approve this please, from both coding and clinical perspective?

[CarolineMorton]

This is absolutely fantastic work. So useful from a clinical perspective. Only minor comments. Happy to approve this.

@richiecroker Slack down for me at present so hopefully you see this is approved

[CarolineMorton]

This is very nice in terms of documentation.

[CarolineMorton]

Just to highlight that the TO BE AMENDED is still there in this text. Is this intentional?

[richiecroker]

yes, i need to make sure it's right before I publish!

[CarolineMorton]

Maybe either add a reference or harm such as .... to text