Opioids Dosing, Methadone and Cross Tolerance

Give the current environment of increased regulation on outpatient non - cancerous drug pain management and OUD, I am listing some very helpful; sites and books and a recent NEJM article on Opioid in Critical Illness.
If you want to become a true opioid expert , learn to dose methadone in the inpatient setting safely and also adjust opioid for cross tolerance when rotating drugs to avoid opioid hyperalgesia this is the book that has it all:


Demystifying Opioid Conversion Calculations- A Guide for Effective dosing by Mary Lynn McPherson . I still have the first edition from 2009 , but the 2nd edition published in 2018 is vastly improved , with multiple patient examples and clinical pearls.


A good website with also an Apple/Android app is https://www.crediblemeds.org/ as it ranks drugs form low to high risk when patient are on methadone and I think we see a lot of them admitted on methadone to the ICU.

Finally, the NEJM article on Opiods in Critical Illness is very helpful, particularly the online appendix with patient examples . I can definitely relate to this and the first example was the multi modal therapy they used on me including nerve blocks  ( it would have been better if the darn epidurals would have stayed  stay in place !!) , and certainly was very grateful for this after my MVA.

Please add comments or pearls of wisdom ....