‘Must-Have’ New Medical Book “Demystifies” Opioid Conversions

University of Maryland School of Pharmacy’s McPherson guides medical professionals through the art and science of managing pain treatments.

By Steve Berberich
August 12, 2009

When a medical team needs to change pain treatment to an oral morphine solution for a 75-year-old breast cancer patient who has become too weak to swallow her pills, the task can be tricky.

Now, a new book by a leading pain-care specialist at the University of Maryland School of Pharmacy is being billed as the best guide yet for such opioid conversion calculations, which are among the medical professionals’ most complex and challenging responsibilities,

Mary Lynn McPherson, PharmD, BCPS, CPE, a professor of pharmacy practice and science at the School of Pharmacy, is an authority on how to dose opioids to treat pain in a variety of health care settings. For example, switching from one opioid or method of administration to a different opioid or another method is a critical skill in managing patients transitioning between health care settings, and in caring for a patient with a life-limiting illness. She says, “To be able to ease the pain of someone dying is huge. It’s everything.”

The term opioid conversions, common to medical professionals, is the practice of calculating dose, timing, desired effect, etc., when switching a patient’s pain medications. It also includes how and why to consider a mix of factors, including possible lack of effectiveness, adverse effects, changes in patient status as they decline, and patient-specific profiles. Opioids are the mainstay of pain management for patients with moderate to severe pain.

McPherson thought about a need for her book, “Demystifying Opioid Conversion Calculations,” for a very long time, she says, because, as a patient’s medical condition changes, “the switch from one opioid to another can get very complicated.”

The book should be in the pharmacy library of every hospital pharmacy in the country and is a must for hospice and palliative care practitioners, says McPherson. “I wanted the book to be modestly priced so a wide range of practitioners and clinicians in training can learn these important skills.”

Others agree.

It “provides a great discussion of the impact of various patient and medication-related variables on opioid dosing and calculations. [It’s a] great resource for students learning the craft for the first time and healthcare professionals interested in honing their opioid calculation skills,” Laura Scarpaci, PharmD, BCPS, manager of clinical performance improvement at excelleRx, Inc. of Philadelphia, wrote to the book’s publisher, the American Society of Health-System Pharmacists (ASHP).

B. Eliot Cole, MD, MPA, CPE, executive director of the American Society of Pain Educators (ASPE), says, “Nothing brings fear into the hearts of healthcare professions like doing opioid conversions. What should be viewed as basic algebra becomes nearly incomprehensible when changing molecules, routes of administration, and going from formulation to formulation.”

“This book is a ‘must have’ for all clinicians involved in the use of opioids for pain management. It is written in an engaging, understandable fashion. The case studies will help the clinician apply principles to practice and ensure safe and effective pain management for their patients,” says Kathleen Broglio, ANP-BC, ACHPN, CPE, pain management nurse practitioner at Bellevue Hospital Center in New York.

McPherson’s latest of many honors was winning a 2009 Health Care Heroes Award from The Daily Record for her long-time efforts in education “to improve the practice of hospice and palliative care throughout the country.”

McPherson is also known for her humor as well as her leadership in pharmacy education. She says her fourth book provides, “edge-of-the seat stuff, I promise!,” a dose of humor that she drops strategically into the pages while maintaining the reader’s attention to what could be an otherwise “dry discussion of drug math!” she says.

“Dr. McPherson has introduced the missing element for success–humor! Let Dr. McPherson take the mystery out of opioid conversions and help you feel comfortable and confident,” added ASPE’s Cole.

Yet, tackling such a topic takes extreme courage, wrote Judith A. Paice, PhD, RN, past president of the American Pain Society, in the book’s forward. She continues, “This book truly represents the definitive effort to explore the strange world of opioid conversions, to seek out new knowledge about these essential compounds, and to share this information with fellow pain clinicians. Dr. Mary Lynn McPherson takes the reader on the voyages and adventures of opioid conversions with the skill of an exceptionally brave commander.”

McPherson routinely mentors pharmacists in the relatively new specialty of palliative care, which is dedicated to symptom and pain management for dying patients. Pharmacists, as the health care professional most seen by patients, are the key to success, she says. “I believe pharmacists should continue to use their basic science training, such as chemistry, throughout their careers. To value their basic science as a clinician as much as the scientists do is of great value to a palliative care team”

“Lynn McPherson’s book on opioids is both very practical and readable. This text is a must for those in hospice and palliative medicine,” says Mellar P. Davis, medical professor at Case Western Reserve University in Cleveland.