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A Comparison of the Reliability of Smartphone Apps for Opioid Conversion

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Many medical professionals use smartphone applications (apps) on a daily basis to support clinical decision making. Opioid switching (conversion of one opioid to another at equianalgesic dose) is common in clinical practice and often challenging for doctors. Apps providing an opioid conversion tool can therefore be a useful resource. Despite rapid growth in the use of medical apps, the lack of robust regulation and peer review to ensure the accuracy and reliability of app content is currently an area of concern.


We searched major online app stores for apps providing an opioid dose conversion tool. We assessed output variability between apps in the dose calculation of seven opioid switches, as well as assessing the level of professional medical involvement in the authorship, creation and design of the apps.


Of 23 different apps identified, more than half (n = 12; 52 %) had no stated medical professional involvement and only 11 (48 %) apps provided direct references to primary sources for their opioid conversion ratios. Conversion of 1 mg of oral morphine to oral codeine demonstrated the largest conversion output range (median 6.67 mg, range 3.333–12 mg). Conversion of 1 mg of oral morphine to methadone ranged from 0.05–0.67 mg, with only 44 % of methadone-converting apps (n = 4) commenting that the conversion ratio changes with magnitude of methadone dose. Overall, 35 % of apps (n = 8) did not warn the user about the standard practice of dose reduction when opioid switching. There was a statistically significant difference in the mean conversion output for hydromorphone (oral) between apps with and without medical professional involvement (0.2256 vs 0.2536; p = 0.0377).


There are significant concerns with regard to the reliability of information provided by apps offering opioid dose conversion, with lack of information regarding evidence-based content and peer review in many cases. It is crucial that better regulation of medical apps is instigated in order to ensure that patient safety is maintained.

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  1. World Health Organisation. Cancer pain relief and palliative care. Geneva: World Health Organisation; 1996.

    Google Scholar 

  2. Knotkova H, Fine PG, Portenoy R. Opioid rotation: the science and the limitations of the equianalgesic dose table. J Pain Symptom Manage. 2009;38(3):426–39.

    Article  PubMed  CAS  Google Scholar 

  3. Foley KM. The treatment of cancer pain. N Engl J Med. 1985;313:84–95.

    Article  PubMed  CAS  Google Scholar 

  4. Quigley C. Opioid switching to improve pain relief and drug tolerability. Cochrane Database Syst Rev 2004;(3):CD004847.

  5. Shaheen PE, Walsh D, Lasheen W, et al. Opioid equianalgesic tables: are they all equally dangerous? J Pain Symptom Manage. 2009;38(3):409–17.

    Article  PubMed  Google Scholar 

  6. Pereira J, Lawlor P, Vigano A, et al. Equianalgesic dose ratios for opioids: a critical review and proposals for long-term dosing. J Pain Symptom Manage. 2001;22(2):672–87.

    Article  PubMed  CAS  Google Scholar 

  7. Visvanathan A, Hamilton A, Brady RRW. Smartphone apps in microbiology: is better regulation required? Clin Microbiol Infect. 2012;18(7):e218–20.

    Article  PubMed  CAS  Google Scholar 

  8. Franko OI, Tirrell TF. Smartphone app use among medical providers in ACGME training programs. J Med Syst. Epub 2011 Nov 4.

  9. Heaton A, Webb DJ, Maxwell SRJ. Undergraduate preparation for prescribing: the views of 2314 UK medical students and recent graduates. Br J Clin Pharmacol. 2008;66(1):128–34.

    Article  PubMed  Google Scholar 

  10. Dornan T, Ashcroft D, Heathfield H, et al. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education—EQUIP study. London: General Medical Council; 2009.

    Google Scholar 

  11. Rothwell C, Burford B, Morrison J, et al. Junior doctors prescribing: enhancing their learning in practice. Br J Clin Pharmacol. 2012;73(2):194–202.

    Article  PubMed  Google Scholar 

  12. Ofcom. The Communications Market Report: United Kingdom. Available from URL: Accessed 2 Aug 2012.

  13. NHS National Patient Safety Agency. Reducing dosing errors with opioid medicines. Rapid Response Report. NPSA, 4 July 2008. Report no. NPSA/2008/RRR05. Available from URL: Accessed 2 Aug 2012.

  14. Shaheen PE, Legrand SB, Walsh D, et al. Errors in opioid prescribing: a prospective survey in cancer pain. J Pain Symptom Manage. 2010;39(4):702–11.

    Article  PubMed  Google Scholar 

  15. Rich BA, Webster LR. A review of forensic implications of opioid prescribing with examples from malpractice cases involving opioid-related overdose. Pain Med. 2011;12(Suppl. 2):59–65.

    Article  Google Scholar 

  16. National Institute for Health and Clinical Excellence. Opioids in palliative care: safe and effective prescribing of strong opioids for pain in palliative care of adults (CG140). London: National Institute for Health and Clinical Excellence; 2012.

    Google Scholar 

  17. Plagge H, Ruppen W, Ott N, et al. Dose calculation in opioid rotation: electronic calculator vs manual calculation. Int J Clin Pharm. 2011;33:25–32.

    Article  PubMed  Google Scholar 

  18. Kho A, Henderson E, Dressler DD, et al. Use of handheld computers in medical education. J Gen Intern Med. 2006;21:531–7.

    Article  PubMed  Google Scholar 

  19. Maxwell S, Mucklow J. e-Learning initiatives to support prescribing. Br J Clin Pharmacol. Epub 2012 Apr 18.

  20. Davies BS, Rafique J, Vincent TR, et al. Mobile Medical Education (MoMEd). How mobile information resources contribute to learning for undergraduate clinical students: a mixed methods study. BMC Med Educ. 2012;12(12):1.

    Article  PubMed  Google Scholar 

  21. Flannigan C, McAloon J. Students prescribing emergency drug infusions utilising smartphones outperformed consultants using the BNFCs. Resuscitation. 2011;82(11):1424–7.

    Article  PubMed  Google Scholar 

  22. McQueen DS, Begg MJ, Maxwell SR. eDrugCalc: an online self-assessment package to enhance medical students’ drug dose calculation skills. Br J Clin Pharmacol. 2010;70(4):492–9.

    Article  PubMed  Google Scholar 

  23. Hamilton AD, Brady RR. Medical professional involvement in smartphone apps in dermatology. Br J Dermatol. Epub 2012 Jan 27.

  24. O’Neill S, Brady RRW. Colorectal apps; opportunities and risks. Colorectal Dis. 2012;14(9):1043–170.

    Article  Google Scholar 

  25. Rosser BA, Eccleston C. Smartphone applications for pain management. J Telemed Telecare. 2011;17(6):308–12.

    Article  PubMed  Google Scholar 

  26. Medicines and Healthcare products Regulatory Agency. Medical device directive 93/42/EEC of 14 Jun 1993. Available from URL: Accessed 2 Aug 2012.

  27. Public Access Database for Medical Device Registration. Manufacturer’s By Device Z999 Burns Assessment-Burns Assessment. Available at URL: Accessed 2 Aug 2012.

  28. Visser BJ, Bouman J. There’s a medical app for that. Student BMJ 2012; 20: e2162. Reprinted in BMJ Careers 2012 Apr 18. Available from URL: Accessed 28 Aug 2012.

  29. D4. Regulation of health apps: a practical guide. Available from URL: Accessed 23 Aug 2012.

  30. US Department of Health and Human Services, Food and Drug Administration. Draft guidance for industry and food and drug administration staff: mobile medical applications. Available from URL: Accessed 2 Aug 2012.

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No external funding was used to assist in the preparation of this study. Richard Brady is owner of, a company that develops medical apps and provides mHealth solutions. Faye Haffey and Simon Maxwell have no conflicts of interest that are directly relevant to the content of this study.

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Correspondence to Richard R. W. Brady.

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Haffey, F., Brady, R.R.W. & Maxwell, S. A Comparison of the Reliability of Smartphone Apps for Opioid Conversion. Drug Saf 36, 111–117 (2013).

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