Additional disclaimer language

[brynrhodes]

Make the following additional changes to the disclaimers sections:

Add a section header for Cautions

Add a section for cautions on the MMECalculator page and the Conversion Factors page

Link to cautions from Home Page

Change the MME Calculation Caution in the Home Page Disclaimers Section to remove the NOTE and replace that paragraph with:

Consult the caution sections of the [MMECalculator](link to cautions section) and [ConversionFactors(link to cautions section) pages for important cautions regarding the use of the MME calculator and conversion factors included in this implementation guide.

Update language in the Caution: on the MMECalculator page to:

“Caution: Do not use the calculated dose in MMEs to determine dosage for converting one opioid to another—the new opioid should be dosed lower to avoid unintentional overdose caused by incomplete cross-tolerance and individual differences in opioid pharmacokinetics. Consult the medication label.”

Add the following additional cautions to the MMECalculator page:

• Caution: Dosage thresholds in the 2016 CDC Guideline are based on overdose risk when opioids are prescribed for pain and should not guide dosing of medication treatment for opioid use disorder (MOUD).
• Caution: Tapentadol is a mu receptor agonist and norepinephrine reuptake inhibitor. MMEs are based on degree of mu-receptor agonist activity, but it is unknown if this drug is associated with overdose in the same dose-dependent manner as observed with medications that are solely mu receptor agonists.

Add the following additional cautions to the Conversion Factors page:

• Caution: Buprenorphine, as a partial opioid agonist, is not associated with overdose in the same dose-dependent manner as observed with medications that are full opioid agonists, and is not/should not be included in the calculator
• Caution: Equianalgesic dose conversions are only estimates and cannot account for individual variability in genetics and pharmacokinetics.

[gregoryawhite]

CDC has updated the language of one of cautions above as of Dec 18, 2020. The original caution read "Dosage thresholds in the 2016 CDC Guideline are based on overdose risk when opioids are prescribed for pain and should not guide dosing of medication treatment for opioid use disorder (MOUD)."

The updated language reads "Dosage thresholds in the 2016 CDC Guideline are based on overdose risk when opioids are prescribed for pain and should not guide dosing of medication treatment for opioid use disorder (i.e., medication-assisted treatment [MAT])." The updated version should be used.