Opioid Prescribing Support Implementation Guide
4.0.0 - CI Build

Opioid Prescribing Support Implementation Guide, published by Centers for Disease Control and Prevention (CDC). This is not an authorized publication; it is the continuous build for version 4.0.0). This version is based on the current content of https://github.com/cqframework/opioid-cds-r4/ and changes regularly. See the Directory of published versions

Recommendation #1 - Nonpharmacologic and Nonopioid Pharmacologic Therapy Consideration

Recommendation #1:

Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate (recommendation category: A, evidence type: 3).

Functional Description

  • When
    • Provider is prescribing an opioid analgesic with ambulatory misuse potential in the outpatient setting
    • Prescription is for treating chronic pain.
    • Opioid review is useful for this patient:
      • Patient is 18 or over
      • Patient does not have findings indicating limited life expectancy
      • Patient does not have orders for therapies indicating end of life care
      • Patient is not undergoing active cancer treatment:
        • Patient has had at least 2 encounters within the past year with any diagnosis of cancer
    • Patient is opioid naive:
      • No indication of opioid use in the past 90 days from a prescription, self report, or a dispensing event
  • Then
    • Recommend the use of nonpharmacologic therapy and nonopioid pharmacologic therapy as an alternative. Potential actions include:
      • Document reason for opioid use
      • Document that alternative therapy was attempted, snooze 3 months
      • N/A - see comment, snooze 3 months
      • Select from order set for alternative therapies
      • Remove triggering medication

For Chronic Pain

Chronically on Opioids

Opioid Review Useful

Active Cancer Treatment

Opioid Naive

Content

The following artifacts formalize the description of the logic and behavior defined by this recommendation.

Common Libraries

Resource Type Description
CDC Opioid Prescribing Guideline Recommendation #1 PlanDefinition Event-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #1
Recommendation #1 - Nonpharmacologic and Nonopioid Pharmacologic Therapy Consideration Library Defines the data requirements to support evaluation of recommendation #1
CDC Opioid Prescribing Guideline Recommendation #1 CQL Source For reference, the complete CQL content for Recommendation #1

Example Data/Requests

Description Bundle CDS Hooks Request Expected Response
Patient is 18 years or older and has an outpatient Medication Request of Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) authored “Today” as well as a Medication Statement 95 days prior to today which will result in recommendation inclusion in addition to Opioid Naive & Opioid Review Useful inclusion. Patients "Dosage Instructions" are 1 Film per day for 30 days. This should result in a summary message: "Recommend use of nonpharmacologic therapy and nonopioid pharmacologic therapy as alternative." Test Bundle Request JSON Response JSON
Patient is 18 years or older and has an inpatient Medication Request of Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603). Patients “Dosage Instructions” are 1 Film per day for 30 days. This will result in an empty set of cards due to the Medication Request being inpatient. Test Bundle Request JSON Response JSON