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 #3 - Opioid Therapy Risk/Benefit Discussion

Recommendation #3:

Before starting and periodically during opioid therapy, clinicians should discuss with patients known risks and realistic benefits of opioid therapy and patient and clinician responsibilities for managing therapy (recommendation category: A, evidence type: 3).

Functional Description

  • When
    • Provider is prescribing an opioid 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 does not have documented discussion of opioid harms and risks in the past 90 days, including today
  • Then
    • Recommend counseling regarding potential opioid harms and risks. Potential actions include:
      • Order counseling
      • Document that counseling was provided
      • Document the reason for not counseling; snooze 3 months
      • N/A - see comment; snooze 3 months

For Chronic Pain

Chronically on Opioids

Opioid Review Useful

Active Cancer Treatment

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 #3 PlanDefinition Event-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #3
Recommendation #3 - Opioid Therapy Risk/Benefit Discussion Library Defines the data requirements to support evaluation of recommendation #3
CDC Opioid Prescribing Guideline Recommendation #3 CQL Source For reference, the complete CQL content for Recommendation #3

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” and a “documented discussion of opioid harms and risks” procedure completed 91 days prior to today. Patients “Dosage Instructions” are 1 Film per day for 30 days. This will result in a summer message: “Recommend counseling regarding potential opioid harms and risks” Test Bundle Request JSON Response JSON
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” and a “documented discussion of opioid harms and risks” procedure completed 88 days prior to today. Patients “Dosage Instructions” are 1 Film per day for 30 days. This will not result in any recommendation messages. Test Bundle Request JSON Response JSON