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 #4 - Opioid Release Rate When Starting Opioid Therapy

Recommendation #4:

When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids (recommendation category: A, evidence type: 4).

Functional Description

  • When
    • Provider is prescribing an extended release 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 use of immediate release opioids:
      • Will prescribe immediate release opioid analgesic with ambulatory misuse potential
      • Benefits outweigh risks, snooze 3 months
      • N/A - see comment, snooze 3 months

For Chronic Pain

Chronically on Opioids

Opioid Review Useful

Active Cancer Treatment

Opioid Naive

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 #4 PlanDefinition Event-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #4
Recommendation #4 - prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids Library Defines the data requirements to support evaluation of recommendation #4
CDC Opioid Prescribing Guideline Recommendation #4 CQL Source For reference, the complete CQL content for Recommendation #4

Example Data/Requests

Description Bundle CDS Hooks Request Expected Response
Patient is 18 years or older and has a Medication Request authored “Today” for 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet which is an “Extended Release Opioid with Ambulatory Abuse Potential.” Additionally, the patient has a previous encounter within the past 12 months. This will result in a recommendation message: “Recommend use of immediate-release opioids instead of extended release/long acting opioids when starting patient on opioids.” Test Bundle Request JSON Response JSON
Patient is 18 years or older and has a Medication Request authored “Today” for 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet which is an “Extended Release Opioid with Ambulatory Abuse Potential. The patient does not have a previous encounter within the past 12 months and will not result in any recommendation messages. Test Bundle Request JSON Response JSON
Patient is 18 years or older and has a Medication Request authored 4 months prior to today for 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet which is an “Extended Release Opioid with Ambulatory Abuse Potential. Additionally, the patient has a Medication Request authored “Today” for Buprenorphine 2 MG / Naloxone 0.5 MG Oral Strip which is not an “Extended Release Opioid…” This will not result in any recommendation messages. Test Bundle Request JSON Response JSON
Patient is 18 years or older and has a 2 Medication Requests authored “Today” and 14 days prior to today, respectively, for 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet which is an “Extended Release Opioid with Ambulatory Abuse Potential. Patient also has a previous encounter within the past 12 months but will not result in any recommendation messages as the patient is excluded by having a prior extended release opioid Medication Request within the preceding 91 days. Test Bundle Request JSON Response JSON