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 #5 - Lowest Effective Dose

Recommendation #5:

When opioids are started, providers should prescribe the lowest effective dosage. Providers should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to >90 MME/day (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 Morphine Milligram Equivalent (MME) greater than or equal to 50
  • Then
    • Recommend to consider tapering dosage when MME is greater than or equal to 50 and less than 90 or taper dosage now when MME is greater than or equal to 90:
      • Will reduce dosage
      • Benefits outweigh risks, snooze 3 months
      • Active pain, snooze 1 month
      • 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

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 #5 PlanDefinition Event-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #5
Recommendation #5 - lowest effective dosage Library CQL Library that provides logic for evaluating whether a prescription exceeds the MME of 50 mg/day
CDC Opioid Prescribing Guideline Recommendation #5 CQL Source For reference, the complete CQL content for Recommendation #5

Example Data/Requests

Description Bundle CDS Hooks Request Expected Response
Patient is 18 or older. Patient has been prescribed 72 HR Fentanyl 0.075 MG/HR Transdermal System (RXNorm 197696) one patch per 3 days for 30 days.This will trigger the message “High risk for opioid overdose - taper now” It will then link to the “MME Conversation Tables” "https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf" Test Bundle Request JSON Response JSON
Patient is 18 or older. Patient has been prescribed 72 HR Fentanyl 0.075 MG/HR Transdermal System (RXNorm 197696) one patch per 12 days for 30 days.The patient will be excluded and no message will be triggered – an empty set of cards will be returned. Test Bundle Request JSON Response JSON