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 #6 - Prescribe Lowest Effective Dose and Duration

Recommendation #6:

Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed (recommendation category: A, evidence type: 4).

Functional Description

  • When
    • Provider is prescribing an opioid analgesic with ambulatory misuse potential in the outpatient setting
    • 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
    • Prescription is for treating acute pain.
    • Prescription is for more than 7 days or for an extended release opioid
  • Then
    • Recommend limiting therapy to no more than 3 days with an absolute maximum of 7 days and limit to immediate release opioids. Potential actions include:
      • Change order to ≤ 7 days
      • Document reason for not limiting therapy; snooze 3 months
      • N/A - see comment; snooze 3 months

For Acute Pain

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 #6 PlanDefinition Event-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #6
Recommendation #6 - Prescribe Lowest Effective Dose and Duration Library Defines the data requirements to support evaluation of recommendation #6
CDC Opioid Prescribing Guideline Recommendation #6 CQL Source For reference, the complete CQL content for Recommendation #6

Example Data/Requests

Description Bundle CDS Hooks Request Expected Response
Patient is 18 or older. Patient has been prescribed oxyCODONE HCl 10 MG 12HR Extended Release Oral Tablet (RXNorm 1049502). Patients “Dosage Instructions” are 1 Tablet per day for 29 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
Patient is 18 or older. Patient has been prescribed oxyCODONE HCl 10 MG 12HR Extended Release Oral Tablet (RXNorm 1049502).Patients “Dosage Instructions” are 1 Tablet per day for 27 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