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 #7 - Opioid Therapy Risk Assessment

Recommendation #7:

Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently. If benefits do not outweigh harms of continued opioid therapy, clinicians should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue opioids (recommendation category: A, evidence type: 4).

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 has not undergone an opioid misuse assessment procedure in the last 90 days
  • Then
    • Recommend performing opioid misuse assessment:
      • Will schedule opioid misuse assessment
      • 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 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 #7 PlanDefinition Event-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #7
Recommendation #7 - benefits and harms of starting and/or continuing opioid therapy for chronic pain Library Defines the data requirements to support evaluation of recommendation #7
CDC Opioid Prescribing Guideline Recommendation #7 CQL Source For reference, the complete CQL content for Recommendation #7

Example Data/Requests

Description Bundle CDS Hooks Request Expected Response
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502).one tablet per day for 30 days. Patient is also being prescribed maCarbinoxamineleate 0.4 MG/ML / Hydrocodone Bitartrate 1 MG/ML / Pseudoephedrine Hydrochloride 6 MG/ML Oral Solution (RXNorm 1012727) 3 tablets per day 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
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) 1 tablet per day 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
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) one tablet per 1 day for 7 days. Patient has also been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm one tablet per 1 day for 7 days. "Assessment of risk for opioid use procedure." Patients on opioid therapy should be evaluated for benefits and harms within 1 to 4 weeks of starting opioid therapy and every 3 months or more subsequently. Assessment of risk for opioid abuse (procedure) Test Bundle Request JSON Response JSON
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet. (RXNorm 1049502) one tablet per 1 day for 6 days. Patient has also been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (Rxnorm 0149502) one tablet per 1 day for 6 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 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) one tablet per 1 day for 30 days. Patient has also been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) one tablet per 1 day for 63 days. This will trigger the message "No evaluation for benefits and harms associated with opioid therapy has been performed for the patient in the past 3 months" Patients on opioid therapy should be evaluated for benefits and harms within 1 to 4 weeks of starting opioid therapy and every 3 months or more subsequently. Test Bundle Request JSON Response JSON
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) 1 tablet per 1 day for 30 days. Patient has also been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) 1 tablet per 1 day for 62 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