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 #8 - Naloxone Consideration

Recommendation #8:

Before starting and periodically during continuation of opioid therapy, clinicians should evaluate risk factors for opioid-related harms. Clinicians should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present (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 is not currently prescribed naloxone medications
    • Factors that increase risk for opioid overdose are present:
      • Concurrent benzodiazepine use
      • High opioid dosages (MME/day >= 50)
      • History of substance abuse
  • Then
    • Recommend performing opioid misuse assessment:
      • Will offer naloxone medications
      • 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 #8 PlanDefinition Event-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #8
Recommendation #8 - risk factors for opioid-related harms before and during opioid therapy Library Defines the data requirements to support evaluation of recommendation #8
CDC Opioid Prescribing Guideline Recommendation #8 CQL Source For reference, the complete CQL content for Recommendation #8

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) 1 patch per 10 days for 30 days. This will trigger the message “Incorporate into the management plan strategies to mitigate risk; including considering offering naloxone when factors that increase risk for opioid overdose are present”Consider offering naloxone given following risk factor(s) for opioid overdose: Average MME (54.000000 'mg/d') >= 50 mg/day. 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) 1 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
Patient is 18 or older. Patient has been prescribed 72 HR Fentanyl 0.075 MG/HR Transdermal System (RXNorm 197696) 1 patch per 12 days for 30 days. Patient has also been prescribed Temazepam 20 MG Oral Tablet (RXNorm 104693) 1 tablet per 1 day for 30 days. This will trigger the message “Incorporate into the management plan strategies to mitigate risk; including considering offering naloxone when factors that increase risk for opioid overdose are present. Consider offering naloxone given following risk factor(s) for opioid overdose: concurrent use of benzodiazepine. 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) 1 patch per 12 days for 30 days. Patient has also been prescribed Naloxone Hydrochloride 0.02 MG/ML Injectable Solution (RXNorm 1191212) 1ml per 1 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 72 HR Fentanyl 0.075 MG/HR Transdermal System (RXNorm 197696) 1 patch per 12 days for 30 days. This will trigger the message "Incorporate into the management plan strategies to mitigate risk; including considering offering naloxone when factors that increase risk for opioid overdose are present" Consider offering naloxone given following risk factor(s) for opioid overdose: history of alcohol or drug abuse. Test Bundle Request JSON Response JSON