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 #9 - Consider Patient’s History of Controlled Substance Prescriptions

Recommendation #9:

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:
    • 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
    • PDMP data has not been reviewed in the past 90 days
  • Then
    • Notify the prescriber that PDMP data for this patient has not been reviewed in the past 90 days. Potential actions include:
      • Recommend launch of SMART-APP to search PDMP data for this patient
      • Document PDMP data reviewed; snooze 3 months
      • N/A - see comment; snooze 3 months

For Chronic Pain

Chronically on Opioids

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 #9 PlanDefinition Event-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #9
Recommendation #9 - Consider Patient’s History of Controlled Substance Prescriptions Library Defines the data requirements to support evaluation of recommendation #9
CDC Opioid Prescribing Guideline Recommendation #9 CQL Source For reference, the complete CQL content for Recommendation #9

Example Data/Requests

Description Bundle CDS Hooks Request Expected Response
Patient is 18 or older. Patient has been prescribed Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) Patients “Dosage Instructions” are 1 FIlm per day for 30 days. This will trigger the message “PDMP Data Review” Test Bundle Request JSON Response JSON
Patient is 18 or older. Patient has been prescribed Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) Patients “Dosage Instructions” are 1 Film 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