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 #10 - Urine Drug Testing

Recommendation #10:

When prescribing opioids for chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs (recommendation category: B, 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
    • Urine drug screening has not been performed in last 12 months
  • Then
    • Recommend urine drug screening:
      • Will perform urine screening
      • Not for chronic pain management, snooze 3 months
      • N/A - see comment; snooze 3 months

For Chronic Pain

Chronically on Opioids

Opioid Review Useful

Active Cancer Treatment


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 #10 PlanDefinition Event-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #10
Recommendation #10 - urine drug testing when prescribing opioids for chronic pain Library Defines the data requirements to support evaluation of recommendation #10
CDC Opioid Prescribing Guideline Recommendation #10 CQL Source For reference, the complete CQL content for Recommendation #10

Example Data/Requests

Description Bundle CDS Hooks Request Expected Response
Patient 18 or older. Patient is being prescribed 72 HR Fentanyl 0.075 MG/HR Transdermal System (RxNorm code 197696), once every 12 days for 30 days. This triggers the message that urine drug screening is recommended with the following three feedback options: i. Perform the screening ii. Indicate that the prescription is not for chronic pain management and snooze for 3 months iii. Indicate that it is not applicable, log a comment and snooze for 3 months. Test Bundle Request JSON Response JSON