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 #11 - Concurrent Use of Opioids and Benzodiazepines

Recommendation #11:

Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible (recommendation category: A, evidence type: 3).

Functional Description

  • When
    • Provider is prescribing an opioid analgesic with ambulatory misuse potential in the outpatient setting:
    • Provider is prescribing a benzodiazepine medication
    • 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 prescribed opioid analgesic with ambulatory misuse potential and benzodiazepine medication concurrently
  • Then
    • Recommend to avoid prescribing opioid pain medication and benzodiazepine concurrently:
      • Will revise
      • 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 #11 PlanDefinition Event-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #11
Recommendation #11 - concurrent opioid pain medication and benzodiazepines prescriptions Library Defines the data requirements to support evaluation of recommendation #11
CDC Opioid Prescribing Guideline Recommendation #11 CQL Source For reference, the complete CQL content for Recommendation #11

Example Data/Requests

Description Bundle CDS Hooks Request Expected Response
Patient is 18 or older. Patient is being prescribed Flurazepam Hydrochloride 15 MG Oral Capsule (RxNorm code 1298088), once per day for 30 days. Patient is also being prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RxNorm code 1049502), once per day for 30 days. This triggers a message with the recommendation to avoid prescribing opioid pain medication and benzodiazepine concurrently with following three feedback options: i. Revise ii. Indicate that the benefits outweigh the risks 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
Patient is 18 or older. Patient is being prescribed Flurazepam Hydrochloride 15 MG Oral Capsule (RxNorm code 1298088), once 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 is being prescribed Flurazepam Hydrochloride 15 MG Oral Capsule (RxNorm code 1298088), once per day for 30 days. Patient is also being prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RxNorm code 1049502), once per day for 30 days. This triggers a message with the recommendation to avoid prescribing opioid pain medication and benzodiazepine concurrently with following three feedback options: i. Revise ii. Indicate that the benefits outweigh the risks 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
Patient is 18 or older. Patient is being prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RxNorm code 1049502), once 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