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 #12 - Evidence-based Treatment for Patients with Opioid Use Disorder

Recommendation #12:

Clinicians should offer or arrange evidence-based treatment (usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies) for patients with opioid use disorder (recommendation category: A, evidence type: 2).

Functional Description

  • When
    • Patient is 18 years and older and not receiving evidence-based treatment for opioid use disorder, which may include medication treatment with buprenorphine or methadone, or opioid-specific behavioral counseling
    • Patient has a diagnosis of opioid use disorder in the past 90 days
    • Patient has an order for or performance of substance misuse behavioral counseling in the past 90 days
  • Then
    • Recommend opioid agonist or partial agonist treatment with methadone maintenance therapy, buprenorphine therapy, and/or behavioral therapy. Potential actions include:
      • Order methadone or buprenorphine
      • Refer to qualified treatment provider (i.e. substance disorder specialist)
      • N/A - see comment; snooze 3 months

Rationale for Medication-Assisted Treatment or Behavioral Therapy

Definition Expression Data (Terminology) Requirement
Presence of diagnosis of opioid use disorder Existing active diagnosis of opioid use disorder
  • Opioid use disorder value set
Positive result from opioid use disorder evaluation tool
  • Evidence of positive result from opioid use disorder evaluation tool
  • Timing – within 90 days
  • Value set for opioid use disorder evaluation tool(s) – LOINC pan
  • Result options for such opioid use disorder evaluation tool(s) – perhaps LOINC normative responses that differentiate positive from negative results.
  • Consider this element a FUTURE option
Opioid metabolites in urine drug screening
  • Urine drug screening tests – need to evaluate ALL urine screening tests and not just the first one found performed in last 90 days
  • Evidence of positive result from screening tests
  • Urine drug screening tests (perhaps a LOINC panel)
  • Consider this element a FUTURE option
MME >= 90
  • Calculate per Recommendation 5
  • Consider whether the correct result should be >= 90 due to the potential for over-use. Also, consider whether the preferred assessment should be MME (i.e., maximum morphine equivalents that may be taken any given day of a prescription duration), or AME (i.e., average morphine equivalents for all days within the prescription duration).
  • Dispensed data will require AME since the sig (if present) is not structured.
  • No new value sets except in the situation where dispensed drug is used (i.e., NDC codes) instead of prescribed.

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 #12 PlanDefinition Event-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #12
Recommendation #12 - Evidence-based Treatment for Patients with Opioid Use Disorder Library Defines the data requirements to support evaluation of recommendation #12
CDC Opioid Prescribing Guideline Recommendation #12 CQL Source For reference, the complete CQL content for Recommendation #12

Example Data/Requests

Description Bundle CDS Hooks Request Expected Response
Patient is 18 or older. Patient has a diagnosis of opioid misuse disorder in past 90 days. This will trigger the message “Recommend opioid agonist or partial agonist treatment with methadone maintenance therapy or buprenorphine and/or behavioral therapy”. Test Bundle Request JSON Response JSON
Patient is 18 or older. Patient has not been diagnosed with opioid misuse disorder in the past 90 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