8.6.0 Recommendation #4 - Opioid Release Rate When Starting Opioid Therapy

Recommendation #4:

When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids (recommendation category: A, evidence type: 4).

8.6.1 Functional Description

Patient is being prescribed opioids for chronic pain.

Patient does not appear to be at end of life.

Patient is being prescribed extended release opioids with ambulatory abuse potential.

Patient has not been prescribed an opioid with ambulatory abuse potential in the past 90 days.

There exists an encounter with the patient in the past 12 months.

This is to ensure that the patient is not new to the system.

If prescribed extended release opioid and encounter in past 12 months without prescription for opioid in past 90 days, provide a recommendation to use immediate release:

Recommend use of immediate-release opioids instead of extended release/long acting opioids when starting patient on opioids.

Provide links to the CDC Guidance.

One of the following responses should be required:

  • Will prescribe immediate release
  • Risk of overdose carefully considered and outweighed by benefit; snooze 3 months.
  • N/A-see comment (will be reviewed by medical director); snooze 3 months.

8.6.2 Content

The following artifacts formalize the description of the logic and behavior defined by this recommendation.

ResourceTypeDescription
Opioid Terminology Management Knowledgdebase Logic (OMTK) LibraryLibraryCQL Library that provides logic for implementation of opioid management functionality including Milligram Morphine Equivalents (MME).
Opioid Terminology Management Knowledgebase Logic (OMTK)CQL SourceFor reference, the complete CQL source for the OMTK Logic Library.
Opioid Terminology Management Knowledgdebase Data (OMTK) LibraryLibraryCQL Library that provides logic for implementation of opioid management functionality including Milligram Morphine Equivalents (MME).
Opioid Terminology Management Knowledgebase Data (OMTK)CQL SourceFor reference, the complete CQL source for the OMTK Logic Library.
Common Opioid Decision Support LogicLibraryCQL Library that provides common logic for the recommendations
Common Opioid Decision Support LogicSTU3 CQL SourceFor reference, the complete CQL source for the common logic.
CDC Opioid Prescribing Guideline Recommendation #4PlanDefinitionEvent-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #4
Recommendation #4 - prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioidsLibraryDefines the data requirements to support evaluation of recommendation #4
Recommendation #4 - prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioidsSTU3 CQL SourceFor reference, the complete CQL content for recommendation #4