8.8.0 Recommendation #7 - Opioid Therapy Risk Assessment

Recommendation #7:

Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently. If benefits do not outweigh harms of continued opioid therapy, clinicians should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue opioids (recommendation category: A, evidence type: 4).

8.8.1 Functional Description

The ranges introduced are based on practical considerations for identifying a course of treatment likely to be subject to the recommendation. They were arrived at through discussion with pilot partner clinicians.

Patient is being prescribed opioids for chronic pain.

Patient does not appear to be at end of life.

Determine whether patient has been assessed for benefits and harms of opioid therapy in past 90 days.

Assessment of risk for opioid abuse:

  • Assessment of risk for opioid abuse (procedure) SCTID: 454281000124100
  • High risk drug monitoring (regime/therapy): SCTID: 268525008

Determine whether patient has taken opioid for at least seven of past ten days AND has an encounter in the past 12 months (excluding today)

OR

Determine whether patient has taken opioid for at least 21 of past 30 days for the past three months

If the patient has not been assessed for opioid risk in past 90 days and has taken opioid in seven of the past ten days with an encounter in the past 12 months or has taken opioid in 63 of the past 90 days, provide a recommendation to conduct an opioid therapy risk assessment:

Patients on opioid therapy should be evaluated for benefits and harms within 1 to 4 weeks of starting opioid therapy and every 3 months or more subsequently.

Provide a suggestion in the form of a Procedure resource populated with one of the risk assessment codes listed above.

In addition, provide links to the CDC Guidance.

One of the following responses should be required:

  • Will schedule assessment of risk for opioid use.
  • 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.

8.8.2 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 #7PlanDefinitionEvent-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #7
Recommendation #7 - benefits and harms of starting and/or continuing opioid therapy for chronic painLibraryDefines the data requirements to support evaluation of recommendation #7
Recommendation #7 - benefits and harms of starting and/or continuing opioid therapy for chronic painSTU3 CQL SourceFor reference, the complete CQL content for recommendation #7.