8.9.0 Recommendation #8 - Naloxone Consideration

Recommendation #8:

Before starting and periodically during continuation of opioid therapy, clinicians should evaluate risk factors for opioid-related harms. Clinicians should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present (recommendation category: A, evidence type: 4).

8.9.1 Functional Description

Patient is being prescribed opioids for chronic pain.

Patient does not appear to be at end of life.

Patient is not currently prescribed Naloxone.

Determine whether patient is being prescribed Benzodiazepine.

Calculate the morphine milligram equivalence (MME) for the opioid being prescribed plus any other active opioid prescriptions.

Determine whether patient has a history of substance abuse

Substance Abuse History:

  • ICD10: F10-F19, Mental and behavioral disorders due to psychoactive substance use
  • ICD9: 304, Drug dependence and 303, Alcohol dependence syndrome

If the patient is not being prescribed Naloxone AND is currently prescribed Benzodiazepine OR MME >= 50 OR has history of substance abuse, provide a recommendation to offer Naloxone:

Consider offering naloxone given following risk factor(s) for opioid overdose: (average MME >= 50/day), (concurrent use of benzodiazepine), (history of alcohol or drug abuse).

Provide links to the CDC Guidance.

One of the following responses should be required:

  • Will offer Naloxone.
  • 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.

8.9.2 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 #8PlanDefinitionEvent-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #8
Recommendation #8 - risk factors for opioid-related harms before and during opioid therapyLibraryDefines the data requirements to support evaluation of recommendation #8
Recommendation #8 - risk factors for opioid-related harms before and during opioid therapySTU3 CQL SourceFor reference, the complete CQL source for recommendation #8