8.10.0 Recommendation #10 - Urine Drug Testing

Recommendation #10:

When prescribing opioids for chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs (recommendation category: B, evidence type: 4).

8.10.1 Functional Description

The GetDrugNamesFromScreeningCodes(value List<FHIR.Coding>) function extracts the drug name from the display value for the given code. The expectation is that the drug name will be at the beginning of the string and will end with any of the following characters/strings: ‘[‘, ‘tested’, ‘cutoff’. Anything in the string that precedes the first occurrence of any of those characters/strings will be assumed to be the drug name.

The "Missing Opioids" set is identified by comparing the medication code displays with the urine drug screen code's displays - a dependency that implementers should be aware of.

Patient is being prescribed opioids for chronic pain.

Patient does not appear to be at end of life.

Patient has not had a urine drug screening within the last 12 months

Display a message indicating that urine drug testing results are not available within the last 12 months. Patient should have a urine drug test performed.

One of the following responses should be required:

  • Will perform urine screening
  • Not for chronic pain management; snooze 3 months
  • N/A-see comment (will be reviewed by medical director); snooze 3 months.

Patient has a urine drug screening but does test not positive for opioids, or tests positive for other drugs

Display a message indicating that urine drug testing results are inconsistent with the patient's medication regimen.

8.10.2 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 #10PlanDefinitionEvent-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #10
Recommendation #10 - urine drug testing when prescribing opioids for chronic painLibraryDefines the data requirements to support evaluation of recommendation #10
CDC Opioid Prescribing Guideline Recommendation #10 Patient ViewPlanDefinitionEvent-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #10
Recommendation #10 Patient View - urine drug testing when prescribing opioids for chronic painLibraryDefines the data requirements to support evaluation of recommendation #10
Recommendation #10 - urine drug testing when prescribing opioids for chronic painSTU3 CQL SourceFor reference, the complete CQL source for recommendation #10
Recommendation #10 Patient View - urine drug testing when prescribing opioids for chronic painSTU3 CQL SourceFor reference, the complete CQL source for recommendation #10