Use of Opioids at High Dosage in Persons Without Cancer

Pain is among the most common reasons adults seek medical care. The clinical impact of this measure is high, as opioids can lead to unintended consequences. Abuse and overdose of opioids is a major public health issue. Although the 2022 CDC guideline for prescribing opioids for chronic pain does not set a dose threshold, physicians should be aware of risks and reduce dosage safely . The CDC guideline excludes patients with sickle cell disease; the PMC would like an exclusion for sickle cell disease to follow the current CDC guideline recommendation. Specifications for this performance measure lack clarity, and this could lead to incorrect calculations. The committee noted that the denominator time frame for assessing patients with two opioid prescriptions over the measurement year is appropriate. However, it is atypical for a physician to prescribe opioids that will last longer than 30 days. This performance measure is tested and validated at the health plan level and is only currently implemented at that level. However, the committee noted that these performance measures can impact physicians at the individual physician level if they participate in an integrated delivery system. Some delivery systems lack standardized data management systems, making obtaining the patient’s medication history challenging. Physicians in areas with higher cross coverage, i.e., physicians who provide care for other physicians when they are not available, may be penalized. Some electronic health records (EHRs) do not recognize free text directions, which prevents the calculation of morphine milligram equivalents (MME). The EHR will not capture patients with potentially high dosage of opioids if the MME calculation is not implemented correctly. The health plan attribution is logical because health plans can implement hard stops on opioid ordering within their EHR systems.