Use of Opioids from Multiple Providers in Persons without Cancer

The clinical impact of this measure is high, as pain is among the most common reasons adults seek medical care. Abuse and overdose of opioids is a major public health issue and can lead to unintended consequences. As an inverse performance measure, performance rates with lower scores indicate higher quality care. Performance rates ranged between 32-39 percent based on plan type, indicating a performance gap. (9). 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 could lead to incorrect calculations. The performance measure has been 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 affect physicians if they participate in an integrated delivery system. Some delivery systems lack standardized data management systems, which can make it difficult to obtain the patient’s medication history. Physicians in areas with higher cross coverage, i.e., physicians who provide care for other physicians when they are not available, may be penalized. Ultimately, the pharmacy is responsible for reviewing the prescription database and denying an opioid prescription. While all states have drug monitoring programs, not all states have a law dictating how often a prescriber must check the prescription database.