Evaluation or Interview for Risk of Opioid Misuse
All patients 18 and older prescribed opiates for longer than six weeks duration evaluated for risk of opioid misuse using a brief validated instrument (e.g. Opioid Risk Tool, SOAPP-R) or patient interview documented at least once during Opioid Therapy in the medical record.
ACP supports QPP measure 414: "Evaluation or Interview for Risk of Opioid Misuse” because implementation will likely lead to measureable and meaningful improvements in patient outcomes and prevent the misuse and abuse of opioid prescription therapy. Additionally, the measure aligns with clinical recommendations and state requirements on opioid prescription therapy. While we support this measure, evidence exists to suggest that opioid addiction develops in less than 6 weeks duration of prescribed therapy. As such, this measure could unfairly penalize clinicians who do not initiate opioid therapy (e.g., therapy initiated as part of a post-operative care program). Measure developers should consider updating the denominator specifications to include an evidence-based therapy duration. Also, the opioid measures would benefit from additional testing to determine which interventions are most impactful in preventing opioid misuse and abuse. Finally, a better measure may include exclusion criteria for patients receiving active cancer treatment, palliative care, and end-of-life care.