Risk of Continued Opioid Use (COU)
HEDIS Measure
Risk of Continued Opioid Use (COU)
Line of business: Commercial Medicaid Medicare
Data Collection Method: Administrative
Measure Description
The percentage of members 18 years of age and older who have a new episode of opioid use that puts them at risk for continued opioid use. Two rates are reported:
- The percentage of members with at least 15 days of prescription opioids in a 30-day period.
- The percentage of members with at least 31 days of prescription opioids in a 62-day period.
*Inverted Measure
Numerator Compliance
≥15 Days Covered - Members who had 15 or more calendar days covered by an opioid medication during the 30-day period beginning on the IPSD through 29 days after the IPSD.
≥31 Days Covered - Members who had 31 or more calendar days covered by an opioid medication during the 62-day period beginning on the IPSD through 61 days after the IPSD.
IPSD - Index Prescription Start Date. The earliest prescription dispensing date for any statin medication of any intensity during the measurement year.
Best Practices
- Reference the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
Opioid Medications
Prescription | Medication Lists |
---|---|
Benzhydrocodone | Acetaminophen Benzhydrocodone Medications List |
Buprenorphine (transdermal patch and buccal film) | Buprenorphine Medications List |
Butorphanol | Butorphanol Medications List |
Codeine | Acetaminophen Butalbital Caffeine Codeine Medications List, Acetaminophen Codeine Medications List, Aspirin Butalbital, Caffeine Codeine Medications List, Aspirin Carisoprodol Codeine Medications List, Aspirin Codeine Medications List, Codeine Phosphate Medications List, Codeine Sulfate Medications List |
Dihydrocodeine | Acetaminophen Caffeine Dihydrocodeine Medications List, Aspirin Caffeine Dihydrocodeine Medications List |
Fentanyl | Fentanyl Medications List |
Hydrocodone | Acetaminophen Hydrocodone Medications List, Hydrocodone Medications List, Hydrocodone Ibuprofen Medications List |
Hydromorphone | Hydromorphone Medications List |
Levorphanol | Levorphanol Medications List |
Meperidine | Meperidine Medications List, Meperidine Promethazine Medications List |
Methadone | Methadone Medications List |
Morphine | Morphine Medications List, Morphine Naltrexone Medications List |
Opium | Belladonna Opium Medications List, Opium Medications List |
Oxycodone | Acetaminophen Oxycodone Medications List, Aspirin Oxycodone Medications List, Ibuprofen Oxycodone Medications List Oxycodone Medications List |
Oxymorphone | Oxymorphone Medications List |
Pentazocine | Naloxone Pentazocine Medications List |
Tapentadol | Tapentadol Medications List |
Tramadol | Acetaminophen Tramadol Medications List, Tramadol Medications List |