Evaluation of Clinical Decision Support in Opioid Tapering

The 2022 Center for Disease Control and Prevention (CDC) clinical practice guideline for prescribing opioids for pain recommends that when tapering a patient's opioid dose, doses should be decreased at a slow rate to reduce the risk of withdrawal symptoms, overdose, and to promote tolerance of the tapering. This project will evaluate a clinical decision support (CDS) tool in the form of a clinical care pathway that gives providers information, recommendations, and educational material on strategies for opioid tapering. Primary care providers will be randomized at the clinic location to a control arm or intervention arm. The control arm will have the clinical care pathway available, but will not be reminded of the pathway when tapering a patient. The intervention arm will receive a nudge when prescribing a tapering opioid strategy to a patient to use the clinical care pathway. The rate of opioid tapering in line with CDC guidelines will be examined as well as long-term patient outcomes of opioid overdose or poisoning using existing patient health records. The study period will be approximately 18 months.

Inclusion Criteria: Primary care patients being tapered from an opioid. Tapering patients: * Have an active opioid prescription for more than 3 months and * Prescribed more than 90 morphine milligram equivalents (MME) per day or * Co-prescribed an opioid and benzodiazepine or * Received a reduction in opioid dosage by more than 5% MME per day Exclusion Criteria: * Patients \<12 and \>89 * Patients with active cancer diagnosis in last 1 year * Patients with hospice care/palliative care order * Patients with sickle cell disease diagnosis