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  2. CQM-6423

CMS506v5-Modern buprenorphine therapy should not be withheld based on presence or absence of benzodiazepine

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    • Icon: EC eCQMs EC eCQMs
    • Resolution: Answered
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    • Margaret McGee
    • 201-967-4000x 26381
    • Bergen New Bridge Medical Center
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      Thank you for your feedback on CMS506v5 Safe Use of Opioids-Concurrent Prescribing. We understand the challenges presented by the measure as it is currently specified regarding standards of care. We are currently reviewing potential exclusions for Opioid Use Disorder diagnosis and/or medications used for treatment of Opioid Use Disorders. We hope this helps.
      Show
      Thank you for your feedback on CMS506v5 Safe Use of Opioids-Concurrent Prescribing. We understand the challenges presented by the measure as it is currently specified regarding standards of care. We are currently reviewing potential exclusions for Opioid Use Disorder diagnosis and/or medications used for treatment of Opioid Use Disorders. We hope this helps.
    • CMS0506v5
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      This quality measure, though well-intentioned, will erroneously flag patient-records that are in compliance with current standard of care.

      The current opioid-benzodiazepine co-prescription quality measure will cause patients who have comorbid opioid use disorder and anxiety with or without benzodiazepine dependence, who are legitimately prescribed both buprenorphine and a benzodiazepine such as clonazepam to flag, despite being on evidence-based treatment.
      Show
      This quality measure, though well-intentioned, will erroneously flag patient-records that are in compliance with current standard of care. The current opioid-benzodiazepine co-prescription quality measure will cause patients who have comorbid opioid use disorder and anxiety with or without benzodiazepine dependence, who are legitimately prescribed both buprenorphine and a benzodiazepine such as clonazepam to flag, despite being on evidence-based treatment.

      This current standard is in contrast to prior trainings from 2003-2015 which noted that buprenorphine should be withheld from patients taking benzodiazepines, a view that is no longer considered standard of care.  

      It is the case that co-prescription of opioids and benzodiazepines increases the risk of unintentional overdose.  This risk, however, must be balanced against the risk of forced-tapering patients who have been chronically co-prescribed.  

      As an Addiction Treatment Unit, our patients frequently require co-prescription of opioid and benzodiazepine prescriptions at discharge to continue safe withdrawal management.

      Recommendation:
      Option A) Exclude buprenorphine from the opioid co-prescription source-list.
      Option B) Sort the buprenorphine+benzodiazepine co-prescription list separately.
      Option C) Provide a comment or note section that allows that clinician to justify the co-prescription and patient removed from measure.

            JLeflore Mathematica EH eCQM Team
            Peggy.McGee Margaret McGee
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