| name | langcare-opioid-risk |
| description | Performs opioid risk assessment by calculating morphine milligram equivalents (MME), applying Opioid Risk Tool scoring, and evaluating CDC 2022 guideline thresholds. Flags concurrent benzodiazepines, missing naloxone, and high-MME prescriptions. Use when asked to assess opioid risk, calculate MME, check opioid safety, or review opioid prescriptions.
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Opioid Risk Assessment
When to Use This Skill
Use when a clinician needs to evaluate opioid prescribing safety including total daily MME calculation, concurrent CNS depressant screening, ORT scoring, and CDC guideline compliance.
Clinical Workflow
- Use
fhir_read to retrieve Patient demographics (age, gender for ORT scoring)
- Use
fhir_search to pull all active MedicationRequest resources; classify as opioids, benzodiazepines, gabapentinoids, muscle relaxants, Z-drugs, naloxone
- Calculate total daily MME for each opioid using dose x frequency x MME conversion factor (see references/mme-conversion-table.md)
- Evaluate against CDC 2022 thresholds: <20 lower risk, 20-49 moderate, 50-89 caution, >=90 high risk
- Use
fhir_search to pull Condition resources for ORT scoring: substance use history, psychiatric diagnoses
- Apply Opioid Risk Tool scoring (gender-specific criteria)
- Use
fhir_search to check for recent urine drug screen (LOINC 19295-5) and pain assessments (LOINC 72514-3)
- Assess naloxone co-prescription status; recommend if MME >= 50 or concurrent CNS depressants
FHIR Resources
- MedicationRequest -- Active opioid and concurrent prescriptions with dosing details
- MedicationDispense -- Fill history for pattern analysis
- Patient -- Age and gender for ORT scoring
- Condition -- Psychiatric diagnoses, substance use history for ORT
- Observation -- Urine drug screen results, pain scores
FHIR Query Examples
Pull Active Medications
fhir_search(resourceType="MedicationRequest", queryParams="patient=[patient-id]&status=active&_count=100")
Pull Substance Use History
fhir_search(resourceType="Condition", queryParams="patient=[patient-id]&_count=100")
Pull Urine Drug Screen
fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&code=19295-5,3426-4&_sort=-date&_count=5")
Clinical Guidelines
- CDC 2022 Clinical Practice Guideline for Prescribing Opioids for Pain
- FDA REMS for extended-release/long-acting opioids
- PDMP (Prescription Drug Monitoring Program) check recommended before each opioid prescription
Interpretation Guide
- Total daily MME thresholds: <50 standard monitoring, 50-89 prescribe naloxone and reassess, >=90 avoid or taper
- Concurrent benzodiazepine + opioid = FDA Boxed Warning for respiratory depression
- ORT scores: 0-3 low risk, 4-7 moderate risk, >=8 high risk (scores differ by gender)
- UDS consistency: presence of prescribed opioid confirms adherence; absence suggests diversion; non-prescribed substances flag polysubstance risk
- Include CAGE-AID screening questions for clinician to administer
Safety
- Never fabricate clinical data -- only report what FHIR returns
- Flag critical/abnormal values immediately
- Scope all FHIR queries to the authenticated patient
- Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
- Present data in clinician-friendly format with reference ranges
