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20-513 Start with Primary Care to Manage High-Risk-Opioid Use

Date: 08/18/20

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

For Medi-Cal, this information applies to Fresno, Kings, and Madera counties.

Learn how to improve your Health Care Effectiveness Data and Information Set (HEDIS®) rates.

Review these quality measures on opioid use and other resources available to you.

Quality measure

Percentage of members ages 18 and older who…

Use of opioids1 at high dosage (HDO)

Received prescribed opioids at a high dosage (average milligram morphine equivalent [MME] > 120 mg).

Denominator: Two or more prescriptions on different dates of service with ≥ 5 total days covered by opioids during the measurement year (calendar year).2

Use of opioids from multiple providers (UOP) and pharmacies

Received prescribed opioids for ≥ 15 total days during the measurement year (calendar year)2 from ≥ 4 providers and pharmacies.


Concurrent use of opioids and benzodiazepines

Had a concurrent use of prescription opioids and benzodiazepines. Beneficiaries with a cancer diagnosis or in hospice are excluded.
  • Opioids
    • Butorphanol
    • Codeine
    • Dihydrocodeine
    • Fentanyl
    • Hydrocodone
    • Hydromorphone
    • Levorphanol
    • Meperidine
    • Methadone
    • Morphine
    • Opium
    • Oxycodone
    • Oxymorphone
    • Pentazocine
    • Tapentadol
    • Tramadol
  • Benzodiazepines
    • Alprazolam
    • Chlordiazepoxide
    • Clobazam
    • Clonazepam
    • Clorazepate
    • Diazepam
    • Estazolam
    • Flurazepam
    • Lorazepam
    • Midazolam
    • Oxazepam
    • Quazepam
    • Temazepam
    • Triazolam

Initiation and engagement of alcohol and other drug treatment (IET)


Had a new episode of alcohol or other drug (AOD) abuse or dependence who received the following (each measurement year, the quality measure collects data on new episodes of AOD abuse and  dependence between January 1–November 14 of the calendar year):

  • Initiation of AOD treatment – Percentage of members who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter, partial hospitalization, telehealth, or medication treatment within 14 days of the diagnosis.
  • Engagement of AOD treatment – Percentage of members who initiated treatment and who had two or more additional AOD services or medication treatment within 30 days of the initiation visit.        


Access the provider updates below in the Provider Library.

For questions or more  information, email the Quality Improvement Department at

Provider update

Distribution date

Update number

Best Practices Prescribing and Managing Opioid Medications

May, 20, 2019


Patient Education Tips for Opioid Therapy

July 26, 2019


To Help You End Opioid Abuse: Preferred Drug List Changes Focus on Opioid Pain Medications

September 11, 2019


Improve Treatment of OUD in Pregnancy with These Resources

October 21, 2019


Refer Members to myStrength: An Additional Resource to Help with OUD and Substance Use

February 4, 2020


Online articles and sites



American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Assessing Benefits and Harms of Opioid Therapy

Benzodiazepines and Opioids

Calculating Total Daily Dose of Opioids for Safer Dosage

Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain

Opioid Oral Morphine Milligram Equivalent (MME) Conversion Factors

Additional information

For questions or more information, email the Quality Improvement Department at



  • Members diagnosed with cancer or sickle cell disease.
  • The opioid medication list excludes injectables; opioid cough and cold products; and single-agent and combination buprenorphine products used to treat opioid use disorder for medication assisted treatment (buprenorphine sublingual tablets, buprenorphine subcutaneous implant and all buprenorphine/naloxone combination products), and Ionsys® (fentanyl transdermal patch; for inpatient use only and is available only through a restricted program under a Risk Evaluation and Mitigation Strategy [REMS]).

2The measurement year is the year data is collected for HEDIS. Example: HEDIS 2020 reporting year reflects services or data collected in the 2019 calendar year and reported in July 2020.

Last Updated: 08/17/2020