Use of Opioids at High Dosage (HDO)

Assesses potentially high-risk opioid analgesic prescribing practices: The proportion of members 18 years and older who received prescription opioids at a high dosage (average morphine milligram equivalent dose [MME] ≥90) for ≥15 days during the measurement year.

Note: A lower rate indicates better performance.

Why It Matters

In 2016, opioid-related overdoses accounted for more than 42,000 deaths in the United States.1 Of those, 40% involved prescription opioids.1 Literature suggests there is a correlation between high dosages of prescription opioids and the risk of both fatal and nonfatal overdose.2,3,4

The Centers for Disease Control and Prevention Guideline on opioid prescribing for chronic, nonmalignant pain recommends the use of “additional precautions” when prescribing dosages ≥50 morphine equivalent dose (MED) and recommends providers avoid or “carefully justify” increasing dosages ≥90 mg MED.5

In 2019, the authors of the 2016 guidelines published commentary that cautioned providers, systems, payers and states from developing policies and practices that are “inconsistent with and go beyond” the guideline recommendations.6 The commentary included cautions regarding strict enforcement of dosage and duration thresholds, as well as abrupt tapering of opioids.6 The opioid dosage assessed in this measure is a reference point for health plans to identify members who may be at high risk for opioid overuse and misuse.

Results – National Averages

Use of Opioids at High Dosage

Measure YearCommercial HMOCommercial PPOMedicaid HMOMedicare HMOMedicare PPO

§ Not available due to CMS suspension of data reporting during COVID-19 pandemic.

This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via for analysis that accounts for trend breaks.


  1. S. Department of Health and Human Services (HHS). 2019. “What is the U.S. Opioid Epidemic?” Updated September 4, 2019. Retrieved from:
  2. Dunn, K.M., K.W. Saunders, C.M. Rutter, C.J. Banta-Green, J.O. Merrill, M.D. Sullivan, M. Von Korff. 2010. “Overdose and Prescribed Opioids: Associations Among Chronic Non-Cancer Pain Patients.” Annals of Internal Medicine 152(2), 85–92.
  3. Gomes, T., M.M. Mamdani, I.A. Dhalla, J.M. Paterson, and D.N. Juurlink, 2011. Opioid dose and Drug-Related Mortality in Patients With Nonmalignant Pain. Arch Intern Med 171:686–91.
  4. Paulozzi L.J., C. Jones, K. Mack, and R. Rudd. 2011. “Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008.” MMWR 60(43):1487–92.
  5. Dowell, D., T.M. Haegerich, and R. Chou. 2016. “CDC guideline for prescribing opioids for chronic pain—United States, 2016.” JAMA 315(15), pp.1624–45.
  6. Dowell, D., T. Haegerich, and R. Chou. 2019. “No Shortcuts to Safer Opioid Prescribing.” The New England Journal of Medicine 380: 2285–7.

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