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The clinical impact of this performance measure is high, as opioids can lead to unintended consequences. Abuse and overdose of opioids is a major public health issue. However, this performance measure combines CMIT #748 and CBE #2950, which reduces the meaningful impact since the other two performance measures capture the same areas of opioid prescribing. As an inverse performance measure, performance rates with lower scores indicate higher quality care. Performance data ranged from one to three percent, demonstrating little to no room for improvement. The committee recommends excluding sickle cell disease to follow the current CDC guideline recommendation. The committee had difficulty following the performance measure logic and was concerned with the clarity of the specifications. Unclear instructions to calculate the performance measure could lead to incorrect performance rates. There are several feasibility limitations with this performance measure. Some electronic health records (EHRs) do not recognize free text directions, which prevents the accurate calculation of morphine milligram equivalents (MME). Pharmacies cannot transfer a controlled substance prescription to another pharmacy if there are shortages, which results in the pharmacy sending back the prescription to the prescriber and raising the likelihood of multiple prescribers. Lastly, the pharmacy is ultimately responsible for reviewing the prescription database and denying an opioid prescription. While all states have drug monitoring programs, not all states have a law dictating how often a prescriber must check the prescription database.