The agency issued a notice this month outlining the new measures (PDF), which come amid a national epidemic of opioid abuse and a rising unease with the high rates of antipsychotic medications prescribed to minors for off-label uses.

About 28,600 people died in 2014 from overdoses of prescription painkillers, heroin and other opioids, the Centers for Disease Control and Prevention reported this month. The figure was the highest on record and has tripled since 2000.

The CMS will require Medicaid programs, beginning no later than December 2016, to track the use of opioids at high dosages acquired from four or more providers and pharmacies by beneficiaries who don’t have cancer.

The measure is intended to indicate inappropriate prescribing or fragmented care, according to the Pharmacy Quality Alliance (PDF), which endorsed the measure this year.

The American Pharmacists Association said the new Medicaid measure could help identify patterns of opioid misuse.

Medicaid recipients are twice as likely as people in commercial insurance plans to receive a prescription for an opioid painkiller and six times as likely to overdose on the drugs, according to a 2014 study (PDF) by the National Association of Medicaid Directors. They’re also more likely to visit an emergency room for treatment, where opioids are often prescribed, the association found.

“Many of these doctor shoppers need addiction treatment for themselves or they are diverting medication to others,” said Dr. Jeanmarie Perrone, a drug safety researcher at the University of Pennsylvania. “Either way, we need to help identify and control this excess source of opioids.”

The CHIP measure, meanwhile, would track the percentage of children and adolescents who are on two or more antipsychotic medications at the same time. The metric is supported by the National Collaborative for Innovation in Quality Measurement (NCINQ), a multistate and multistakeholder collaborative with a focus on pediatric care.

Antipsychotic prescribing for children has increased rapidly in recent decades, driven by new medications and by longer duration of use, according to the NCINQ. Between 1996 and 2002, the number increased fivefold from 8.6 per 1,000 children to 39.4. Children and adolescents who take the drugs are at higher risk of serious health conditions, including weight gain, tremors and diabetes.

In 2008, the most recent year for which complete data are available, Medicaid and CHIP spent $3.6 billion on antipsychotic medications, up from $1.65 billion in 1999, according to Mathematica Policy Research.

In March 2015, an analysis by HHS’ Office of Inspector General found that 92% of antipsychotics taken by Medicaid children in five states were prescribed for off-label uses.

Based on that finding, the OIG recommended that the CMS work with state Medicaid programs to review the use of antipsychotics by children enrolled in Medicaid.

The use of multiple antipsychotic medications “is seldom justified and is an appropriate focus for a quality measure,” said Stephen Crystal, a professor of health policy at Rutgers University. Crystal’s research suggests children on Medicaid are prescribed antipsychotics at much higher rates than privately insured children.

Dr. Mark Olfson, a professor of psychiatry at Columbia University, also said the new measure was wise “in light of the widespread prescription of complex psychotropic medication regimens to young people and the risks of antipsychotic medications.” According to research Olfson published in JAMA Psychiatry in September, drugs intended to treat bipolar disorder and schizophrenia are often used to treat children and teenagers for ADHD even though safer treatments are available.

Other experts, however, expressed concern that the new measure could dissuade providers from prescribing multiple antipsychotics when the severity of the case calls for it.

“I’m hoping they don’t get dinged because they are prescribing what might be necessary for care,” said Dr. Michael Naylor, a former president for the American Academy of Child and Adolescent Psychiatry.