2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide
2022.1.0 - CI Build

2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide, published by Centers for Disease Control and Prevention (CDC). This guide is not an authorized publication; it is the continuous build for version 2022.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/opioid-cds-r4/ and changes regularly. See the Directory of published versions

PlanDefinition: PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #6 (Experimental)

Official URL: http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-06 Version: 2022.1.0
Draft as of 2023-05-01 Realm: United States of America flag Computable Name: CDC_opioid_06
Other Identifiers: cdc-opioid-guidance (use: OFFICIAL)

Usage:Clinical Focus: Medication requested (situation), Clinical Focus: Chronic pain (finding)

Copyright/Legal: © CDC 2016+.

When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.

The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder and overdose. The Guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.

Id: opioidcds-06
Url: PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #6
Version: 2022.1.0
Identifier:

value: cdc-opioid-guidance

Name: CDC_opioid_06
Title: PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #6
Status: draft
Experimental: true
Type:

system: PlanDefinitionType

code: eca-rule

display: ECA Rule

Date: 2023-05-01
Publisher: Centers for Disease Control and Prevention (CDC)
Description: When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.
Logic Definitions:
Library NameNamesequence
OpioidCDSREC06 Get Summary 0
define "Get Summary":
  if "Is Recommendation Applicable?"
    then 'When Treating Acute Pain, Prescribe No Greater Quantity Than Needed'
  else null


Library NameNamesequence
OpioidCDSREC06 Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions 1
define "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
  ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
    where Routines."Is Acute Pain Prescription?"( AmbulatoryOpioidPrescription )
      and Routines."Acute Pain Prescription Greater Than 7 Days?"(AmbulatoryOpioidPrescription)


Library NameNamesequence
OpioidCDSREC06 Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain 2
define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain":
  exists( "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )


Library NameNamesequence
OpioidCDSRoutines Patient Age Less Than 18 3
define "Patient Age Less Than 18":
  if (Config."Age Less than 18 Years Is Enabled") then
    AgeInYearsAt(Today()) < 18
  else
    false


Library NameNamesequence
OpioidCDSRoutines Condition Positive for Sickle Cell 4
define "Condition Positive for Sickle Cell":
      if (Config."Sickle Cell Check Enabled") then
        exists(
            Common."Positive Sickle Cell Condition"
        )  else
        false


Library NameNamesequence
OpioidCDSCommon US Core-Categorized Conditions 5
// 3. Medications indicating end of life
    /* or exists (
      "Medications Indicating End of Life"
    ) */
define "US Core-Categorized Conditions":
  [Condition: category in "Encounter Diagnosis Condition Category"]
    union [Condition: category in "Problem List Condition Category"]
    union [Condition: category in "US Core Health Concern Condition Category"]


Library NameNamesequence
OpioidCDSRoutines Conditions Indicating End Of Life Present 6
define "Conditions Indicating End Of Life Present":
  exists (
    Common."US Core-Categorized Conditions" LLEC
      where LLEC.code in Common."Limited life expectancy conditions"
        and LLEC.clinicalStatus in Common."Active Condition"
  )


Library NameNamesequence
OpioidCDSCommon Service Requests 7
define "Service Requests":
   [ServiceRequest] SR
    return SR


Library NameNamesequence
OpioidCDSRoutines Palliative Care Lookback Period 8
/*
**  Routine #1
**  Opioid Review Useful Routine
**
**  Definition              | Answer to Proceed   | Details                                      | Data (Terminology) Requirement
**  ------------------------------------------------------------------------------------------------------------------------------------
**  Age < 18 years?         | No                  | Calculate age from date of birth; exclude    | Date of birth
**                          |                     | patients with age less than 18 years at the  |
**                          |                     | time of the prescription                     |
**  ------------------------------------------------------------------------------------------------------------------------------------
**  Evidence of             | No                  | Look for documented findings consistent      | Sickle cell disease conditions
**  sickle cell disease?    |                     | with those listed in the sickle cell         |
**                          |                     | value set                                    |
**  ------------------------------------------------------------------------------------------------------------------------------------
**  Limited life            | No                  | Look for documented findings consistent      | Limited life expectancy conditions
**  expectancy conditions   |                     | with those listed in the limited life        |
**  present?                |                     | expectancy value set (terminal illness, bad  |
**                          |                     | prognosis, pre-terminal)                     |
**  ------------------------------------------------------------------------------------------------------------------------------------
**  Order for therapies     | No                  | Look for patients with an existing order for | Therapies indicating end of life care
**  indicating end of life  |                     | therapies indicating end of life care        |
**  care in past 90 days?   |                     | written within past 90 days                  |
**  ------------------------------------------------------------------------------------------------------------------------------------
**  Active cancer           | No                  | See sub-routine 3                            | See sub-routine 3
**  treatment?              |                     |                                              |
**  ------------------------------------------------------------------------------------------------------------------------------------
**  Conditions Likely       | No                  | Look for patients with active conditions in  | Conditions likely terminal for opioid
**  Terminal for opioid     |                     | the value set end-of-life-conditions         | prescribing
**  prescribing present?    |                     |                                              |
**  ------------------------------------------------------------------------------------------------------------------------------------
**
*/
define "Palliative Care Lookback Period":
  Interval[Today() - 90 days, Today()]


Library NameNamesequence
OpioidCDSRoutines Order For Palliative Care In Past 90 Days 9
define "Order For Palliative Care In Past 90 Days":
  exists (
    Common."Service Requests" SR
    where SR.status in { 'active', 'completed'}
      and SR.intent in {'proposal', 'plan,', 'directive', 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}
      and FHIRHelpers.ToDateTime(SR.authoredOn) during day of "Palliative Care Lookback Period"
      and SR.code in Common."Therapies indicating end of life care"
  )


Library NameNamesequence
OpioidCDSRoutines Is Active Cancer Treatment? 10
define "Is Active Cancer Treatment?":
  if (Config."Active Cancer Treatment Encounters Condition Is Enabled") then
      "Has Two or More Encounters with Cancer Diagnosis During Encounter Period"
    else
      false


Library NameNamesequence
OpioidCDSRoutines Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present 11
define "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present":
  if (Config."End-Stage Disease Criteria Enabled") then
    exists (
      Common."US Core-Categorized Conditions" EOLC
        where EOLC.code in Common."Conditions likely terminal for opioid prescribing"
          and EOLC.clinicalStatus in Common."Active Condition"
    )
  else
    false


Library NameNamesequence
OpioidCDSRoutines Is Opioid Review Useful? 12
define "Is Opioid Review Useful?":
  not "Patient Age Less Than 18"
    and not "Condition Positive for Sickle Cell"
    and not "Conditions Indicating End Of Life Present"
    and not "Order For Palliative Care In Past 90 Days"
    and not "Is Active Cancer Treatment?"
    and not "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present"


Library NameNamesequence
OpioidCDSREC06 Order is for Long-Acting Opioid 13
define "Order is for Long-Acting Opioid":
  exists (
    "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" AmbulatoryOpioidPrescription
      where AmbulatoryOpioidPrescription.medication in Common."Extended release opioid with ambulatory misuse potential"
        or Common.GetDurationInDays( AmbulatoryOpioidPrescription.dispenseRequest.expectedSupplyDuration ) > 7 days
  )


Library NameNamesequence
OpioidCDSREC06 Inclusion Criteria 14
define "Inclusion Criteria":
  "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain"
    and Routines."Is Opioid Review Useful?"
    and "Order is for Long-Acting Opioid"


Library NameNamesequence
OpioidCDSREC06 Exclusion Criteria 15
define "Exclusion Criteria":
  false


Library NameNamesequence
OpioidCDSREC06 Is Recommendation Applicable? 16
define "Is Recommendation Applicable?":
  "Inclusion Criteria"
    and not "Exclusion Criteria"


Library NameNamesequence
OpioidCDSREC06 Get Detail 17
define "Get Detail":
    if "Is Recommendation Applicable?"
      then 'Consider a shorter duration for opioid therapy

[For guidance regarding prescribing opioids for acute pain see Recommendation 6 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm)'
    else null


Library NameNamesequence
OpioidCDSREC06 Get Indicator 18
define "Get Indicator":
  if "Is Recommendation Applicable?"
    then 'warning'
  else null


Knowledge Capability: shareable computable executable publishable
Use Context:
codevaluedisplay
focus 182888003 Medication requested (situation)
focus 82423001 Chronic pain (finding)
Jurisdiction: US
Purpose:

The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder and overdose. The Guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.

Usage: When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.
Copyright:

© CDC 2016+.

Related Artifacts:

Documentation

Libraries:
Library - Recommendation #6 - Prescribe Lowest Effective Dose and Duration
Actions:
Current Order is for Opioid With Ambulatory Misuse Potential.: Checking if the trigger prescription meets the inclusion criteria for recommendation #6 workflow.
When: named-event: order-sign
If: applicability: Check whether the current Order is for Opioid With Ambulatory Misuse Potential. (Is Recommendation Applicable?)
Then:
: Document - Will adjust opioid order
Then:
: Snooze* - Benefits of opioid therapy duration outweigh risks, snooze 3 months
Then:
: Snooze* - N/A see comment, snooze 3 months
Then: