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 #10 (Experimental)

Official URL: http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-10 Version: 2022.1.0
Draft as of 2023-05-01 Realm: United States of America flag Computable Name: CDC_opioid_10
Other Identifiers: cdc-opioid-guidance (use: OFFICIAL)

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

Copyright/Legal: © CDC 2016+.

When prescribing opioids for subacute or chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.

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-10
Url: PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #10
Version: 2022.1.0
Identifier:

value: cdc-opioid-guidance

Name: CDC_opioid_10
Title: PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #10
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 prescribing opioids for subacute or chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.
Logic Definitions:
Library NameNamesequence
OpioidCDSREC10 Subacute or Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions 0
define "Subacute or Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
  ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
    where Routines."Is Subacute or Chronic Pain Prescription?"( AmbulatoryOpioidPrescription )


Library NameNamesequence
OpioidCDSREC10 Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential 1
define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential":
  exists( "Subacute or Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )


Library NameNamesequence
OpioidCDSRoutines Patient Age Less Than 18 2
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 3
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 4
// 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 5
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 6
define "Service Requests":
   [ServiceRequest] SR
    return SR


Library NameNamesequence
OpioidCDSRoutines Palliative Care Lookback Period 7
/*
**  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 8
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? 9
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 10
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? 11
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
OpioidCDSREC10Common Lookback Year 12
define "Lookback Year":
  Interval[Today() - 12 months - 1 days, Today() - 1 day]


Library NameNamesequence
OpioidCDSREC10Common Laboratory Observations 13
define "Laboratory Observations":
  [Observation: "category" in Common."Observation Category Laboratory"]


Library NameNamesequence
OpioidCDSREC10Common Non-opioid Screenings 14
define "Non-opioid Screenings":
  GetRelevantScreenings("Laboratory Observations" LabObservations
    where (LabObservations.code in Common."Non-opioid drug urine screening")
  )


Library NameNamesequence
OpioidCDSREC10Common Cocaine Screenings 15
define "Cocaine Screenings":
  GetRelevantScreenings("Laboratory Observations" LabObservations
    where (LabObservations.code in Common."Cocaine Urine Tests")
  )


Library NameNamesequence
OpioidCDSREC10Common PCP Screenings 16
define "PCP Screenings":
  GetRelevantScreenings("Laboratory Observations" LabObservations
    where (LabObservations.code in Common."PCP Urine Tests")
  )


Library NameNamesequence
OpioidCDSREC10Common Patient had Urine Screening in Last 12 Months 17
define "Patient had Urine Screening in Last 12 Months":
  (
    exists ("Non-opioid Screenings")
    or exists ("Cocaine Screenings")
    or exists ("PCP Screenings")
  )
  or
    if Config."Opiate Urine Screening Check Enabled" then
      exists ("Opiate Screenings")
    else
      false


Library NameNamesequence
OpioidCDSREC10Common Inclusion Criteria 18
define "Inclusion Criteria":
  Routines."Is Opioid Review Useful?"
  and (not "Patient had Urine Screening in Last 12 Months")


Library NameNamesequence
OpioidCDSCommon Conditions Indicating End of Life or With Limited Life Expectancy 19
define "Conditions Indicating End of Life or With Limited Life Expectancy":
  (
    "US Core-Categorized Conditions" C
      where C.code in "Conditions likely terminal for opioid prescribing"
        and C.clinicalStatus in "Active Condition"
  )
  union
  (
    "US Core-Categorized Conditions" C
      where C.code in "Limited life expectancy conditions"
        and C.clinicalStatus in "Active Condition"
  )


Library NameNamesequence
OpioidCDSCommon Admitted/Referred/Discharged to Hospice Care 20
define "Admitted/Referred/Discharged to Hospice Care":
  (
    [Procedure: code in "Hospice Procedure Codes"] P
      where P.status.value in { 'in-progress', 'completed' }
  )
  union
  (
    "Service Requests" SR
      where SR.code in "Hospice Procedure Codes"
        and SR.status.value in { 'active', 'completed' }
  )
  union
  (
    if (Config."Hospice Findings Exclusion Enabled") then
      [Observation: code in "Hospice Finding Codes"] O
        where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })
    else
      {}
  )
  union
  (
    [Encounter] E
      where date from E.period.start 1 year or less on or before Today()
        and (
          if E.hospitalization.dischargeDisposition.coding is null
              or not exists (E.hospitalization.dischargeDisposition.coding)
            then false
          else E.hospitalization.dischargeDisposition in "Hospice Disposition"
        )
        and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }
  )


Library NameNamesequence
OpioidCDSCommon End of Life Assessment 21
define "End of Life Assessment":
    // 1. Conditions indicating end of life or with limited life expectancy
    exists (
      "Conditions Indicating End of Life or With Limited Life Expectancy"
    )
    // 2. Admitted/referred/discharged to hospice care
    or exists (
      "Admitted/Referred/Discharged to Hospice Care"
    )


Library NameNamesequence
OpioidCDSREC10Common Exclusion Criteria 22
define "Exclusion Criteria":
  Common."End of Life Assessment"


Library NameNamesequence
OpioidCDSREC10 Is Perform Drug Screen Recommendation Applicable? 23
define "Is Perform Drug Screen Recommendation Applicable?":
  "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
    and Rec10Common."Inclusion Criteria"
    and not Rec10Common."Exclusion Criteria"


Library NameNamesequence
OpioidCDSREC10 Summary 24
define "Summary":
  Rec10Common."Get Summary" ("Is Perform Drug Screen Recommendation Applicable?")


Library NameNamesequence
OpioidCDSREC10 Detail 25
define "Detail":
  Rec10Common."Get Detail" ("Is Perform Drug Screen Recommendation Applicable?")


Library NameNamesequence
OpioidCDSREC10Common Indicator 26
define "Indicator":
  'warning'


Library NameNamesequence
OpioidCDSREC10 Indicator 27
define "Indicator":
  Rec10Common."Indicator"


Library NameNamesequence
OpioidCDSREC10Common Applicable Because of Positive Cocaine or PCP or Opiates 28
define "Applicable Because of Positive Cocaine or PCP or Opiates":
  if exists (Common."Opioid Other Than Synthetic Ordered In Last 12 Months") then
    "Has Positive Screening for Cocaine in Last 12 Months"
    or "Has Positive Screening for PCP in Last 12 Months"
  else
    "Has Positive Screening for Cocaine in Last 12 Months"
      or "Has Positive Screening for PCP in Last 12 Months"
      or
        if Config."Opiate Urine Screening Check Enabled" then
          "Has Positive Screening for Opiates in Last 12 Months"
        else false


Library NameNamesequence
OpioidCDSREC10 Applicable Because of Positive Cocaine or PCP or Opiates 29
define "Applicable Because of Positive Cocaine or PCP or Opiates":
  Rec10Common."Applicable Because of Positive Cocaine or PCP or Opiates"


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: Providers should be aware if patients are taking other prescription drugs or illicit drugs that might increase their risk of an overdose.
Copyright:

© CDC 2016+.

Related Artifacts:

Documentation

Libraries:
Library - Recommendation #10 - Urine Drug Testing
Actions:
1. Annual Urine Screening Check: Patient has not had a urine screening in the past 12 months
When: named-event: order-select
If: applicability: Patient has not had a urine screening in the past 12 months (Is Perform Drug Screen Recommendation Applicable?)
Then:
: Will perform urine screening
Then:
: Not for chronic pain management. Snooze 3 months
Then:
: N/A - see comment, snooze 3 months
Then:
1. Tested Positive for Cocaine, Opiates, or PCP: Urine screening showed positive for cocaine, opiates or PCP
When: named-event: order-select
If: applicability: Urine screening tested positive for cocaine, opiates or PCP (Applicable Because of Positive Cocaine or PCP or Opiates)
Then:
: Will repeat urine drug screen more frequently
Then:
: Will assess patient for substance abuse disorder
Then:
: Will access CDS quality improvement and care coordination for prescribing opioids for chronic pain https://www.cdc.gov/drugoverdose/pdf/prescribing/CDC-DUIP-QualityImprovementAndCareCoordination-508.pdf
Then: