The following table describes the flowchart decisions and sub-routines for the recommendation

Definition	Answer to Proceed	Details	Data (Terminology) Requirement	Profile	Path
Opioid order for subacute or chronic pain?	Yes	See For Subacute or Chronic Pain sub-routine
Opioid review useful?	Yes	See Opioid Review Useful sub-routine
Opioid naïve?	Yes	See Opioid Naïve sub-routine
Pain treatment plan created or edited in past 90 days?	No	Look for a pain treatment plan that has been established or edited within the past 90 days (including the day of the visit). The following criteria should be met: • the treatment plan has an initiation date or an edited date within the past 90 days. • the treatment plan should have been created or reviewed within the past 90 days by the same individual who is writing the new prescription.	Pain treatment plan	CarePlan	CarePlan.category, CarePlan.status, CarePlan.created, CarePlan.lastUpdated, and CarePlan.author
Pain management procedure in past 90 days?	No	Look for a pain management procedure (including the procedure to review a pain management treatment plan) that occurred within the past 90 days (including the day of the visit).	Pain management procedure	Procedure and MedicationRequest	Procedure.performed, Procedure.performer.actor, and MedicationRequest.recorder

Effective Data Requirements

The following artifacts formalize the description of the logic and behavior defined by this recommendation.

Resource	Type	Description
2022 CDC Clinical Practice Guideline Recommendation #2	PlanDefinition	Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #2
Recommendation #2 - Prioritize Nonopioid Pain Therapies	Library	Defines the data requirements to support evaluation of recommendation #2
Opioid Terminology Management Knowledge-base Data (OMTK) Library	Library	CQL Library that provides logic for implementation of opioid management functionality including Milligram Morphine Equivalents (MME).
Opioid Terminology Management Knowledge-base (OMTK) Library	Library	CQL Library that provides logic for implementation of opioid management functionality including Milligram Morphine Equivalents (MME).
Common Opioid Decision Support Logic	Library	CQL Library that provides common logic for the recommendations
Common OpioidCDS Configuration Logic	Library	CQL Library that provides common configuration logic for the recommendations
Common OpioidCDS Routines Logic	Library	CQL Library that provides common routines logic for the recommendations
FHIRHelpers Conversion Logic	Library	CQL Library that defines functions to convert between FHIR data types and CQL system-defined types, as well as functions to support FHIRPath implementation

Description	CDS Hooks Request	Expected Response
Patient is 18 years or older and has an outpatient Medication Request of Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) authored "Today" as well as an Opioid Treatment Care Plan updated 89 days prior to today. Patients "Dosage Instructions" are 1 Film per day for 30 days. This patient will not trigger any cards and there should not be a recommendation message.	Request JSON example-rec-02-in-careplan-revisited	Response JSON example-rec-02-in-careplan-revisited
Patient is 18 years or older and has an outpatient Medication Request of Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) authored "Today" as well as a Care Plan most recently updated 120 days prior to today. Patients "Dosage Instructions" are 1 Film per day for 30 days. Due to the most recent review of the Care Plan having been conducted more than 89 days prior to today this will result in a summary message: "Recommend creation, review or update of opioid treatment plan."	Request JSON example-rec-02-out-careplan-not-revisited	Response JSON example-rec-02-out-careplan-not-revisited

• When
• Provider is prescribing an opioid with ambulatory misuse potential in the outpatient setting
• Prescription is for treating subacute and/or chronic pain.
• Opioid review is useful for this patient:
• Patient is 18 or over
• Patient does not have evidence of sickle cell disease
• Patient does not have findings indicating limited life expectancy
• Patient does not have orders for therapies indicating end of life care
• Patient is not undergoing active cancer treatment:
• Patient has had at least 2 office visits within the past 12 months with an oncology specialist present, or
• Patient has had at least 2 office visits within the past 12 months with a CDC malignant cancer condition diagnosis
• Patient does not have conditions likely terminal for opioid prescribing present
• Patient is opioid naive:
• No indication of opioid use in the past 90 days from a prescription, self report (for future implementation), or a dispensing event (for future implementation)
• Pain management procedure in past 90 days is not present and
• Pain treatment plan created, edited, or reviewed by the prescribing physician in past 90 days is not present
• Then
• Maximize Nonopioid Therapies as Appropriate:
• Document - Collaborated with patient to identify treatment goals
• Snooze - Attempting alternate therapy, snooze 3 months
• Order - Select alternative therapies from order select
• Snooze - N/A see comment, snooze 3 months
• Remove - Will remove triggering medication order

The following table describes the flowchart decisions and sub-routines for the recommendation

Definition	Answer to Proceed	Details	Data (Terminology) Requirement	Profile	Path
Opioid order for subacute or chronic pain?	Yes	See For Subacute or Chronic Pain sub-routine
Opioid review useful?	Yes	See Opioid Review Useful sub-routine
Opioid naïve?	Yes	See Opioid Naïve sub-routine
Pain treatment plan created or edited in past 90 days?	No	Look for a pain treatment plan that has been established or edited within the past 90 days (including the day of the visit). The following criteria should be met: • the treatment plan has an initiation date or an edited date within the past 90 days. • the treatment plan should have been created or reviewed within the past 90 days by the same individual who is writing the new prescription.	Pain treatment plan	CarePlan	CarePlan.category, CarePlan.status, CarePlan.created, CarePlan.lastUpdated, and CarePlan.author
Pain management procedure in past 90 days?	No	Look for a pain management procedure (including the procedure to review a pain management treatment plan) that occurred within the past 90 days (including the day of the visit).	Pain management procedure	Procedure and MedicationRequest	Procedure.performed, Procedure.performer.actor, and MedicationRequest.recorder

Effective Data Requirements

The following artifacts formalize the description of the logic and behavior defined by this recommendation.

Resource	Type	Description
2022 CDC Clinical Practice Guideline Recommendation #2	PlanDefinition	Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #2
Recommendation #2 - Prioritize Nonopioid Pain Therapies	Library	Defines the data requirements to support evaluation of recommendation #2
Opioid Terminology Management Knowledge-base Data (OMTK) Library	Library	CQL Library that provides logic for implementation of opioid management functionality including Milligram Morphine Equivalents (MME).
Opioid Terminology Management Knowledge-base (OMTK) Library	Library	CQL Library that provides logic for implementation of opioid management functionality including Milligram Morphine Equivalents (MME).
Common Opioid Decision Support Logic	Library	CQL Library that provides common logic for the recommendations
Common OpioidCDS Configuration Logic	Library	CQL Library that provides common configuration logic for the recommendations
Common OpioidCDS Routines Logic	Library	CQL Library that provides common routines logic for the recommendations
FHIRHelpers Conversion Logic	Library	CQL Library that defines functions to convert between FHIR data types and CQL system-defined types, as well as functions to support FHIRPath implementation

Description	CDS Hooks Request	Expected Response
Patient is 18 years or older and has an outpatient Medication Request of Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) authored "Today" as well as an Opioid Treatment Care Plan updated 89 days prior to today. Patients "Dosage Instructions" are 1 Film per day for 30 days. This patient will not trigger any cards and there should not be a recommendation message.	Request JSON example-rec-02-in-careplan-revisited	Response JSON example-rec-02-in-careplan-revisited
Patient is 18 years or older and has an outpatient Medication Request of Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) authored "Today" as well as a Care Plan most recently updated 120 days prior to today. Patients "Dosage Instructions" are 1 Film per day for 30 days. Due to the most recent review of the Care Plan having been conducted more than 89 days prior to today this will result in a summary message: "Recommend creation, review or update of opioid treatment plan."	Request JSON example-rec-02-out-careplan-not-revisited	Response JSON example-rec-02-out-careplan-not-revisited