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: Recommendation #6 - Prescribe Lowest Effective Dose and Duration (Experimental)

Official URL: http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-06 Version: 2022.1.0
Draft as of 2024-04-22 Realm: United States of America flag Computable Name: PlanDefinition_Recommendation_06_Order_Sign
Other Identifiers: cdc-opioid-guidance (use: official)

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

Copyright/Legal: © CDC 2016+.

When opioids are needed for acute pain, clinicians 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 clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.

Id: opioidcds-06
Url: Recommendation #6 - Prescribe Lowest Effective Dose and Duration
Version: 2022.1.0
Identifier:

value: cdc-opioid-guidance

Name: PlanDefinition_Recommendation_06_Order_Sign
Title: Recommendation #6 - Prescribe Lowest Effective Dose and Duration
Status: draft
Experimental: true
Type:

system: PlanDefinitionType

code: eca-rule

display: ECA Rule

Date: 2024-04-22
Publisher: Centers for Disease Control and Prevention (CDC)
Description: When opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.
Logic Definitions:
Library NameNamesequence
OpioidCDSREC06 Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions 0 
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 1 
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 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
OpioidCDSRoutines Is Active Cancer Treatment? 6 
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 7 
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? 8 
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 "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 9 
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 10 
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 11 
define "Exclusion Criteria":
  false


Library NameNamesequence
OpioidCDSREC06 Is Recommendation Applicable? 12 
define "Is Recommendation Applicable?":
  "Inclusion Criteria"
    and not "Exclusion Criteria"
Knowledge Capability: shareable computable executable publishable
Use Context:
codevaluedisplay
focus 182888003 Medication requested (situation)
focus 274663001 Acute pain (finding)
Jurisdiction: US
Purpose:

The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.
Usage: When the diagnosis and severity of acute pain warrant use of opioids, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. For many common causes of nontraumatic, nonsurgical pain, when opioids are needed, a few days or less are often sufficient, and shorter courses can minimize the need to taper opioids to prevent withdrawal symptoms at the end of a course of opioids. However, durations should be individualized to the patient's clinical circumstances.
Copyright:

© CDC 2016+.
Related Artifacts:

Documentation
Libraries:
Library - Recommendation #6 - Prescribe Lowest Effective Dose and Duration
Actions:
When Treating Acute Pain, Prescribe No More Opioids Than Needed: Please verify that the opioid order quantity and duration are no more than needed for the expected duration of pain severe enough to require opioids. 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#Recommendation6).
When: named-event: order-sign
If: applicability: Check whether the current order is for an opioid with ambulatory misuse potential for acute pain with an intended duration of more than 7 days and if an opioid review is appropriate for the patient (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: