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 #12 - Evidence-based Treatment for Patients with Opioid Use Disorder (patient-view) (Experimental)

Official URL: http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-12-patient-view Version: 2022.1.0
Draft as of 2024-04-22 Realm: United States of America flag Computable Name: PlanDefinition_Recommendation_12_Patient_View
Other Identifiers: cdc-opioid-guidance (use: official)

Usage:Clinical Focus: Opioid abuse (disorder)

Copyright/Legal: © CDC 2016+.

Clinicians should offer or arrange treatment with evidence-based medications to treat patients with opioid use disorder. Detoxification on its own, without medications for opioid use disorder, is not recommended for opioid use disorder because of increased risks for resuming drug use, overdose, and overdose death.

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-12-patient-view
Url: Recommendation #12 - Evidence-based Treatment for Patients with Opioid Use Disorder (patient-view)
Version: 2022.1.0
Identifier:

value: cdc-opioid-guidance

Name: PlanDefinition_Recommendation_12_Patient_View
Title: Recommendation #12 - Evidence-based Treatment for Patients with Opioid Use Disorder (patient-view)
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: Clinicians should offer or arrange treatment with evidence-based medications to treat patients with opioid use disorder. Detoxification on its own, without medications for opioid use disorder, is not recommended for opioid use disorder because of increased risks for resuming drug use, overdose, and overdose death.
Logic Definitions:
Library NameNamesequence
OpioidCDSCommonConfig Age Less than 18 Years Is Enabled 0 
// Opioid Review Useful
define "Age Less than 18 Years Is Enabled":
  true


Library NameNamesequence
OpioidCDSCommon Patient 18 or Older? 1 
define "Patient 18 or Older?":
  Config."Age Less than 18 Years Is Enabled"
    and AgeInYears() >= 18


Library NameNamesequence
OpioidCDSCommonConfig Evidence Based Treatment Criteria For Opioid Use Disorder 2 
// Recommendation 12
define "Evidence Based Treatment Criteria For Opioid Use Disorder":
  true


Library NameNamesequence
OpioidCDSREC12PatientView Not Receiving Evidence-Based Treatment for Opioid Use Disorder 3 
define "Not Receiving Evidence-Based Treatment for Opioid Use Disorder":
  Config."Evidence Based Treatment Criteria For Opioid Use Disorder"
    and not (
        if Config."Can the implementing EHR support queries for past medications by date range?" then
          exists (
            [MedicationRequest: Common."Buprenorphine and methadone medications"] MR
              where MR.status in { 'active', 'completed' }
                and date from MR.authoredOn during day of "Opioid Use Disorder Lookback Period"
          )
        else
            true
    /* update 2022 removes "behavioral therapy condition"
      or exists (
        [Procedure: Common."Substance misuse behavioral counseling"] P
          where P.status ~ 'completed'
            and (
              case
                when P.performed is FHIR.dateTime then
                  Interval[FHIRHelpers.ToDateTime(P.performed as FHIR.dateTime), FHIRHelpers.ToDateTime(P.performed as FHIR.dateTime)]
                when P.performed is FHIR.Period then
                  FHIRHelpers.ToInterval(P.performed as FHIR.Period)
                else
                  null as Interval<DateTime>
                end
            ) during day of "Opioid Use Disorder Lookback Period"
      )*/
    )


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
OpioidCDSREC12PatientView Opioid Use Disorder Lookback Period 5 
define "Opioid Use Disorder Lookback Period":
  Interval[Today() - 90 days, Today()]


Library NameNamesequence
OpioidCDSREC12PatientView Presence of Diagnosis of Opioid Use Disorder 6 
define "Presence of Diagnosis of Opioid Use Disorder":
  exists (
    Common."US Core-Categorized Conditions" C
      where C.code in Common."Opioid misuse disorders"
        and C.clinicalStatus in Common."Active Condition"
        and date from C.recordedDate during day of "Opioid Use Disorder Lookback Period"
    )


Library NameNamesequence
OpioidCDSREC12PatientView Positive Result from Opioid Use Disorder Evaluation Tool 7 
define "Positive Result from Opioid Use Disorder Evaluation Tool":
  true


Library NameNamesequence
OpioidCDSREC12PatientView Inclusion Criteria 8 
define "Inclusion Criteria":
  Common."Patient 18 or Older?"
    and "Not Receiving Evidence-Based Treatment for Opioid Use Disorder"
    and "Presence of Diagnosis of Opioid Use Disorder"
    and "Positive Result from Opioid Use Disorder Evaluation Tool"


Library NameNamesequence
OpioidCDSREC12PatientView Exclusion Criteria 9 
define "Exclusion Criteria":
  false


Library NameNamesequence
OpioidCDSREC12PatientView Is Recommendation Applicable? 10 
define "Is Recommendation Applicable?":
  "Inclusion Criteria"
    and not "Exclusion Criteria"
Knowledge Capability: shareable computable executable publishable
Use Context:
codevaluedisplay
focus 5602001 Opioid abuse (disorder)
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: Medication treatment of opioid use disorder has been associated with reduced risk for overdose and overall deaths. Identification of opioid use disorder represents an opportunity for a clinician to initiate potentially life-saving interventions, and the clinician should collaborate with the patient regarding their safety to increase the likelihood of successful treatment.
Copyright:

© CDC 2016+.
Related Artifacts:

Documentation
Libraries:
Library - Recommendation #12 (patient-view) - Evidence-based Treatment for Patients with Opioid Use Disorder
Actions:
Offer Evidence-based Medications to Treat Patients with Opioid Use Disorder: For patients diagnosed with opioid use disorder, consider opioid agonist or partial agonist treatment with methadone or buprenorphine maintenance therapy. Detoxification on its own, without medications for opioid use disorder, is not recommended for opioid use disorder because of increased risks of resuming drug use, overdose, and overdose death. For guidance regarding diagnosing and treating opioid use disorder, see [Recommendation 12 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=evidence%20type%3A%201).-,Implementation%20Considerations,-Although%20stigma%20can). [CDC recommends against releasing patients from care due to diagnosis of opioid use disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=opioid%20use%20disorder.-,Clinicians%20should%20not%20dismiss%20patients%20from%20their%20practice%20because%20of%20opioid%20use%20disorder%20because%20this%20can%20adversely%20affect%20patient%20safety.,-Medication%20treatment%20of). [MME conversion factors should not be applied to dosage decisions related to the management of opioid use disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=These%20conversion%20factors%20should%20not%20be%20applied%20to%20dosage%20decisions%20related%20to%20the%20management%20of%20opioid%20use%20disorder.). [Do not use the calculated dose in MMEs to determine the doses to use when converting one opioid to another; when converting opioids, the new opioid is typically dosed at a substantially lower dose than the calculated MME dose to avoid overdose because of incomplete cross-tolerance and individual variability in opioid pharmacokinetics](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Do%20not%20use%20the,variability%20in%20opioid%20pharmacokinetics.). Consult the FDA approved product labeling for specific guidance on medications.
When: named-event: patient-view
If: applicability: Check whether the patient is 18 or older with an active condition of opioid misuse disorder and doesn't have an active prescription (order) for buprenorphine or methadone medications. (Is Recommendation Applicable?)
Then:
: Document - Will order medication to treat opioid use disorder
Then:
: Refer - Will refer patient to SUD specialist
Then:
: Snooze* - N/A see comments, snooze 3 months
Then: