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
Draft as of 2024-04-22 |
<PlanDefinition xmlns="http://hl7.org/fhir">
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<table class="grid dict">
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">opioidcds-12-patient-view</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="PlanDefinition-opioidcds-12-patient-view.html">Recommendation #12 - Evidence-based Treatment for Patients with Opioid Use Disorder (patient-view)</a></td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">2022.1.0</td>
</tr>
<tr>
<th scope="row"><b>Identifier: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<b>value: </b> <span>cdc-opioid-guidance</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Name: </b></th>
<td style="padding-left: 4px;">PlanDefinition_Recommendation_12_Patient_View</td>
</tr>
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">Recommendation #12 - Evidence-based Treatment for Patients with Opioid Use Disorder (patient-view)</td>
</tr>
<tr>
<th scope="row"><b>Status: </b></th>
<td style="padding-left: 4px;">draft</td>
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<tr>
<th scope="row"><b>Experimental: </b></th>
<td style="padding-left: 4px;">true</td>
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<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<b>system: </b> <span><a href="http://terminology.hl7.org/5.5.0/CodeSystem-plan-definition-type.html">PlanDefinitionType</a></span>
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<p style="margin-bottom: 5px;">
<b>code: </b> <span>eca-rule</span>
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<p style="margin-bottom: 5px;">
<b>display: </b> <span>ECA Rule</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Date: </b></th>
<td style="padding-left: 4px;">2024-04-22</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">Centers for Disease Control and Prevention (CDC)</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;">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.</td>
</tr>
<tr>
<th scope="row"><a name="effective-data-requirements"> </a><b>Logic Definitions: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommonConfig</td>
<td>Age Less than 18 Years Is Enabled</td>
<td>0</td>
</tr>
</table>
<pre><code class="language-cql">// Opioid Review Useful
define &quot;Age Less than 18 Years Is Enabled&quot;:
true</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommon</td>
<td>Patient 18 or Older?</td>
<td>1</td>
</tr>
</table>
<pre><code class="language-cql">define &quot;Patient 18 or Older?&quot;:
Config.&quot;Age Less than 18 Years Is Enabled&quot;
and AgeInYears() &gt;= 18</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommonConfig</td>
<td>Evidence Based Treatment Criteria For Opioid Use Disorder</td>
<td>2</td>
</tr>
</table>
<pre><code class="language-cql">// Recommendation 12
define &quot;Evidence Based Treatment Criteria For Opioid Use Disorder&quot;:
true</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSREC12PatientView</td>
<td>Not Receiving Evidence-Based Treatment for Opioid Use Disorder</td>
<td>3</td>
</tr>
</table>
<pre><code class="language-cql">define &quot;Not Receiving Evidence-Based Treatment for Opioid Use Disorder&quot;:
Config.&quot;Evidence Based Treatment Criteria For Opioid Use Disorder&quot;
and not (
if Config.&quot;Can the implementing EHR support queries for past medications by date range?&quot; then
exists (
[MedicationRequest: Common.&quot;Buprenorphine and methadone medications&quot;] MR
where MR.status in { 'active', 'completed' }
and date from MR.authoredOn during day of &quot;Opioid Use Disorder Lookback Period&quot;
)
else
true
/* update 2022 removes &quot;behavioral therapy condition&quot;
or exists (
[Procedure: Common.&quot;Substance misuse behavioral counseling&quot;] 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&lt;DateTime&gt;
end
) during day of &quot;Opioid Use Disorder Lookback Period&quot;
)*/
)</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommon</td>
<td>US Core-Categorized Conditions</td>
<td>4</td>
</tr>
</table>
<pre><code class="language-cql">// 3. Medications indicating end of life
/* or exists (
&quot;Medications Indicating End of Life&quot;
) */
define &quot;US Core-Categorized Conditions&quot;:
[Condition: category in &quot;Encounter Diagnosis Condition Category&quot;]
union [Condition: category in &quot;Problem List Condition Category&quot;]
union [Condition: category in &quot;US Core Health Concern Condition Category&quot;]</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSREC12PatientView</td>
<td>Opioid Use Disorder Lookback Period</td>
<td>5</td>
</tr>
</table>
<pre><code class="language-cql">define &quot;Opioid Use Disorder Lookback Period&quot;:
Interval[Today() - 90 days, Today()]</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSREC12PatientView</td>
<td>Presence of Diagnosis of Opioid Use Disorder</td>
<td>6</td>
</tr>
</table>
<pre><code class="language-cql">define &quot;Presence of Diagnosis of Opioid Use Disorder&quot;:
exists (
Common.&quot;US Core-Categorized Conditions&quot; C
where C.code in Common.&quot;Opioid misuse disorders&quot;
and C.clinicalStatus in Common.&quot;Active Condition&quot;
and date from C.recordedDate during day of &quot;Opioid Use Disorder Lookback Period&quot;
)</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSREC12PatientView</td>
<td>Positive Result from Opioid Use Disorder Evaluation Tool</td>
<td>7</td>
</tr>
</table>
<pre><code class="language-cql">define &quot;Positive Result from Opioid Use Disorder Evaluation Tool&quot;:
true</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSREC12PatientView</td>
<td>Inclusion Criteria</td>
<td>8</td>
</tr>
</table>
<pre><code class="language-cql">define &quot;Inclusion Criteria&quot;:
Common.&quot;Patient 18 or Older?&quot;
and &quot;Not Receiving Evidence-Based Treatment for Opioid Use Disorder&quot;
and &quot;Presence of Diagnosis of Opioid Use Disorder&quot;
and &quot;Positive Result from Opioid Use Disorder Evaluation Tool&quot;</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSREC12PatientView</td>
<td>Exclusion Criteria</td>
<td>9</td>
</tr>
</table>
<pre><code class="language-cql">define &quot;Exclusion Criteria&quot;:
false</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSREC12PatientView</td>
<td>Is Recommendation Applicable?</td>
<td>10</td>
</tr>
</table>
<pre><code class="language-cql">define &quot;Is Recommendation Applicable?&quot;:
&quot;Inclusion Criteria&quot;
and not &quot;Exclusion Criteria&quot;</code></pre>
<br/><br/>
</td>
</tr>
<tr>
<th scope="row"><b>Knowledge Capability: </b></th>
<td style="padding-left: 4px;">
shareable computable executable publishable
</td>
</tr>
<tr>
<th scope="row"><b>Use Context: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr><th><b>code</b></th><th><b>value</b></th><th><b>display</b></th></tr>
<tr>
<td>focus</td>
<td>5602001</td>
<td>Opioid abuse (disorder)</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Jurisdiction: </b></th>
<td style="padding-left: 4px;">US</td>
</tr>
<tr>
<th scope="row"><b>Purpose: </b></th>
<td style="padding-left: 4px;"><div><p>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.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Usage: </b></th>
<td style="padding-left: 4px;">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.</td>
</tr>
<tr>
<th scope="row"><b>Copyright: </b></th>
<td style="padding-left: 4px;"><div><p>© CDC 2016+.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Related Artifacts: </b></th>
<td style="padding-left: 4px;">
<p><b>Documentation</b></p>
<ul>
<li>
<a href="https://www.cdc.gov/mmwr/volumes/71/rr/pdfs/rr7103a1-H.pdf"> 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain</a>
</li>
</ul>
</td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr><td><a href="Library-OpioidCDSREC12PatientView.html">Library - Recommendation #12 (patient-view) - Evidence-based Treatment for Patients with Opioid Use Disorder</a></td></tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Actions: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td>
<b> Offer Evidence-based Medications to Treat Patients with Opioid Use Disorder:</b> 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.<br/>
<b>When:</b> <i>named-event:</i> patient-view<br/>
<b>If:</b> <i>applicability:</i> 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. <i>(Is Recommendation Applicable?)</i><br/>
<b>Then:</b>
<table class="grid-dict">
<tr>
<td>
<b> :</b> Document - Will order medication to treat opioid use disorder<br/>
<b>Then:</b>
</td>
</tr>
<tr>
<td>
<b> :</b> Refer - Will refer patient to SUD specialist<br/>
<b>Then:</b>
</td>
</tr>
<tr>
<td>
<b> :</b> Snooze* - N/A see comments, snooze 3 months<br/>
<b>Then:</b>
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
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value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-clinical-status-active"/>
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<codeFilter>
<path value="category"/>
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value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category"/>
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define "Age Less than 18 Years Is Enabled":
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url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
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Config."Age Less than 18 Years Is Enabled"
and AgeInYears() >= 18"/>
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<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
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<extension url="name">
<valueString
value="Evidence Based Treatment Criteria For Opioid Use Disorder"/>
</extension>
<extension url="statement">
<valueString
value="// Recommendation 12
define "Evidence Based Treatment Criteria For Opioid Use Disorder":
true"/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
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<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
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value="Not Receiving Evidence-Based Treatment for Opioid Use Disorder"/>
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<extension url="statement">
<valueString
value="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"
)*/
)"/>
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<extension
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<extension url="statement">
<valueString
value="// 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"]"/>
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</extension>
</extension>
<extension
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<extension url="libraryName">
<valueString value="OpioidCDSREC12PatientView"/>
</extension>
<extension url="name">
<valueString value="Opioid Use Disorder Lookback Period"/>
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<extension url="statement">
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Interval[Today() - 90 days, Today()]"/>
</extension>
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url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC12PatientView"/>
</extension>
<extension url="name">
<valueString value="Presence of Diagnosis of Opioid Use Disorder"/>
</extension>
<extension url="statement">
<valueString
value="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"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC12PatientView"/>
</extension>
<extension url="name">
<valueString
value="Positive Result from Opioid Use Disorder Evaluation Tool"/>
</extension>
<extension url="statement">
<valueString
value="define "Positive Result from Opioid Use Disorder Evaluation Tool":
true"/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC12PatientView"/>
</extension>
<extension url="name">
<valueString value="Inclusion Criteria"/>
</extension>
<extension url="statement">
<valueString
value="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""/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC12PatientView"/>
</extension>
<extension url="name">
<valueString value="Exclusion Criteria"/>
</extension>
<extension url="statement">
<valueString value="define "Exclusion Criteria":
false"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC12PatientView"/>
</extension>
<extension url="name">
<valueString value="Is Recommendation Applicable?"/>
</extension>
<extension url="statement">
<valueString
value="define "Is Recommendation Applicable?":
"Inclusion Criteria"
and not "Exclusion Criteria""/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
<valueReference>
<reference value="#effective-data-requirements"/>
</valueReference>
</extension>
<url
value="http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-12-patient-view"/>
<identifier>
<use value="official"/>
<value value="cdc-opioid-guidance"/>
</identifier>
<version value="2022.1.0"/>
<name value="PlanDefinition_Recommendation_12_Patient_View"/>
<title
value="Recommendation #12 - Evidence-based Treatment for Patients with Opioid Use Disorder (patient-view)"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/>
<code value="eca-rule"/>
<display value="ECA Rule"/>
</coding>
</type>
<status value="draft"/>
<experimental value="true"/>
<date value="2024-04-22"/>
<publisher value="Centers for Disease Control and Prevention (CDC)"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.cdc.gov"/>
</telecom>
</contact>
<description
value="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."/>
<useContext>
<code>
<system
value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
<code value="focus"/>
<display value="Clinical Focus"/>
</code>
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="5602001"/>
<display value="Opioid abuse (disorder)"/>
</coding>
</valueCodeableConcept>
</useContext>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="US"/>
<display value="United States of America"/>
</coding>
</jurisdiction>
<purpose
value="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
value="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 value="© CDC 2016+."/>
<topic>
<text value="Opioid Prescribing"/>
</topic>
<author>
<name value="Kensaku Kawamoto, MD, PhD, MHS"/>
</author>
<author>
<name value="Bryn Rhodes"/>
</author>
<author>
<name value="Floyd Eisenberg, MD, MPH"/>
</author>
<author>
<name value="Robert McClure, MD, MPH"/>
</author>
<relatedArtifact>
<type value="documentation"/>
<display
value="2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain"/>
<url value="https://www.cdc.gov/mmwr/volumes/71/rr/pdfs/rr7103a1-H.pdf"/>
<document>
<contentType value="application/pdf"/>
<language value="en-US"/>
<url
value="https://www.cdc.gov/mmwr/volumes/71/rr/pdfs/rr7103a1-H.pdf"/>
</document>
</relatedArtifact>
<library
value="http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSREC12PatientView"/>
<action>
<title
value="Offer Evidence-based Medications to Treat Patients with Opioid Use Disorder"/>
<description
value="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."/>
<priority value="urgent"/>
<documentation>
<type value="documentation"/>
<url
value="https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation12:~:text=and%20overdose%20death-,(recommendation%20category%3A%20A%3B%20evidence%20type%3A%201).,-Implementation%20Considerations"/>
<document>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/recommendation-strength"/>
<code value="strong"/>
<display value="Strong"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/evidence-quality"/>
<code value="high"/>
<display value="High quality"/>
</coding>
</valueCodeableConcept>
</extension>
<url
value="https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation12:~:text=and%20overdose%20death-,(recommendation%20category%3A%20A%3B%20evidence%20type%3A%201).,-Implementation%20Considerations"/>
</document>
</documentation>
<trigger>
<type value="named-event"/>
<name value="patient-view"/>
</trigger>
<condition>
<kind value="applicability"/>
<expression>
<description
value="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."/>
<language value="text/cql.identifier"/>
<expression value="Is Recommendation Applicable?"/>
</expression>
</condition>
<groupingBehavior value="visual-group"/>
<selectionBehavior value="any"/>
<action>
<description
value="Document - Will order medication to treat opioid use disorder"/>
</action>
<action>
<description value="Refer - Will refer patient to SUD specialist"/>
</action>
<action>
<description value="Snooze* - N/A see comments, snooze 3 months"/>
</action>
</action>
</PlanDefinition>