Recommendation #12 - Evidence-based Treatment for Patients with Opioid Use Disorder - 2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide v2022.1.0

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

Recommendation #12 - Evidence-based Treatment for Patients with Opioid Use Disorder

Recommendations #12 (2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain):

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 (recommendation category: A; evidence type: 1).

Contents

Functional Description
Content
Example Data/Requests

Functional Description

When

Patient is 18 years or older
Patient has a diagnosis of opioid use disorder in the past 90 days
No active order for buprenorphine or methadone medication

Then

Offer evidence-based medications to treat patients with opioid use disorder:

Document - Will order medication to treat opioid use disorder
Refer - Will refer patient to SUD specialist
Snooze - N/A see comment, snooze 3 months

The following table describes the flowchart decisions and sub-routines for the recommendation
Definition	Answer to Proceed	Details	Data (Terminology) Requirement	Profile	Path
Age ≥ 18?	Yes	Age greater than or equal to 18 years		Patient	Patient.birthDate
Presence of diagnosis of opioid misuse disorders in past 90 days?	Yes	Look for an active condition of opioid misuse disorder	Opioid misuse disorders	Condition	Condition.category, Condition.code, Condition.clinicalStatus, and Condition.recordedDate
Active order for buprenorphine or methadone medications?	No	An active prescription (order) for buprenorphine or methadone medications	Buprenorphine and methadone medications	MedicationRequest	MedicationRequest.medication, MedicationRequest.category, MedicationRequest.status, and MedicationRequest.authoredOn

Effective Data Requirements

Rationale for Medication-Assisted Treatment

Definition	Expression	Data (Terminology) Requirement
Presence of diagnosis of opioid misuse disorder	Existing active diagnosis of opioid misuse disorder	Opioid misuse disorders value set
Positive result from opioid misuse disorder evaluation tool	Evidence of positive result from opioid misuse disorder evaluation tool Timing - within 90 days	Value set for opioid misuse disorders evaluation tool(s) - LOINC pan Result options for such opioid misuse disorder evaluation tool(s) - perhaps LOINC normative responses that differentiate positive from negative results. Consider this element a FUTURE option
Not Receiving Evidence-Based Treatment for Opioid Use Disorder	Evidence of an ordered medication for opioid misuse disorder treatment in the last 90 days Status active or completed	Buprenorphine and methadone medications

Content

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

Resource	Type	Description
2022 CDC Clinical Practice Guideline Recommendation #12 (patient-view)	PlanDefinition	Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #12
Recommendation #12 (patient-view) - Evidence-based Treatment for Patients with Opioid Use Disorder	Library	Defines the data requirements to support evaluation of recommendation #12
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

Example Data/Requests - patient-view hook

Description	CDS Hooks Request	Expected Response
Patient is 18 or older. Patient has a diagnosis of opioid misuse disorder in past 90 days. This will trigger the message "Recommend opioid agonist or partial agonist treatment with methadone maintenance therapy or buprenorphine and/or behavioral therapy".	Request JSON	Response JSON
Patient is 18 or older. Patient has a diagnosis of opioid misuse disorder and has been prescribed Buprenorphine 2 MG / Naloxone 0.5 MG Sublingual Film (1010600) in past 90 days. The patient will be excluded and no message will be triggered - an empty set of cards will be returned.	Request JSON	Response JSON

Description

CDS Hooks Request

Expected Response

Patient is 18 or older. Patient has a diagnosis of opioid misuse disorder in past 90 days. This will trigger the message "Recommend opioid agonist or partial agonist treatment with methadone maintenance therapy or buprenorphine and/or behavioral therapy".

Request JSON

Response JSON

Patient is 18 or older. Patient has a diagnosis of opioid misuse disorder and has been prescribed Buprenorphine 2 MG / Naloxone 0.5 MG Sublingual Film (1010600) in past 90 days. The patient will be excluded and no message will be triggered - an empty set of cards will be returned.

Request JSON

Response JSON