Id: OpioidCDSREC04And05 Url: Library - Recommendations #4 and #5 - Lowest Effective Dose Version: 2022.1.0 Name: OpioidCDSREC04And05 Title: Library - Recommendations #4 and #5 - Lowest Effective Dose Status: active Experimental: true Type: system: http://terminology.hl7.org/CodeSystem/library-type code: logic-library Date: 2026-01-27 18:30:23+0000 Publisher: Centers for Disease Control and Prevention (CDC) Related Artifacts: Dependencies http://fhir.org/guides/cqf/common/Library/FHIR-ModelInfo|4.0.1 Library - OpioidCDS Commonversion: null2022.1.0) Library - OpioidCDS Common Configurationversion: null2022.1.0) Library - OpioidCDS Routinesversion: null2022.1.0) Morphine Milligram Equivalent (MME) Calculator for FHIR R4version: null3.0.0) Parameters: Name Type Min Max In/Out ContextPrescriptions MedicationRequest 0 * In Patient Patient 0 1 Out Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions MedicationRequest 0 * Out Total MME Quantity 0 1 Out Taper Now boolean 0 1 Out Consider Tapering boolean 0 1 Out Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential boolean 0 1 Out Inclusion Criteria boolean 0 1 Out Exclusion Criteria boolean 0 1 Out Is Recommendation Applicable? boolean 0 1 Out Data Requirements: Type Profile MS Code Filter Patient http://hl7.org/fhir/StructureDefinition/Patient Content: text/cql library OpioidCDSREC04And05 version '2022.1.0' using FHIR version '4.0.1' include OpioidCDSCommon version '2022.1.0' called Common include OpioidCDSCommonConfig version '2022.1.0' called Config include OpioidCDSRoutines version '2022.1.0' called Routines /*include fhir.cdc."opioid-mme-r4".MMECalculator version '3.0.0' called MMECalculator */ include MMECalculator version '3.0.0' called MMECalculator /* ** ** Recommendation #4 ** When opioids are initiated for opioid-naïve patients with acute, subacute, or chronic pain, ** clinicians should prescribe the lowest effective dosage. If opioids are continued for ** subacute or chronic pain, clinicians should use caution when prescribing opioids at any dosage, ** should carefully evaluate individual benefits and risks when considering increasing dosage, and ** should avoid increasing dosage above levels likely to yield diminishing returns in benefits ** relative to risks to patients (recommendation category: A; evidence type: 3) ** Recommendation #5 ** For patients already receiving opioid therapy, clinicians should carefully weigh benefits and ** risks and exercise care when changing opioid dosage. If benefits outweigh risks of continued ** opioid therapy, clinicians should work closely with patients to optimize nonopioid therapies ** while continuing opioid therapy. If benefits do not outweigh risks of continued opioid therapy, ** clinicians should optimize other therapies and work closely with patients to gradually taper to ** lower dosages or, if warranted based on the individual circumstances of the patient, appropriately ** taper and discontinue opioids. Unless there are indications of a life-threatening issue such as ** warning signs of impending overdose (e.g., confusion, sedation, or slurred speech), opioid therapy ** should not be discontinued abruptly, and clinicians should not rapidly reduce opioid dosages from ** higher dosages (recommendation category: B; evidence type: 4). ** ** When ** Provider is prescribing an opioid analgesic with ambulatory misuse potential in the outpatient setting ** CDC 2022 guideline general inclusion criteria met 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 Morphine Milligram Equivalent (MME) greater than or equal to 50 ** Then ** Calibrate to Lowest Opioid Dose Needed for Expected Results and Exercise Care When Changing Opioid Dosages: ** Document - Will prescribe a lower dose ** Document - Will calibrate a gradual change in dosage ** Snooze - Benefits outweigh risks, snooze 3 months ** Snooze - Short term benefits outweigh risks, snooze 1 month ** Snooze - N/A add comment, snooze 3 months ** */ // META: Plan Definition: http://fhir.org/guides/cdc/opioid-cds-r4/PlanDefinition/opioid-cds-04-05 parameter ContextPrescriptions List<MedicationRequest> context Patient define "Taper Now": "Total MME".value >= 90 define "Consider Tapering": "Total MME".value < 90 define "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions": ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription where Routines."Is Subacute or Chronic Pain Prescription?"( AmbulatoryOpioidPrescription ) define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential": exists( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" ) define "Total MME": MMECalculator.TotalMME( ( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" union Common."Active Ambulatory Opioid Rx" ) AmbulatoryOpioidPrescription where Routines."Is Subacute or Chronic Pain Prescription?"( AmbulatoryOpioidPrescription ) ) define "Inclusion Criteria": "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential" and Routines."CDC 2022 Guideline General Inclusion Criteria" and "Total MME" >= 50 '{MME}/d' define "Exclusion Criteria": Common."End of Life Assessment" define "Is Recommendation Applicable?": "Inclusion Criteria" and not "Exclusion Criteria" Content: application/elm+xml Encoded data (30516 characters) Content: application/elm+json Encoded data (49484 characters)
Library - Recommendations #4 and #5 - Lowest Effective Dose
Centers for Disease Control and Prevention (CDC)
Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions
Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential