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
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Official URL: http://fhir.org/guides/cdc/opioid-cds/ImplementationGuide/fhir.cdc.opioid-cds-r4
This implementation guide provides resources and discussion in support of applying the Centers
for Disease Control and Prevention (CDC) 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain:
This implementation guide was developed based on work initially done as part of the
Clinical Quality Framework (CQF)
Initiative, a public-private partnership sponsored by the Centers for Medicare & Medicaid Services (CMS) and
the U.S. Office of the National Coordinator for Health Information Technology (ONC) to identify, develop, and harmonize
standards for clinical decision support and electronic clinical quality measurement, as well as a joint effort by
the Centers for Disease Control and Prevention (CDC) and the Office of the National Coordinator for Health IT (ONC)
focused on improving processes for the development of standardized, shareable, computable decision support artifacts
using the 2022 CDC Clinical Practice Guideline as a model case.
Feedback and contributions are welcome and can be submitted using the New Issue link in the footer of every page. Discussions on the
use of this IG as well as other CQF projects take place regularly on the CPG-on-FHIR calls, a subworkgroup of the HL7 Clinical Decision Support Workgroup.
Scope
This implementation guide includes support for the following guideline recommendations:
For clinical informaticists interested in how the behavior for the artifacts was determined,
refer to the Process Documentation.
Trigger Overview
This implementation guide assumes that CDS Hooks will serve as the technical framework for EHR integration. The table below outlines the supported triggering events for each guideline recommendation:
Caution: All doses are in mg/day except for fentanyl, which is mcg/hr.
Caution: Equianalgesic dose conversions are only estimates and cannot account for individual variability in genetics and pharmacokinetics.
Caution: 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. Consult the FDA approved product labeling for specific guidance on medications.
Caution: Use particular caution with methadone dose conversions because methadone has a long and variable half-life, and peak respiratory depressant effect occurs later and lasts longer than peak analgesic effect.
Caution: Use particular caution with transdermal fentanyl because it is dosed in mcg/hr instead of mg/day, and its absorption is affected by heat and other factors.
Caution: Buprenorphine products approved for the treatment of pain are not included in the table because of their partial µ-receptor agonist activity and resultant ceiling effects compared with full µ-receptor agonists.
Caution: These conversion factors should not be applied to dosage decisions related to the management of opioid use disorder.
Morphine milligram equivalent doses for commonly prescribed opioids for pain management table
This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
Using RxNorm codes of type SAB=RXNORM as this specification describes does not require a UMLS license. Access to the full set of RxNorm definitions, and/or additional use of other RxNorm structures and information requires a UMLS license. The use of RxNorm in this specification is pursuant to HL7's status as a licensee of the NLM UMLS. HL7's license does not convey the right to use RxNorm to any users of this specification; implementers must acquire a license to use RxNorm in their own right.
Implementation guidance for creating Clinical Practice Guidelines with formal artifacts to facilitate sharing and implementation of the guideline (built Thu, Feb 11, 2021 20:29+0000+00:00)
Package fhir.cqf.common#4.0.1
This implementation guide contains common FHIR assets for use in CQFramework content IGs, including FHIRHelpers and the FHIR-ModelInfo libraries. (built Fri, Nov 12, 2021 16:25+1100+11:00)
Package fhir.cdc.opioid-mme-r4#3.0.0
Opioid Morphine Milligram Equivalent (MME) calculation logic in FHIR and Clinical Quality Language (CQL) (built Thu, Nov 25, 2021 15:13+1100+11:00)
Package hl7.fhir.uv.extensions.r4#1.0.0
This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Mar 26, 2023 08:46+1100+11:00)
Package hl7.fhir.uv.extensions.r4#5.1.0
This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, Apr 27, 2024 18:39+1000+10:00)
Package hl7.fhir.uv.crmi#1.0.0
This implementation guide defines profiles, operations, capability statements and guidance to facilitate the content management lifecycle for authoring, publishing, distribution, and implementation of FHIR knowledge artifacts such as value sets, profiles, libraries, rules, and measures. The guide is intended to be used by specification and content implementation guide authors as both a dependency for validation of published artifacts, and a guide for construction and publication of content. (built Fri, May 31, 2024 16:38+0000+00:00)
Globals
There are no Global profiles defined
Tapentadol is a µ-receptor agonist and norepinephrine reuptake inhibitor. MMEs are based on degree of µ-receptor agonist activity; however, it is unknown whether tapentadol is associated with overdose in the same dose-dependent manner as observed with medications that are solely µ-receptor agonists. ↩
Tramadol is a µ-receptor agonist and norepinephrine and serotonin reuptake inhibitor. MMEs are based on degree of µ-receptor agonist activity; however, it is unknown whether tramadol is associated with overdose in the same dose-dependent manner as observed with medications that are solely µ-receptor agonists. ↩
2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide
