Opioid Prescribing Support Implementation Guide
4.0.0 - CI Build

Opioid Prescribing Support Implementation Guide, published by Centers for Disease Control and Prevention (CDC). This is not an authorized publication; it is the continuous build for version 4.0.0). 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 #2 - Opioid Therapy Goals Discussion

Recommendation #2:

Before starting opioid therapy for chronic pain, clinicians should establish treatment goals with all patients, including realistic goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks. Clinicians should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety (recommendation category: A, evidence type: 4).

Functional Description

  • When
    • Provider is prescribing an opioid with ambulatory misuse potential in the outpatient setting
    • Prescription is for treating chronic pain.
    • Opioid review is useful for this patient:
      • Patient is 18 or over
      • 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 encounters within the past year with any diagnosis of cancer
    • Patient is opioid naive:
      • No indication of opioid use in the past 90 days from a prescription, self report, or a dispensing event
    • Patient does not have an opioid treatment plan that was created, edited, or reviewed by the prescribing physician in the past 90 days
    • Patient does not have a pain management procedure in the past 90 days
  • Then
    • Recommend creation, review or update of an opioid treatment plan. Potential actions include:
      • Create treatment plan with goals for opioid use
      • Update patient’s opioid treatment plan
      • Review patient’s opioid treatment plan
      • N/A - see comment, snooze 3 months
      • Taper / Discontinue opioid

For Chronic Pain

Chronically on Opioids

Opioid Review Useful

Active Cancer Treatment

Opioid Naive

Content

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

Common Libraries

Resource Type Description
CDC Opioid Prescribing Guideline Recommendation #2 PlanDefinition Event-Condition-Action rule that implements behavior for CDC Opioid Prescribing Guideline Recommendation #2
Recommendation #2 - Opioid Therapy Goals Discussion Library Defines the data requirements to support evaluation of recommendation #2
CDC Opioid Prescribing Guideline Recommendation #2 CQL Source For reference, the complete CQL content for Recommendation #2

Example Data/Requests

Description Bundle CDS Hooks Request Expected Response
Patient is 18 years or older and has an outpatient Medication Request of Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) authored “Today” as well as an Opioid Treatment Care Plan updated 89 days prior to today. Patients “Dosage Instructions” are 1 Film per day for 30 days. This patient will not trigger any cards and there should not be a recommendation message.This will result in a summary message: “Recommend creation, review or update of opioid treatment plan.” CarePlan.category.code needs to be Common.”Opioid Treatment Plan…” Test Bundle example-rec-02-true-make-recommendations Request JSON example-rec-02-in-careplan-revisited Response JSON example-rec-02-in-careplan-revisited
Patient is 18 years or older and has an outpatient Medication Request of Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) authored “Today” as well as a Care Plan most recently updated 120 days prior to today. Patients “Dosage Instructions” are 1 Film per day for 30 days. Due to the most recent review of the Care Plan having been conducted more than 89 days prior to today this will result in a summary message: “Recommend creation, review or update of opioid treatment plan. CarePlan.category.code needs to be Common.”Opioid Treatment Plan…” Test Bundle example-rec-02-false-due-to-careplan-within-90-days Request JSON example-rec-02-out-careplan-not-revisited Response JSON example-rec-02-out-careplan-not-revisited