2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide
2022.1.0 - Release 2022.1
2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide
2022.1.0 - Release 2022.1
2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide, published by CDC / Security Risk Solutions, Inc. (SRS). 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/security-rs/opioid-cds-r4/ and changes regularly. See the Directory of published versions
| Official URL: http://fhir.org/guides/cdc/opioid-cds/ImplementationGuide/fhir.cdc.opioid-cds-r4 | Version: 2022.1.0 | |||
| Active as of 2026-03-07 | Computable Name: Opioid_CDC | |||
Copyright/Legal: Centers for Disease Control and Prevention (CDC) |
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This implementation guide (IG) 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, including support for the following guideline recommendations:
For further details on how the behaviors for the artifacts were determined, refer to the Process Documentation.
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. Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), to identify, develop, and harmonize standards for clinical decision support and electronic clinical quality measurement, as well as a joint effort by the CDC and ASTP/ONC focused on improving processes for the development of standardized, shareable, computable decision support artifacts using the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain as a model case.
Discussions on the use of this IG happen at the HL7 Clinical Decision Support (CDS) Workgroup. Feedback and contributions are welcome and can be raised with the CDS Workgroup or submitted directly using the New Issue link in the footer of every page.
This implementation guide has followed and applied the methodology laid out by the HL7 Clinical Practice Guideline (CPG) IG. The CPG IG offers an abstract high-level methodology for translating clinical guidelines into electronic Clinical Decision Support (eCDS) artifacts based on the following steps:
The following diagram depicts the relationship and (navigable) links between the artifacts in the CPG IG and their respective instantiations in this IG.
The HL7 Data Exchange Profiles for 2022 CDC Clinical Practice Guideline for Prescribing Opioids has been developed to define a set of conformance requirements for supporting the data queries used in this implementation guide. By conforming to these profiles (which are derived from US Core) EHRs can ensure they are prepared to support the integration with this IG.
This implementation guide assumes that CDS Hooks serves as the technical framework for EHR integration. The table below outlines the supported triggering events for each guideline recommendation:
(*) Developed for implementations without capabilities to support the preferred trigger.
All doses are in mg/day except for fentanyl, which is mcg/hr.
Equianalgesic dose conversions are only estimates and cannot account for individual variability in genetics and pharmacokinetics.
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.
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.
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.
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.
These conversion factors should not be applied to dosage decisions related to the management of opioid use disorder.
| Opioid | Conversion Factor |
|---|---|
| Codeine | 0.15 |
| Fentanyl transdermal (in mcg/hr) | 2.4 |
| Hydrocodone | 1.0 |
| Hydromorphone | 5.0 |
| Methadone | 4.7 |
| Morphine | 1.0 |
| Oxycodone | 1.5 |
| Oxymorphone | 3.0 |
| Tapentadol * | 0.4 |
| Tramadol ** | 0.2 |
* 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.
Project Team
Government Leadership
This publication includes IP covered under the following statements.
This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (fhir.cdc.opioid-cds-r4.r4) and R4B (fhir.cdc.opioid-cds-r4.r4b) are available.
| IG | Package | FHIR | Comment |
|---|---|---|---|
  2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide | fhir.cdc.opioid-cds-r4#2022.1.0 | R4 | |
 HL7 Terminology (THO) | hl7.terminology.r4#7.1.0 | R4 | Automatically added as a dependency - all IGs depend on HL7 Terminology |
  FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.2.0 | R4 | |
 Clinical Practice Guidelines | hl7.fhir.uv.cpg#1.0.0 | R4 | |
| CDC MME CQL Calculator | fhir.cdc.opioid-mme-r4#3.0.0 | R4 | |
| Clinical Quality Framework Common FHIR Assets | fhir.cqf.common#4.0.1 | R4 | |
| Canonical Resource Management Infrastructure Implementation Guide | hl7.fhir.uv.crmi#1.0.0 | R4 | |
| HL7 Terminology (THO) | hl7.terminology#5.5.0 | R4 | |
| FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#1.0.0 | R4 | |
| FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.1.0 | R4 | |
 FHIR Tooling Extensions IG | hl7.fhir.uv.tools.r4#1.1.2 | R4 | for example references |
Package hl7.fhir.uv.extensions.r4#5.2.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Mon, Feb 10, 2025 21:45+1100+11:00) |
Package hl7.fhir.uv.cpg#1.0.0 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) |
Package hl7.fhir.uv.tools.r4#1.1.2 This IG defines the extensions that the tools use internally. Some of these extensions are content that are being evaluated for elevation into the main spec, and others are tooling concerns (built Tue, Mar 24, 2026 11:13+1100+11:00) |
There are no Global profiles defined