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

Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Common Logic Libraries

HelloWorld

HelloWorld Library

HelloWorldPatientView

HelloWorldPatientView Library

CDCMMEClinicalConversionFactors

CDCMMEClinicalConversionFactors Library

OpioidCDSRoutines

Common Routines Library

OpioidCDSCommon

Common Logic Library

OpioidCDSCommonConfig

Common Configuration Library

OpioidLogicMK2020

OMTK Logic MK (2020) Library

OpioidData2020

OMTK Data (2020) Library

FHIRHelpers

FHIR Helpers Library

FHIRModelInfo

FHIR ModelInfo Library

Recommendation Logic Libraries

OpioidCDSREC10CommonLibrary

Common Logic Library for Recommendation #10 - Urine Drug Testing

OpioidCDSREC01Library

Logic Library for Recommendation #1 (order-sign) - Nonpharmacologic and Nonopioid Pharmacologic Therapy Consideration

OpioidCDSREC02Library

Logic Library for Recommendation #2 (order-sign) - Opioid Therapy Goals Discussion

OpioidCDSREC03Library

Logic Library for Recommendation #3 (order-sign) - Opioid Immediate Release Form When Starting Opioid Therapy

OpioidCDSREC04And05Library

Logic Library for Recommendations #4 and #5 (order-sign) - Lowest Effective Dose

OpioidCDSREC06Library

Logic Library for Recommendation #6 (order-sign) - Prescribe Lowest Effective Dose and Duration

OpioidCDSREC07Library

Logic Library for Recommendation #7 (order-sign) - Opioid Therapy Risk Assessment

OpioidCDSREC08Library

Logic Library for Recommendation #8 (order-sign) - Naloxone Consideration

OpioidCDSREC09Library

Logic Library for Recommendation #9 (order-sign) - Consider Patient’s History of Controlled Substance Prescriptions

OpioidCDSREC10Library

Logic Library for Recommendation #10 (order-sign) - Urine Drug Testing

OpioidCDSREC10PatientViewLibrary

Logic Library for Recommendation #10 (patient-view) - Urine Drug Testing

OpioidCDSREC11Library

Logic Library for Recommendation #11 (order-select) - Concurrent Use of Opioids and Benzodiazepines

OpioidCDSREC11PatientViewLibrary

Logic Library for Recommendation #11 (patient-view) - Concurrent Use of Opioids and Benzodiazepines

OpioidCDSREC12PatientViewLibrary

Logic Library for Recommendation #12 (patient-view) - Evidence-based Treatment for Patients with Opioid Use Disorder

ActivityDefinitions

OpioidRiskAssessmentActivityDefinition

An ActivityDefinition for recommendation of risk assessment

OpioidUrineScreeningActivityDefinition

An ActivityDefinition for recommendation of urine screening

Knowledge Artifacts: Plan Definitions

These define workflows, rules, strategies, or protocols as part of content in this implementation guide.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #1

Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for subacute or chronic pain.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #10

When prescribing opioids for subacute or chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #10 (order-sign)

When prescribing opioids for subacute or chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #10 (patient-view)

When prescribing opioids for subacute or chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #11

Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #11 (patient-view)

Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #12 (patient-view)

Arrange evidence-based treatment (usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies) for patients with opioid use disorder.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #2

Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #3

When starting opioid therapy for subacute or chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #6

When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #7

Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for subacute or chronic pain or of dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #8

Clinicians should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #8 (order-sign)

Clinicians should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #9

Clinicians should review PDMP data when starting opioid therapy for subacute or chronic pain and periodically during opioid therapy for chronic pain.

PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendations #4 and #5

When opioids are started, providers should prescribe the lowest effective dosage.

Knowledge Artifacts: Libraries

These define logic, asset collections and other libraries as part of content in this implementation guide.

Morphine Milligram Equivalent (MME) Calculator for FHIR R4

This library contains logic to surface the MME calculation functionality provided by the OMTKLogic library by extracting appropriate information from FHIR R4 MedicationRequest resource.

Morphine Milligram Equivalent (MME) Conversion Factors for FHIR R4

This library contains logic to expose configurable conversion factors for the MME calculation functionality provided by the OMTKLogic library.

Opioid Management Terminology Knowledge Data

This library contains drug ingredient data for opioid ingredients of combinations drugs as determined using the RxNav API. The content was produced using the process described here.

Opioid Management Terminology Knowledge Logic

This library provides functionality for calculating Morphine Milligram Equivalents (MME) for opioid medications, as described in the CDC Opioid Prescribing Guideline.

Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide.

CDC_CarePlan

Profile of CarePlan for use with 2022 CDC Clinical Practice Guideline

CDC_MedicationRequest

Profile of MedicationRequest for use with 2022 CDC Clinical Practice Guideline

CDC_Observation

Profile of Observation for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

CDC_RequestGroup

Profile of RequestGroup for use with 2022 CDC Clinical Practice Guideline

CDC_ValueSet

Profile of ValueSet for use with 2022 CDC Clinical Practice Guideline

Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide.

CDC 2022 Opioid Guidance Clinical Focus Extension

Describes the clinical focus for the ValueSet.

CDC 2022 Opioid Guidance Data Element Extension

Describes the data element scope for the ValueSet.

CDC 2022 Opioid Guidance Inclusion Criteria Extension

Describes the clinical focus for the ValueSet.

CDC 2022 Opioid Guidance exclusion Criteria Extension

Describes the clinical focus for the ValueSet.

DataDateRollerExtension

Declares the DateLastUpdated and Frequency arguments to be used by the Data Date Roller for maintaining/rolling test data dates to keep them from going stale.

EffectiveDataRequirement Extension

A module definition library that contains the effective data requirements for the PlanDefinition (i.e. the calculated data requirements for the expressions referenced by the PlanDefinition structure).

Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide.

CodeSystem - CDC 2022 Opioid Indicator

Indicates the urgency/importance of what this RequestGroup action conveys

Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.

Ambulatory Opioid MedicationDispense

Ambulatory Opioid MedicationDispense Example

Ambulatory Opioid MedicationRequest

Ambulatory Opioid MedicationRequest Example

Ambulatory setting non-opioid CNS depressant medications

Medications potentially used in ambulatory setting that are CNS depressants but not contain an opioid class medication, and also do not contain cough medications or bowl transit modifiers.

Amphetamine class medications

Amphetamine class medications based upon the mapping of SNOMED CT drug class to ingredient then linked to RXNorm

Amphetamine-class drugs and metabolite urine tests

Urine tests, both quantitative and qualitative, including confirmatory, that detect Amphetamine-class drugs and metabolites

Benzodiazepine medications

All benzodiazepine clinical drugs

Buprenorphine and Methadone medications

All Buprenorphine and Methadone medications

CDC malignant cancer conditions

All neoplastic and malignant conditions, including pain due to neoplasm.

CNS depressant medications

Medications considered to have an ingredient considered to be a CNS depressant, some of which may be mild. Removed from this set are cough medications and bowl transit modifiers.

Cancer Diagnosis Condition

Cancer Diagnosis Condition Example

Cancer Diagnosis Encounter

Cancer Diagnosis Encounter Example

Cannabinoid class urine drug screening

Cannabinoid, including synthetic and THC, urine tests

Cocaine urine drug screening tests

Urine tests for cocaine and cocaine metabolites

Condition Clinical Status Active

The subject is currently experiencing the condition or situation, there is evidence of the condition or situation, or considered to be a significant risk.

Conditions documenting substance misuse

Any finding or condition that indicate problematic misuse of a substance other than tobacco or laxatives, including “history of” conditions.

Conditions likely terminal for opioid prescribing

Conditions that generally are thought to have terminal prognosis

Encounter Diagnosis Condition Category

Encounter Diagnosis condition category.

End of Life Condition

End of Life Condition Example

Ethanol urine drug screening tests

Urine tests to identify ethanol, metabolites, and disulfiram

Extended release opioid with ambulatory misuse potential

All opioid clinical drugs except those restricted to surgical use only, and that are in an extended release dose form code

Fentanyl-type medications

Fentanyl and similar medications (sufentanil, alfentanil, remifentanil)

Fentanyl-type urine drug screening tests

Urine tests for fentanyl-type drugs and metabolites

General opiate urine drug screening tests

Presumed general urine tests for naturally occurring opioids (i.e. opiates) that are not specific to a particular substance based upon the inclusion of the word ‘opiates’ in the long name.

Hospice Disposition

This value set contains concepts that represent patients receiving hospice care outside of a hospital or long term care facility.

Hospice Finding

Finding codes for receiving hospice care

Hospice Procedure

Procedure codes for referral, admission, or transfer to a hospice

Limited life expectancy conditions

A finding that documents a terminal prognosis

Methadone medications

Medication codes representing methadone medications

Methadone urine drug screening tests

Urine tests to identify methadone and metabolites

Naloxone medications

All naloxone medications

Non-opioid drug urine screening

Individual tests and panels of tests of urine for illicit drugs EXCEPT those for opioids.

Non-synthetic opioid medications

Medications derived from the opium plant that are not synthetically created . All metabolize to morphine.

Observation Category Laboratory

Laboratory Observation Category

Observation Category Procedure

Procedure Observation Category

Office Visit

Codes specifying outpatient encounters

Oncology Participant Encounter

Oncology Participant Encounter Example

Oncology Specialist PractitionerRole

Oncology Specialist PractitionerRole Example

Oncology specialty designations (NUCC)

NUCC oncology provider types who may provide encounters to patients with cancer

Opiate specific urine drug screening tests

Urine tests for naturally occurring opioids (i.e. opiates) that are specific to a particular naturally occurring opioid and therefore do not have the general word ‘opiates’ in the long name.

Opioid analgesics with ambulatory misuse potential

All opioid clinical drugs except cough medications, antispasmodics, or those restricted to surgical use only as identified by those using an injectable form.

Opioid counseling procedure

Procedure for counseling on opioid use

Opioid drug urine screening

Individual tests and panels of tests of urine for opioids

Opioid misuse assessment procedure

Procedure to assess the risk of opioid abuse occurring by a patient

Opioid misuse disorders

Conditions indicating opioid misuse

Opioid treatment assessment procedure

Broad set of concepts that may represent a procedure to assess the risk of opioid abuse occurring by a patient

OpioidCDS CarePlan

CarePlan Example

OpioidCDS MedicationRequest

MedicationRequest Example

OpioidCDS Observation

Observation Example

OpioidCDS Patient

Patient Example

OpioidCDS RequestGroup

RequestGroup Example

PDMP data reviewed finding

Finding indicating that the Prescription Drug Monitoring Program (PDMP) data was reviewed

PDMP review procedure

Procedure for Prescription Drug Monitoring Program (PDMP) review

Pain management procedure

Procedure for subacute or chronic pain control management

Pain treatment plan

A Pain medicine Plan of care note

Palliative Care ServiceRequest

Palliative Care ServiceRequest Example

Phencyclidine urine drug screening tests

Urine tests for phencyclidine

Problem List Condition Category

Problem list condition category.

Sickle-cell diseases

Sickle-cell disorders that cause painful crisis

Sleep disordered breathing

Conditions associated with sleep-related breathing disorders.

Substance misuse behavioral counseling

Counseling and associated procedures for substance misuse

Synthetic opioid medications

Opioid medications that are not exclusively and solely derived from the opium plant. These are synthetic or semisynthetic opioids.

Synthetic opioid urine drug screening tests

Urine tests for synthetic and semi-synthetic (non-opiate) substances

Terminal Condition

Terminal Condition Example

Therapies indicating end of life care

Therapeutic activities indicating end of life. Include procedures or therapies specific to a terminal patient, exclude procedures or therapies performed on a deceased patient

US Core Health Concern Condition Category

US Core Health Concern Condition Category.

Other

These are resources that are used within this implementation guide that do not fit into one of the other categories.

CQFToolingDevice

A Device that represents a CQF Tooling version.