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: 2025-11-13 15:52:38+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) http://fhir.org/guides/cdc/opioid-cds/Library/MMECalculator|3.0.0 http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1 Library - OpioidCDS Commonversion: null2022.1.0) http://fhir.org/guides/cdc/opioid-cds/Library/OMTKLogic|3.0.0 http://fhir.org/guides/cdc/opioid-cds/Library/OMTKData|3.0.0 http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1 http://fhir.org/guides/cdc/opioid-cds/Library/ConversionFactors|3.0.0 http://fhir.org/guides/cdc/opioid-cds/Library/CDCMMEClinicalConversionFactors|3.0.0 http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1 UsageContextType CDC MME Usage Context Codes Opioid analgesics with ambulatory misuse potential ValueSet - Medication Request Category Community Encounter Diagnosis Condition Category Problem List Condition Category US Core Health Concern Condition Category Conditions likely terminal for opioid prescribing Condition Clinical Status Active Limited life expectancy conditions Parameters: Name Type Min Max In/Out ContextPrescriptions MedicationRequest 0 * In ErrorLevel string 0 1 In ConversionFactorSupplementName string 0 1 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 Condition http://hl7.org/fhir/StructureDefinition/Condition ; code filter: path: category value set: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category Condition http://hl7.org/fhir/StructureDefinition/Condition ; code filter: path: category value set: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category Condition http://hl7.org/fhir/StructureDefinition/Condition ; code filter: path: category value set: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category Encounter http://hl7.org/fhir/StructureDefinition/Encounter ;;;; 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.&quot;opioid-mme-r4&quot;.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 ** Opioid review is useful 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&lt;MedicationRequest&gt; context Patient define &quot;Taper Now&quot;: &quot;Total MME&quot;.value &gt;= 90 define &quot;Consider Tapering&quot;: &quot;Total MME&quot;.value &lt; 90 define &quot;Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions&quot;: ( Common.&quot;Is Opioid Analgesic with Ambulatory Misuse Potential?&quot;( ContextPrescriptions ) ) AmbulatoryOpioidPrescription where Routines.&quot;Is Subacute or Chronic Pain Prescription?&quot;( AmbulatoryOpioidPrescription ) define &quot;Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential&quot;: exists( &quot;Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions&quot; ) define &quot;Total MME&quot;: MMECalculator.TotalMME( ( &quot;Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions&quot; union Common.&quot;Active Ambulatory Opioid Rx&quot; ) AmbulatoryOpioidPrescription where Routines.&quot;Is Subacute or Chronic Pain Prescription?&quot;( AmbulatoryOpioidPrescription ) ) define &quot;Inclusion Criteria&quot;: &quot;Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential&quot; and Routines.&quot;Is Opioid Review Useful?&quot; and &quot;Total MME&quot; &gt;= 50 '{MME}/d' define &quot;Exclusion Criteria&quot;: Common.&quot;End of Life Assessment&quot; define &quot;Is Recommendation Applicable?&quot;: &quot;Inclusion Criteria&quot; and not &quot;Exclusion Criteria&quot; Content: application/elm+xml Encoded data (29116 characters) Content: application/elm+json Encoded data (45880 characters)
Library - Recommendations #4 and #5 - Lowest Effective Dose
Centers for Disease Control and Prevention (CDC)
Value set Opioid analgesics with ambulatory misuse potential
Value set Encounter Diagnosis Condition Category
Value set Problem List Condition Category
Value set US Core Health Concern Condition Category
Value set Conditions likely terminal for opioid prescribing
Value set Limited life expectancy conditions
Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions
Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential