opioidcds-08
type: PlanDefinition
node role: treeRoot
id:
  v: opioidcds-08
meta:
  profile:
    v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition
    l: cpg-recommendationdefinition
  profile:
    v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-publishableplandefinition
    l: cpg-publishableplandefinition
text:
  status:
    v: extensions
  div:
    v: Id: opioidcds-08 Url: Recommendation #8 - Naloxone Consideration Version: 2022.1.0 Identifier: value: cdc-opioid-guidance Name: PlanDefinition_Recommendation_08_Order_Sign Title: Recommendation #8 - Naloxone Consideration Status: draft Experimental: true Type: system: http://terminology.hl7.org/CodeSystem/plan-definition-type code: eca-rule display: ECA Rule Date: 2024-11-19 Publisher: Centers for Disease Control and Prevention (CDC) Description: Before starting and periodically during continuation of opioid therapy, clinicians should evaluate risk for opioid-related harms and discuss risk with patients. Clinicians should work with patients to incorporate into the management plan strategies to mitigate risk, including offering naloxone. Logic Definitions: Library Name Name sequence OpioidCDSREC08 Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions 0 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 ) Library Name Name sequence OpioidCDSREC08 Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential 1 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; ) Library Name Name sequence OpioidCDSRoutines Patient Age Less Than 18 2 define &quot;Patient Age Less Than 18&quot;: if (Config.&quot;Age Less than 18 Years Is Enabled&quot;) then AgeInYearsAt(Today()) &lt; 18 else false Library Name Name sequence OpioidCDSRoutines Condition Positive for Sickle Cell 3 define &quot;Condition Positive for Sickle Cell&quot;: if (Config.&quot;Sickle Cell Check Enabled&quot;) then exists( Common.&quot;Positive Sickle Cell Condition&q…
contained: Library
  id:
    v: effective-data-requirements
  status:
    v: active
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/library-type
        l: library-type
      code:
        v: module-definition
  related artifact:
    type:
      v: depends-on
    display:
      v: Library Common
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommon|2022.1.0
      l: http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommon
  related artifact:
    type:
      v: depends-on
    display:
      v: Library FHIRHelpers
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1
      l: http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers
  related artifact:
    type:
      v: depends-on
    display:
      v: Library Routines
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSRoutines|2022.1.0
      l: http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSRoutines
  related artifact:
    type:
      v: depends-on
    display:
      v: Library MMECalculator
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/MMECalculator|3.0.0
      l: http://fhir.org/guides/cdc/opioid-cds/Library/MMECalculator
  related artifact:
    type:
      v: depends-on
    display:
      v: Library OMTKLogic
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/OMTKLogic|3.0.0
      l: http://fhir.org/guides/cdc/opioid-cds/Library/OMTKLogic
  related artifact:
    type:
      v: depends-on
    display:
      v: Library OMTKData
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/OMTKData|3.0.0
      l: http://fhir.org/guides/cdc/opioid-cds/Library/OMTKData
  related artifact:
    type:
      v: depends-on
    display:
      v: Library FHIRHelpers
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1
      l: http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers
  related artifact:
    type:
      v: depends-on
    display:
      v: Library ConversionFactors
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/ConversionFactors|3.0.0
      l: http://fhir.org/guides/cdc/opioid-cds/Library/ConversionFactors
  related artifact:
    type:
      v: depends-on
    display:
      v: Library CDCMMEClinicalConversionFactors
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/CDCMMEClinicalConversionFactors|3.0.0
      l: http://fhir.org/guides/cdc/opioid-cds/Library/CDCMMEClinicalConversionFactors
  related artifact:
    type:
      v: depends-on
    display:
      v: Library FHIRHelpers
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1
      l: http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers
  related artifact:
    type:
      v: depends-on
    display:
      v: Library FHIRHelpers
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1
      l: http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers
  related artifact:
    type:
      v: depends-on
    display:
      v: Library Config
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommonConfig|2022.1.0
      l: http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommonConfig
  related artifact:
    type:
      v: depends-on
    display:
      v: Code system Usage Context Type
    resource:
      v: http://terminology.hl7.org/CodeSystem/usage-context-type
      l: usage-context-type
  related artifact:
    type:
      v: depends-on
    display:
      v: Code system CDC MME Usage Context Codes
    resource:
      v: http://fhir.org/guides/cdc/opioid-mme-r4/CodeSystem/CDCMMEUsageContextCodes
      l: CDCMMEUsageContextCodes
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set Opioid analgesics with ambulatory misuse potential
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-analgesics-with-ambulatory-misuse-potential
      l: opioid-analgesics-with-ambulatory-misuse-potential
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set Community
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/medicationrequest-category-community
      l: medicationrequest-category-community
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set Encounter Diagnosis Condition Category
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category
      l: condition-encounter-diagnosis-category
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set Problem List Condition Category
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category
      l: condition-problem-list-category
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set US Core Health Concern Condition Category
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category
      l: condition-us-core-health-concern-category
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set Limited life expectancy conditions
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/limited-life-expectancy-conditions
      l: limited-life-expectancy-conditions
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set Active Condition
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-clinical-status-active
      l: condition-clinical-status-active
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set Substance misuse behavioral counseling
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/substance-misuse-behavioral-counseling
      l: substance-misuse-behavioral-counseling

type:
  v: depends-on
display:
  v: Value set Conditions documenting substance misuse
resource:
  v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/conditions-documenting-substance-misuse
  l: conditions-documenting-substance-misuse

type:
  v: depends-on
display:
  v: Value set Conditions Documenting Sleep Disordered Breathing
resource:
  v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/conditions-documenting-sleep-disordered-breathing
  l: conditions-documenting-sleep-disordered-breathing

type:
  v: depends-on
display:
  v: Value set Conditions likely terminal for opioid prescribing
resource:
  v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/conditions-likely-terminal-for-opioid-prescribing
  l: conditions-likely-terminal-for-opioid-prescribing

name:
  v: ContextPrescriptions
use:
  v: in
min:
  v: 0
max:
  v: *
type:
  v: MedicationRequest

name:
  v: ErrorLevel
use:
  v: in
min:
  v: 0
max:
  v: 1
type:
  v: string

name:
  v: ConversionFactorSupplementName
use:
  v: in
min:
  v: 0
max:
  v: 1
type:
  v: string

name:
  v: Is Recommendation Applicable?
use:
  v: out
min:
  v: 0
max:
  v: 1
type:
  v: boolean

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/StructureDefinition/Condition
  l: Condition
must support:
  v: category
code filter:
  path:
    v: category
  value set:
    v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category
    l: condition-encounter-diagnosis-category

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/StructureDefinition/Condition
  l: Condition
must support:
  v: category
code filter:
  path:
    v: category
  value set:
    v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category
    l: condition-problem-list-category

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/StructureDefinition/Condition
  l: Condition
must support:
  v: category
code filter:
  path:
    v: category
  value set:
    v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category
    l: condition-us-core-health-concern-category

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/StructureDefinition/Procedure
  l: Procedure
must support:
  v: code
code filter:
  path:
    v: code
  value set:
    v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/substance-misuse-behavioral-counseling
    l: substance-misuse-behavioral-counseling

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/StructureDefinition/Encounter
  l: Encounter
must support:
  v: period
must support:
  v: period.start
must support:
  v: status
must support:
  v: status.value

url:
  v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
  l: cpg-knowledgeCapability
value: Code
  v: shareable

url:
  v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
  l: cpg-knowledgeCapability
value: Code
  v: computable

url:
  v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
  l: cpg-knowledgeCapability
value: Code
  v: executable

url:
  v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
  l: cpg-knowledgeCapability
value: Code
  v: publishable

url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem
  l: cqfm-softwaresystem
value: Reference
  l: cqf-tooling
  reference:
    v: Device/cqf-tooling

id:
  v: effective-data-requirements
url:
  v: http://fhir.org/guides/cdc/opioid-cds/StructureDefinition/effectiveDataRequirements
  l: effectiveDataRequirements
value: Reference
  l: effective-data-requirements
  reference:
    v: #effective-data-requirements

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSREC08
extension:
  url:
    v: name
    l: name
  value: String
    v: Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions": ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription where Routines."Is Subacute or Chronic Pain Prescription?"( AmbulatoryOpioidPrescription )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 0
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSREC08
extension:
  url:
    v: name
    l: name
  value: String
    v: Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential": exists( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 1
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSRoutines
extension:
  url:
    v: name
    l: name
  value: String
    v: Patient Age Less Than 18
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Patient Age Less Than 18": if (Config."Age Less than 18 Years Is Enabled") then AgeInYearsAt(Today()) < 18 else false
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 2
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSRoutines
extension:
  url:
    v: name
    l: name
  value: String
    v: Condition Positive for Sickle Cell
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Condition Positive for Sickle Cell": if (Config."Sickle Cell Check Enabled") then exists( Common."Positive Sickle Cell Condition" ) else false
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 3
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: US Core-Categorized Conditions
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // 3. Medications indicating end of life /* or exists ( "Medications Indicating End of Life" ) */ define "US Core-Categorized Conditions": [Condition: category in "Encounter Diagnosis Condition Category"] union [Condition: category in "Problem List Condition Category"] union [Condition: category in "US Core Health Concern Condition Category"]
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 4
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSRoutines
extension:
  url:
    v: name
    l: name
  value: String
    v: Conditions Indicating End Of Life Present
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Conditions Indicating End Of Life Present": exists ( Common."US Core-Categorized Conditions" LLEC where LLEC.code in Common."Limited life expectancy conditions" and LLEC.clinicalStatus in Common."Active Condition" )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 5
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSRoutines
extension:
  url:
    v: name
    l: name
  value: String
    v: Is Active Cancer Treatment?
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Is Active Cancer Treatment?": if (Config."Active Cancer Treatment Encounters Condition Is Enabled") then "Has Two or More Encounters with Cancer Diagnosis During Encounter Period" else false
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 6
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSRoutines
extension:
  url:
    v: name
    l: name
  value: String
    v: Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present": if (Config."End-Stage Disease Criteria Enabled") then exists ( Common."US Core-Categorized Conditions" EOLC where EOLC.code in Common."Conditions likely terminal for opioid prescribing" and EOLC.clinicalStatus in Common."Active Condition" ) else false
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 7
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSRoutines
extension:
  url:
    v: name
    l: name
  value: String
    v: Is Opioid Review Useful?
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Is Opioid Review Useful?": not "Patient Age Less Than 18" and not "Condition Positive for Sickle Cell" and not "Conditions Indicating End Of Life Present" and not "Is Active Cancer Treatment?" and not "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 8
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: Active Ambulatory Benzodiazepine Rx
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Active Ambulatory Benzodiazepine Rx": if Config."Can the implementing EHR support queries for past medications by date range?" then ( "Get MedicationRequest Medication as Code"("Get Active Ambulatory Medication Requests"([MedicationRequest])) ) Rx where date from Rx.authoredOn 2 years or less on or before Today() and Rx.medication in "Benzodiazepine medications" else List<FHIR.MedicationRequest>{}
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 9
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSREC08
extension:
  url:
    v: name
    l: name
  value: String
    v: On Benzodiazepine
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "On Benzodiazepine": exists( Common."Active Ambulatory Benzodiazepine Rx" )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 10
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OMTKData
extension:
  url:
    v: name
    l: name
  value: String
    v: DrugIngredients
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* This library contains drug ingredient data for opioid ingredients of combinations drugs as determined using the [RxNav](https://rxnav.nlm.nih.gov/) API. The content was produced using the process described [here](http://build.fhir.org/ig/cqframework/opioid-cds-r4/service-documentation.html#solution-component-1-medication-and-terminology-knowledge-base). This version of the content was generated on 2020-10-20 This product uses publicly available data courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services; NLM is not responsible for the product and does not endorse or recommend this or any other product. Nelson SJ, Zeng K, Kilbourne J, Powell T, Moore R. Normalized names for clinical drugs: RxNorm at 6 years. J Am Med Inform Assoc. 2011 Jul-Aug;18(4)441-8. doi: 10.1136/amiajnl-2011-000116. Epub 2011 Apr 21. PubMed PMID: 21515544; PubMed Central PMCID: PMC3128404. [Full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128404/) */ /* DrugIngredients: List<{ drugCode Integer, drugName String, doseFormCode Integer, doseFormName String, ingredientCode Integer, ingredientName String, strength String, strengthValue Decimal, strengthUnit String }> */ // Generated from LocalDataStore_RxNav_OpioidCds-2020-10-20.sqlitedefine DrugIngredients: { { drugCode: 197696, drugName: '72 HR fentanyl 0.075 MG/HR Transdermal System', doseFormCode: 316987, doseFormName: 'Transdermal System', ingredientCode: 4337, ingredientName: 'Fentanyl', strength: '0.075 MG/HR', strengthValue: 0.075, strengthUnit: 'MG/HR' }, { drugCode: 197873, drugName: 'levorphanol tartrate 2 MG Oral Tablet', doseFormCode: 317541, doseFormName: 'Oral Tablet', ingredientCode: 6378, ingredientName: 'Levorphanol', strength: '2 MG', strengthValue: 2.0, strengthUnit: 'MG' }, { drugCode: 205533, drugName: '1 ML buprenorphine 0.3 MG/ML Injection [Buprenex]', doseFormCode: 1649574, doseFormName: 'Injection', ingredientCode: 1819, ingredientName: 'Bupr…
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 11
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: CDCMMEClinicalConversionFactors
extension:
  url:
    v: name
    l: name
  value: String
    v: CDCMMEClinicalConversionFactorsCodeSystem
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define CDCMMEClinicalConversionFactorsCodeSystem: CodeSystem { name: string { value: 'CDCMMEClinicalConversionFactors' }, supplements: canonical { value: 'http://www.nlm.nih.gov/research/umls/rxnorm' }, concept: List<FHIR.CodeSystem.Concept> { FHIR.CodeSystem.Concept { code: code { value: '2670' }, display: string { value: 'Codeine' }, property: List<FHIR.CodeSystem."Concept"."Property"> { FHIR.CodeSystem."Concept"."Property" { code: code { value: 'conversion-factor' }, value: decimal { value: 0.15 } } } }, FHIR.CodeSystem.Concept { code: code { value: '4337' }, display: string { value: 'Fentanyl' }, property: List<FHIR.CodeSystem."Concept"."Property"> { FHIR.CodeSystem."Concept"."Property" { code: code { value: 'dose-form-conversion-factor' }, value: string { value: '316987:7200@0.33333333' } } } }, FHIR.CodeSystem.Concept { code: code { value: '3423' }, display: string { value: 'Hydromorphone' }, property: List<FHIR.CodeSystem."Concept"."Property"> { FHIR.CodeSystem."Concept"."Property" { code: code { value: 'conversion-factor' }, value: decimal { value: 4 } } } }, FHIR.CodeSystem.Concept { code: code { value: '5489' }, display: string { value: 'Hydrocodone' }, property: List<FHIR.CodeSystem."Concept"."Property"> { FHIR.CodeSystem."Concept"."Property" { code: code { value: 'conversion-factor' }, value: decimal { value: 1 } } } }, FHIR.CodeSystem.Concept { code: code { value: '6813' }, display: string { value: 'Methadone' }, property: List<FHIR.CodeSystem."Concept"."Property"> { FHIR.CodeSystem."Concept"."Property" { code: code { value: 'dose-range-conversion-factor' }, value: string { value: '1-20:4' } }, FHIR.CodeSystem."Concept"."Property" { code: code { value: 'dose-range-conversion-factor' }, value: string { value: '21-40:8' } }, FHIR.CodeSystem."Concept"."Property" { code: code { value: 'dose-range-conversion-factor' }, value: string { value: '41-60:10' } }, FHIR.CodeSystem."Concept"."Property" { code: code { value: 'dose-range-conversion-factor' }, value: st…
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 12
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: ConversionFactors
extension:
  url:
    v: name
    l: name
  value: String
    v: ConversionFactorSupplement
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* The use of the CDCMMEClinicalConversionFactors is a workaround for the fact that we can't retrieve the formally defined CodeSystem resource (https://fhir.org/guides/cdc/opioid-mme-r4/CodeSystem-CDCMMEClinicalConversionFactors.html) from the FHIR server */ define ConversionFactorSupplement: CDCMMEClinicalConversionFactors."CDCMMEClinicalConversionFactorsCodeSystem" C where C.supplements.value = 'http://www.nlm.nih.gov/research/umls/rxnorm' and ( C.name.value = ConversionFactorSupplementName or exists ( C.useContext UC where UC.code ~ "Task Usage Context" and UC.value ~ "MME Calculation" ) )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 13
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: Active Ambulatory Opioid Rx
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Active Ambulatory Opioid Rx": if Config."Can the implementing EHR support queries for past medications by date range?" then ( "Get MedicationRequest Medication as Code"("Get Active Ambulatory Medication Requests"([MedicationRequest])) ) Rx where date from Rx.authoredOn 2 years or less on or before Today() and Rx.medication in "Opioid analgesics with ambulatory misuse potential" else List<FHIR.MedicationRequest>{}
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 14
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSREC08
extension:
  url:
    v: name
    l: name
  value: String
    v: Total MME
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Total MME": MMECalculator.TotalMME( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" union Common."Active Ambulatory Opioid Rx" )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 15
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSREC08
extension:
  url:
    v: name
    l: name
  value: String
    v: Has Substance Abuse History
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Has Substance Abuse History": exists ( [Procedure: Common."Substance misuse behavioral counseling"] ) or exists ( Common."US Core-Categorized Conditions" C where C.code in Common."Conditions documenting substance misuse" )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 16
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSREC08
extension:
  url:
    v: name
    l: name
  value: String
    v: Has Sleep Disordered Breathing Condition
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Has Sleep Disordered Breathing Condition": exists ( Common."US Core-Categorized Conditions" C where C.code in Common."Conditions Documenting Sleep Disordered Breathing" and C.clinicalStatus in Common."Active Condition" )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 17
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSREC08
extension:
  url:
    v: name
    l: name
  value: String
    v: Inclusion Criteria
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Inclusion Criteria": "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential" and Routines."Is Opioid Review Useful?" and ( "On Benzodiazepine" or "Total MME" >= 50 '{MME}/d' or "Has Substance Abuse History" or "Has Sleep Disordered Breathing Condition" )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 18
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommonConfig
extension:
  url:
    v: name
    l: name
  value: String
    v: Evidence of Naloxone Enabled
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // Recommendation 8 define "Evidence of Naloxone Enabled": true
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 19
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: Active Ambulatory Naloxone Rx
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Active Ambulatory Naloxone Rx": if Config."Can the implementing EHR support queries for past medications by date range?" then ( "Get MedicationRequest Medication as Code"("Get Active Ambulatory Medication Requests"([MedicationRequest])) ) Rx where date from Rx.authoredOn 2 years or less on or before Today() and Rx.medication in "Naloxone medications" else List<FHIR.MedicationRequest>{}
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 20
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSREC08
extension:
  url:
    v: name
    l: name
  value: String
    v: On Naloxone
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "On Naloxone": exists( Common."Active Ambulatory Naloxone Rx" )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 21
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: Conditions Indicating End of Life or With Limited Life Expectancy
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Conditions Indicating End of Life or With Limited Life Expectancy": ( "US Core-Categorized Conditions" C where C.code in "Conditions likely terminal for opioid prescribing" and C.clinicalStatus in "Active Condition" ) union ( "US Core-Categorized Conditions" C where C.code in "Limited life expectancy conditions" and C.clinicalStatus in "Active Condition" )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 22
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: Admitted/Referred/Discharged to Hospice Care
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Admitted/Referred/Discharged to Hospice Care": ( if (Config."Hospice Findings Exclusion Enabled") then [Observation: code in "Hospice Finding Codes"] O where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' }) else {} ) union ( [Encounter] E where date from E.period.start 1 year or less on or before Today() and ( if E.hospitalization.dischargeDisposition.coding is null or not exists (E.hospitalization.dischargeDisposition.coding) then false else E.hospitalization.dischargeDisposition in "Hospice Disposition" ) and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' } )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 23
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: End of Life Assessment
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "End of Life Assessment": // 1. Conditions indicating end of life or with limited life expectancy exists ( "Conditions Indicating End of Life or With Limited Life Expectancy" ) // 2. Admitted/referred/discharged to hospice care or exists ( "Admitted/Referred/Discharged to Hospice Care" )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 24
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSREC08
extension:
  url:
    v: name
    l: name
  value: String
    v: Exclusion Criteria
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Exclusion Criteria": ( Config."Evidence of Naloxone Enabled" and "On Naloxone" ) or Common."End of Life Assessment"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 25
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSREC08
extension:
  url:
    v: name
    l: name
  value: String
    v: Is Recommendation Applicable?
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Is Recommendation Applicable?": "Inclusion Criteria" and not "Exclusion Criteria"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 26
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

id:
  v: effective-data-requirements
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements
  l: cqfm-effectiveDataRequirements
value: Reference
  l: effective-data-requirements
  reference:
    v: #effective-data-requirements

use:
  v: official
value:
  v: cdc-opioid-guidance

v: 2022.1.0

v: PlanDefinition_Recommendation_08_Order_Sign

v: Recommendation #8 - Naloxone Consideration

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/plan-definition-type
    l: plan-definition-type
  code:
    v: eca-rule
  display:
    v: ECA Rule

v: draft

v: true

v: 2024-11-19

v: Centers for Disease Control and Prevention (CDC)

telecom:
  system:
    v: url
  value:
    v: https://www.cdc.gov

v: Before starting and periodically during continuation of opioid therapy, clinicians should evaluate risk for opioid-related harms and discuss risk with patients. Clinicians should work with patients to incorporate into the management plan strategies to mitigate risk, including offering naloxone.

code:
  system:
    v: http://terminology.hl7.org/CodeSystem/usage-context-type
    l: usage-context-type
  code:
    v: focus
  display:
    v: Clinical Focus
value: CodeableConcept
  coding: http://snomed.info/id/182888003
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 182888003
    display:
      v: Medication requested (situation)

code:
  system:
    v: http://terminology.hl7.org/CodeSystem/usage-context-type
    l: usage-context-type
  code:
    v: focus
  display:
    v: Clinical Focus
value: CodeableConcept
  coding: http://snomed.info/id/82423001
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 82423001
    display:
      v: Chronic pain (finding)

code:
  system:
    v: http://terminology.hl7.org/CodeSystem/usage-context-type
    l: usage-context-type
  code:
    v: focus
  display:
    v: Clinical Focus
value: CodeableConcept
  text:
    v: Subacute pain

v: The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.

v: Clinicians should offer naloxone when prescribing opioids, particularly to patients at increased risk for overdose, including patients with a history of overdose, patients with a history of substance use disorder, patients with sleep-disordered breathing, patients taking higher dosages of opioids (e.g., ≥50 MME/day), patients taking benzodiazepines with opioids (see Recommendation 11), and patients at risk for returning to a high dose to which they have lost tolerance.

v: © CDC 2016+.

text:
  v: Opioid Prescribing

name:
  v: Kensaku Kawamoto, MD, PhD, MHS

name:
  v: Bryn Rhodes

name:
  v: Floyd Eisenberg, MD, MPH

name:
  v: Robert McClure, MD, MPH

type:
  v: documentation
display:
  v: 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain
url:
  v: https://www.cdc.gov/mmwr/volumes/71/rr/pdfs/rr7103a1-H.pdf
  l: rr7103a1-H.pdf
document:
  content type:
    v: application/pdf
  language:
    v: en-US
  url:
    v: https://www.cdc.gov/mmwr/volumes/71/rr/pdfs/rr7103a1-H.pdf
    l: rr7103a1-H.pdf

type:
  v: documentation
display:
  v: MME Conversion Tables
url:
  v: https://www.cdc.gov/opioids/providers/prescribing/pdf/calculating-total-daily-dose.pdf
  l: calculating-total-daily-dose.pdf
document:
  content type:
    v: application/pdf
  language:
    v: en-US
  url:
    v: https://www.cdc.gov/opioids/providers/prescribing/pdf/calculating-total-daily-dose.pdf
    l: calculating-total-daily-dose.pdf

title:
  v: Incorporate Risk Mitigation Strategies Into Opioid Therapy
description:
  v: Recommend incorporating strategies to mitigate opioid therapy risks, including offering naloxone. For guidance regarding assessing opioid therapy risks, see [Recommendation 8 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation8) For more information about prescribing naloxone see https://prescribetoprevent.org **MME Calculator Cautions** 1) All doses are in mg/day except for fentanyl, which is mcg/hr. 2) Equianalgesic dose conversions are only estimates and cannot account for individual variability in genetics and pharmacokinetics. 3) 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. 4) 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. 5) 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. 6) 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. 7) These conversion factors should not be applied to dosage decisions related to the management of opioid use disorder. - 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…
priority:
  v: urgent
documentation:
  type:
    v: documentation
  url:
    v: https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation8:~:text=including%20offering%20naloxone-,(recommendation%20category%3A%20A%3B%20evidence%20type%3A%204).,-Implementation%20Considerations
    l: https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
  document:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation
        l: cqf-strengthOfRecommendation
      value: CodeableConcept
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence
        l: cqf-qualityOfEvidence
      value: CodeableConcept
    url:
      v: https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation8:~:text=including%20offering%20naloxone-,(recommendation%20category%3A%20A%3B%20evidence%20type%3A%204).,-Implementation%20Considerations
      l: https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
trigger:
  type:
    v: named-event
  name:
    v: order-sign
condition:
  kind:
    v: applicability
  expression:
    description:
      v: Check whether the current order is for an opioid with ambulatory misuse potential, if an opioid review is appropriate, there is an active order for nalaxone, the patient exhibits risk factors for opioid-related harms; such as receiving benzodiazepine or other central nervous system depressant medications, a history of substance abuse, an average MME greater than 50 mg/day, and/or an active sleep-disordered breathing condition.
    language:
      v: text/cql.identifier
    expression:
      v: Is Recommendation Applicable?
grouping behavior:
  v: visual-group
selection behavior:
  v: any
action:
  description:
    v: Order - Order Naloxone
action:
  description:
    v: Document - Risk mitigation strategy implemented, snooze 3 months
action:
  description:
    v: Snooze* - N/A see comment, snooze 3 months

system:
  v: http://terminology.hl7.org/CodeSystem/recommendation-strength
  l: recommendation-strength
code:
  v: strong
display:
  v: Strong

system:
  v: http://terminology.hl7.org/CodeSystem/evidence-quality
  l: evidence-quality
code:
  v: very-low
display:
  v: Very Low quality