Id: opioidcds-09 Url: Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions Version: 2022.1.0 Identifier: value: cdc-opioid-guidance Name: PlanDefinition_Recommendation_09_Order_Sign Title: Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions 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: When prescribing initial opioid therapy for acute, subacute, or chronic pain, and periodically during opioid therapy for chronic pain, clinicians should review the patient's history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or combinations that put the patient at high risk for overdose. Logic Definitions: Library Name Name sequence OpioidCDSREC09 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 OpioidCDSREC09 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&quot; ) else false Library Name Name sequence OpioidCDSCommon US Core-Categorized Conditions 4 // 3. Medications indicating end of life /* or exists ( &quot;Medications Indicating End of Life&quot; ) */ define &quot;US Core-Categorized Conditions&quot;: [Condition: category in &quot;Encounter Diagnosis Condition Category&quot;] union [Condition: category in &quot;Problem List Condition Category&quot;] union [Condition: category in &quot;US Core Health Concern Condition Category&quot;] Library Name Name sequence OpioidCDSRoutines Conditions Indicating End Of Life Present 5 define &quot;Conditions Indicating End Of Life Present&quot;: exists ( Common.&quot;US Core-Categorized Conditions&quot; LLEC where LLEC.code in Common.&quot;Limited life expectancy conditions&quot; and LLEC.clinicalStatus in Common.&quot;Active Condition&quot; ) Library Name Name sequence OpioidCDSRoutines Is Active Cancer Treatment? 6 define &quot;Is Active Cancer Treatment?&quot;: if (Config.&quot;Active Cancer Treatment Encounters Condition Is Enabled&quot;) then &quot;Has Two or More Encounters with Cancer Diagnosis During Encounter Period&quot; else false Library Name Name sequence OpioidCDSRoutines Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present 7 define &quot;Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present&quot;: if (Config.&quot;End-Stage Disease Criteria Enabled&quot;) then exists ( Common.&quot;US Core-Categorized Conditions&quot; EOLC where EOLC.code in Common.&quot;Conditions likely terminal for opioid prescribing&quot; and EOLC.clinicalStatus in Common.&quot;Active Condition&quot; ) else false Library Name Name sequence OpioidCDSRoutines Is Opioid Review Useful? 8 define &quot;Is Opioid Review Useful?&quot;: not &quot;Patient Age Less Than 18&quot; and not &quot;Condition Positive for Sickle Cell&quot; and not &quot;Conditions Indicating End Of Life Present&quot; and not &quot;Is Active Cancer Treatment?&quot; and not &quot;Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present&quot; Library Name Name sequence OpioidCDSCommonConfig PDMP Data Not Reviewed in Past 90 Days Criteria Enabled 9 // Recommendation 9 define &quot;PDMP Data Not Reviewed in Past 90 Days Criteria Enabled&quot;: true Library Name Name sequence OpioidCDSREC09 Look Back 90 Days 10 define &quot;Look Back 90 Days&quot;: Interval[Today() - 90 days, Today()] Library Name Name sequence OpioidCDSREC09 PDMP Data Not Reviewed in Past 90 Days 11 define &quot;PDMP Data Not Reviewed in Past 90 Days&quot;: Config.&quot;PDMP Data Not Reviewed in Past 90 Days Criteria Enabled&quot; and not ( exists ( [Procedure: Common.&quot;PDMP review procedure&quot;] P where P.status ~ 'completed' and P.performed during &quot;Look Back 90 Days&quot; ) or exists ( [Observation: Common.&quot;PDMP data reviewed finding&quot;] O where O.status in { 'final', 'amended' } and ( if O.effective is FHIR.Period then (O.effective as FHIR.Period) during day of &quot;Look Back 90 Days&quot; else if O.effective is FHIR.dateTime then date from O.effective in day of &quot;Look Back 90 Days&quot; else false ) ) ) Library Name Name sequence OpioidCDSREC09 Inclusion Criteria 12 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;PDMP Data Not Reviewed in Past 90 Days&quot; Library Name Name sequence OpioidCDSREC09 Exclusion Criteria 13 define &quot;Exclusion Criteria&quot;: false Library Name Name sequence OpioidCDSREC09 Is Recommendation Applicable? 14 define &quot;Is Recommendation Applicable?&quot;: &quot;Inclusion Criteria&quot; and not &quot;Exclusion Criteria&quot; Knowledge Capability: shareable computable executable publishable Use Context: code value display focus 182888003 Medication requested (situation) focus 82423001 Chronic pain (finding) focus 274663001 Acute pain (finding) focus Purpose: 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. Usage: At a minimum, during long-term opioid therapy, PDMP data should be reviewed before an initial opioid prescription and then every 3 months or more frequently. Copyright: © CDC 2016+. Related Artifacts: Documentation 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain Libraries: Library - Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions Actions: Before Ordering Opioids, Review PDMP Data: Review PDMP data for this patient before completing an opioid order.#xD; #xD; For guidance about utilizing PDMP information to improve patient safety, see [Recommendation 9 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20take,see%20Recommendation%2010).).#xD; #xD; [CDC advises not to dismiss patients from your practice on the basis of PDMP information](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20not%20dismiss,Recommendations%208%20and%2012%5D).) When: Named Event: order-sign If: Applicability: Check whether the current order is for an opioid with ambulatory misuse potential, if an opioid review is appropriate or there exists evidence of a prescription drug monitoring program (PDMP) review procedure or finding occurred in the past 90 days. (Is Recommendation Applicable?) Then: : Access Data - Launch app to review PDMP data Then: : Document - PDMP data reviewed, snooze 3 months Then: : Snooze* - N/A see comment, snooze 3 months Then:
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 Limited life expectancy conditions
Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions
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 )
Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential
define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential": exists( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )
define "Patient Age Less Than 18": if (Config."Age Less than 18 Years Is Enabled") then AgeInYearsAt(Today()) < 18 else false
define "Condition Positive for Sickle Cell": if (Config."Sickle Cell Check Enabled") then exists( Common."Positive Sickle Cell Condition" ) else false
// 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"]
Conditions Indicating End Of Life Present
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" )
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
Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present
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
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"
PDMP Data Not Reviewed in Past 90 Days Criteria Enabled
// Recommendation 9 define "PDMP Data Not Reviewed in Past 90 Days Criteria Enabled": true
define "Look Back 90 Days": Interval[Today() - 90 days, Today()]
define "PDMP Data Not Reviewed in Past 90 Days": Config."PDMP Data Not Reviewed in Past 90 Days Criteria Enabled" and not ( exists ( [Procedure: Common."PDMP review procedure"] P where P.status ~ 'completed' and P.performed during "Look Back 90 Days" ) or exists ( [Observation: Common."PDMP data reviewed finding"] O where O.status in { 'final', 'amended' } and ( if O.effective is FHIR.Period then (O.effective as FHIR.Period) during day of "Look Back 90 Days" else if O.effective is FHIR.dateTime then date from O.effective in day of "Look Back 90 Days" else false ) ) )
define "Inclusion Criteria": "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential" and Routines."Is Opioid Review Useful?" and "PDMP Data Not Reviewed in Past 90 Days"
define "Is Recommendation Applicable?": "Inclusion Criteria" and not "Exclusion Criteria"
Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions
Centers for Disease Control and Prevention (CDC)
When prescribing initial opioid therapy for acute, subacute, or chronic pain, and periodically during opioid therapy for chronic pain, clinicians should review the patient's history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or combinations that put the patient at high risk for overdose.
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.
At a minimum, during long-term opioid therapy, PDMP data should be reviewed before an initial opioid prescription and then every 3 months or more frequently.
2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain
Before Ordering Opioids, Review PDMP Data
Review PDMP data for this patient before completing an opioid order. For guidance about utilizing PDMP information to improve patient safety, see [Recommendation 9 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20take,see%20Recommendation%2010).). [CDC advises not to dismiss patients from your practice on the basis of PDMP information](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20not%20dismiss,Recommendations%208%20and%2012%5D).)
Check whether the current order is for an opioid with ambulatory misuse potential, if an opioid review is appropriate or there exists evidence of a prescription drug monitoring program (PDMP) review procedure or finding occurred in the past 90 days.
Access Data - Launch app to review PDMP data
Document - PDMP data reviewed, snooze 3 months
Snooze* - N/A see comment, snooze 3 months