opioidcds-11-patient-view
type: PlanDefinition
node role: treeRoot
id:
  v: opioidcds-11-patient-view
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-11-patient-view Url: Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (patient-view) Version: 2022.1.0 Identifier: value: cdc-opioid-guidance Name: PlanDefinition_Recommendation_11_Patient_View Title: Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (patient-view) 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: Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently and consider whether benefits outweigh risks of concurrent prescribing of opioids and other central nervous system depressants. Logic Definitions: Library Name Name sequence OpioidCDSCommon Active Ambulatory Benzodiazepine or CNS Depressant Rx 0 define &quot;Active Ambulatory Benzodiazepine or CNS Depressant Rx&quot;: if Config.&quot;Can the implementing EHR support queries for past medications by date range?&quot; then ( &quot;Get MedicationRequest Medication as Code&quot;(&quot;Active Medication List&quot;) ) Rx where date from Rx.authoredOn 2 years or less on or before Today() and Rx.medication in &quot;Benzodiazepine medications&quot; or Rx.medication in &quot;CNS Depressant Medications&quot; else List&lt;FHIR.MedicationRequest&gt;{} Library Name Name sequence OpioidCDSCommon Active Ambulatory Opioid Rx 1 define &quot;Active Ambulatory Opioid Rx&quot;: if Config.&quot;Can the implementing EHR support queries for past medications by date range?&quot; then ( &quot;Get MedicationRequest Medication as Code&quot;(&quot;Get Active Ambulatory Medication Requests&quot;([MedicationRequest])) ) Rx where date from Rx.authoredOn 2 years or less on or before Today() and Rx.medication in &quot;Opioid analgesics with ambulatory misuse potential&quot; else List&lt;FHIR.MedicationRequest&gt;{} Library Name Name sequence OpioidCDSRout…
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 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 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: 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 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
  parameter:
    name:
      v: Is Recommendation Applicable?
    use:
      v: out
    min:
      v: 0
    max:
      v: 1
    type:
      v: boolean
  data requirement:
    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
  data requirement:
    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
  data requirement:
    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
  data requirement:
    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
extension:
  url:
    v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
    l: cpg-knowledgeCapability
  value: Code
    v: shareable
extension:
  url:
    v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
    l: cpg-knowledgeCapability
  value: Code
    v: computable
extension:
  url:
    v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
    l: cpg-knowledgeCapability
  value: Code
    v: executable
extension:
  url:
    v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
    l: cpg-knowledgeCapability
  value: Code
    v: publishable
extension:
  url:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem
    l: cqfm-softwaresystem
  value: Reference
    l: cqf-tooling
    reference:
      v: Device/cqf-tooling
extension:
  id:
    v: effective-data-requirements
  value: Reference

Reference
l: effective-data-requirements
reference:
  v: #effective-data-requirements

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: Active Ambulatory Benzodiazepine or CNS Depressant Rx
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Active Ambulatory Benzodiazepine or CNS Depressant Rx": if Config."Can the implementing EHR support queries for past medications by date range?" then ( "Get MedicationRequest Medication as Code"("Active Medication List") ) Rx where date from Rx.authoredOn 2 years or less on or before Today() and Rx.medication in "Benzodiazepine medications" or Rx.medication in "CNS Depressant Medications" else List<FHIR.MedicationRequest>{}
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: 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: 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: OpioidCDSREC11PatientView
extension:
  url:
    v: name
    l: name
  value: String
    v: Inclusion Criteria
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Inclusion Criteria": ( exists (Common."Active Ambulatory Benzodiazepine or CNS Depressant Rx") and exists (Common."Active Ambulatory Opioid Rx") ) and Routines."Is Opioid Review Useful?"
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: 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: 10
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: 11
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: 12
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSREC11PatientView
extension:
  url:
    v: name
    l: name
  value: String
    v: Exclusion Criteria
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Exclusion Criteria": Common."End of Life Assessment"
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: OpioidCDSREC11PatientView
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: 14
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_11_Patient_View

v: Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (patient-view)

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: Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently and consider whether benefits outweigh risks of concurrent prescribing of opioids and other central nervous system depressants.

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)

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 use particular caution when prescribing opioid pain medication and benzodiazepines concurrently. In addition, clinicians should consider whether benefits outweigh risks for concurrent use of opioids with other central nervous system depressants.

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

title:
  v: Use Particular Caution When Prescribing Opioid Pain Medication and Benzodiazepines or Other CNS Depressants Concurrently
description:
  v: Consider whether the benefits outweigh the risks of concurrently prescribing opioids and benzodiazepines, or other central nervous system depressant medications. When co-prescribing risks outweigh benefits, consult [Recommendation 11 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=evidence%20type%3A%203).-,Implementation%20Considerations,-Although%20in%20some) for further guidance. [For patients being treated for opioid use disorder who are also taking benzodiazepines or other medications that depress the central nervous system, the CDC recommends not withholding buprenorphine or methadone](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=gabapentin%20and%20pregabalin).-,Buprenorphine%20or%20methadone%20for%20opioid%20use%20disorder%20should%20not%20be%20withheld%20from%20patients%20taking%20benzodiazepines%20or%20other%20medications%20that%20depress%20the%20central%20nervous%20system.,-Clinicians%20should%20check). If the decision is made to taper benzodiazepine medications, [the CDC recommends tapering benzodiazepines gradually prior to discontinuation](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20taper%20benzodiazepines%20gradually%20before%20discontinuation%20because%20abrupt%20withdrawal%20can%20be%20associated%20with%20rebound%20anxiety%2C%20hallucinations%2C%20seizures%2C%20delirium%20tremens%2C%20and%2C%20rarely%2C%20death.%20The%20rate%20of%20tapering%20should%20be%20individualized).
priority:
  v: urgent
documentation:
  type:
    v: documentation
  url:
    v: https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation11:~:text=nervous%20system%20depressants-,(recommendation%20category%3A%20B%3B%20evidence%20type%3A%203).,-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#Recommendation11:~:text=nervous%20system%20depressants-,(recommendation%20category%3A%20B%3B%20evidence%20type%3A%203).,-Implementation%20Considerations
      l: https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
trigger:
  type:
    v: named-event
  name:
    v: patient-view
condition:
  kind:
    v: applicability
  expression:
    description:
      v: Check whether the patient is using opioids concurrently with benzodiazepines or other central nervous system depressants and if an opioid review is appropriate.
    language:
      v: text/cql.identifier
    expression:
      v: Is Recommendation Applicable?
grouping behavior:
  v: visual-group
selection behavior:
  v: any
action:
  description:
    v: Document - Will modify prescription
action:
  description:
    v: Snooze* - Benefits outweigh risks, snooze 3 months
action:
  description:
    v: Snooze* - N/A see comments, snooze 3 months

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

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