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: 2025-08-06 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 OpioidCDSCommonConfig Can the implementing EHR support queries for past medications by date range? 0 // Subroutine 2 - Past Medications define "Can the implementing EHR support queries for past medications by date range?": true Library Name Name sequence OpioidCDSCommon Active Medication List 1 define "Active Medication List": [MedicationRequest: status in { 'active' }] ActiveMeds where ActiveMeds.category in "Community" Library Name Name sequence OpioidCDSCommon Active Ambulatory Benzodiazepine or CNS Depressant Rx 2 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>{} Library Name Name sequence OpioidCDSCommon Active Ambulatory Opioid Rx 3 define "Active Ambulatory Opioid Rx": if Config."Can the implementing EHR support queries for past medications by date range?" then ( "…
contained: Library
  id:
    v: effective-data-requirements
  name:
    v: EffectiveDataRequirements
  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 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: 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: 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 Benzodiazepine medications
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/benzodiazepine-medications
      l: benzodiazepine-medications
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set CNS Depressant Medications
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/cns-depressant-medications
      l: cns-depressant-medications
  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 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 Sickle Cell Diseases
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/sickle-cell-diseases
      l: sickle-cell-diseases
  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 CDC malignant cancer conditions
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/cdc-malignant-cancer-conditions
      l: cdc-malignant-cancer-conditions
  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
  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 Hospice Finding Codes
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/hospice-finding
      l: hospice-finding
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set Hospice Disposition
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/hospice-disposition
      l: hospice-disposition
  parameter:
    name:
      v: Is Recommendation Applicable?
    use:
      v: out
    min:
      v: 0
    max:
      v: 1
    type:
      v: boolean
  data requirement:
    type:
      v: Medication
    profile:
      v: http://hl7.org/fhir/StructureDefinition/Medication
      l: Medication
    must support:
      v: id
    must support:
      v: code
  data requirement:
    type:
      v: MedicationRequest
    profile:
      v: http://hl7.org/fhir/StructureDefinition/MedicationRequest
      l: MedicationRequest
    must support:
      v: status

v: category

v: medication

v: medication.reference

v: id

v: intent

v: subject

v: authoredOn

v: recorder

v: dosageInstruction

v: dispenseRequest

v: status.value

path:
  v: status
code:
  code:
    v: active

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/StructureDefinition/MedicationRequest
  l: MedicationRequest
must support:
  v: status
must support:
  v: category
must support:
  v: authoredOn
must support:
  v: medication
must support:
  v: medication.reference
must support:
  v: id
must support:
  v: intent
must support:
  v: subject
must support:
  v: recorder
must support:
  v: dosageInstruction
must support:
  v: dispenseRequest
must support:
  v: status.value
code filter:
  path:
    v: status
  code:
    code:
      v: active

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/StructureDefinition/MedicationRequest
  l: MedicationRequest
must support:
  v: authoredOn
must support:
  v: medication
must support:
  v: medication.reference
must support:
  v: id
must support:
  v: status
must support:
  v: intent
must support:
  v: category
must support:
  v: subject
must support:
  v: recorder
must support:
  v: dosageInstruction
must support:
  v: dispenseRequest
must support:
  v: status.value

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/StructureDefinition/Patient
  l: Patient

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/StructureDefinition/Condition
  l: Condition
must support:
  v: category
must support:
  v: code
must support:
  v: clinicalStatus
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: Condition
profile:
  v: http://hl7.org/fhir/StructureDefinition/Condition
  l: Condition
must support:
  v: category
must support:
  v: code
must support:
  v: clinicalStatus
must support:
  v: encounter
must support:
  v: encounter.reference
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
must support:
  v: code
must support:
  v: clinicalStatus
must support:
  v: clinicalStatus.coding
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: Encounter
profile:
  v: http://hl7.org/fhir/StructureDefinition/Encounter
  l: Encounter
must support:
  v: period
must support:
  v: period.start
must support:
  v: id
must support:
  v: hospitalization
must support:
  v: hospitalization.dischargeDisposition
must support:
  v: hospitalization.dischargeDisposition.coding
must support:
  v: status
must support:
  v: status.value

type:
  v: Observation
profile:
  v: http://hl7.org/fhir/StructureDefinition/Observation
  l: Observation
must support:
  v: code
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: code
  value set:
    v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/hospice-finding
    l: hospice-finding

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

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommonConfig
extension:
  url:
    v: name
    l: name
  value: String
    v: Can the implementing EHR support queries for past medications by date range?
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // Subroutine 2 - Past Medications define "Can the implementing EHR support queries for past medications by date range?": true
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 0
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: Active Medication List
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Active Medication List": [MedicationRequest: status in { 'active' }] ActiveMeds where ActiveMeds.category in "Community"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 1
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

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: 2
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-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: 3
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommonConfig
extension:
  url:
    v: name
    l: name
  value: String
    v: Age Less than 18 Years Is Enabled
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // CDC 2022 General Inclusion Criteria define "Age Less than 18 Years Is Enabled": true
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 4
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-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: 5
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommonConfig
extension:
  url:
    v: name
    l: name
  value: String
    v: Sickle Cell Check Enabled
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // Sickle Cell define "Sickle Cell Check Enabled": true
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 6
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommonConfig
extension:
  url:
    v: name
    l: name
  value: String
    v: Sickle Cell Assumed Active
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Sickle Cell Assumed Active": true
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 7
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-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: 8
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: Positive Sickle Cell Condition
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Positive Sickle Cell Condition": if Config."Sickle Cell Check Enabled" and not Config."Sickle Cell Assumed Active" then ( "US Core-Categorized Conditions" C where C.code in "Sickle Cell Diseases" and C.clinicalStatus in "Active Condition" ) else if Config."Sickle Cell Check Enabled" and Config."Sickle Cell Assumed Active" then ( "US Core-Categorized Conditions" C where C.code in "Sickle Cell Diseases" ) else null
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 9
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-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: 10
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommonConfig
extension:
  url:
    v: name
    l: name
  value: String
    v: Active Cancer Treatment Encounters Condition Is Enabled
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // Active Cancer Treatment define "Active Cancer Treatment Encounters Condition Is Enabled": true
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 11
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSRoutines
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter Period
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // End of Opioid Naive Routine /* ** Routine #3 ** Active Cancer Treatment Routine ** ** Definition | Answer to Proceed | Details | Data (Terminology) Requirement ** --------------------------------------------------------------------------------------------------------------------------------- ** Two office visits within the | No | Look for a minimum of two distinct | Office Visit ** past 12 months | | encounters within 12 months of the date | ** | | of the current visit for which each of the | ** | | following is true: | ** | | - the encounter diagnosis (primary or | ** | | secondary or co-morbidity diagnosis) | ** | | is listed in the CDC Malignant Cancer | ** | | Conditions value set | ** --------------------------------------------------------------------------------------------------------------------------------- ** Office visits with an | No | The encounter is performed by an | Oncology specialty ** oncology specialist | | oncologist as defined in the oncology | designations (NUCC) ** present | | specialty designations using the | ** | | National Uniform Claim Committee | ** | | (NUCC) classifications | ** --------------------------------------------------------------------------------------------------------------------------------- ** Office visits including CDC | No | The encounter diagnosis (primary or | CDC malignant cancer ** malignant cancer | | secondary or co-morbidity diagnosis) | conditions ** condition | | is listed in the CDC Malignant Cancer | ** | | Conditions value set | ** ---------------------------------------------------------------------------------------------------------------------------------- ** */ define "Encounter Period": Interval[Today() - 12 months, Today())
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 12
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: USCore Encounter Cancer Diagnoses
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "USCore Encounter Cancer Diagnoses": [Condition: category in "Encounter Diagnosis Condition Category"] CancerDiagnoses where CancerDiagnoses.code in "CDC malignant cancer conditions"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 13
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSRoutines
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounters with Cancer Diagnosis During Encounter Period
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // encounter-diagnosis, problem-list and health-concern Conditions // define "US Core-Categorized Cancer Diagnoses": // Common."US Core-Categorized Conditions" C // where C.code in Common."CDC malignant cancer conditions" // define "Encounters with Cancer Diagnosis During Encounter Period": // [Encounter] Encounter // with "US Core-Categorized Cancer Diagnoses" CancerDiagnosis // such that date from Encounter.period."start".value in day of "Encounter Period" // and EndsWith(CancerDiagnosis.encounter.reference, Encounter.id) define "Encounters with Cancer Diagnosis During Encounter Period": [Encounter] Encounters where date from Encounters.period."start" in day of "Encounter Period" and exists ( Common."USCore Encounter Cancer Diagnoses" CancerDiagnoses where EndsWith(CancerDiagnoses.encounter.reference, Encounters.id) )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 14
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSRoutines
extension:
  url:
    v: name
    l: name
  value: String
    v: Number of Encounters with Cancer Diagnosis During Encounter Period
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Number of Encounters with Cancer Diagnosis During Encounter Period": Count ("Encounters with Cancer Diagnosis During Encounter Period")
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 15
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSRoutines
extension:
  url:
    v: name
    l: name
  value: String
    v: Has Two or More Encounters with Cancer Diagnosis During Encounter Period
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Has Two or More Encounters with Cancer Diagnosis During Encounter Period": "Number of Encounters with Cancer Diagnosis During Encounter Period" >= 2
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 16
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: USCore Problem List Cancer Diagnoses
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "USCore Problem List Cancer Diagnoses": [Condition: category in "Problem List Condition Category"] CancerDiagnoses where CancerDiagnoses.code in "CDC malignant cancer conditions"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 17
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSRoutines
extension:
  url:
    v: name
    l: name
  value: String
    v: Has Active Cancer Diagnosis on Problem List
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Has Active Cancer Diagnosis on Problem List": exists ( Common."USCore Problem List Cancer Diagnoses" CancerDiagnoses where CancerDiagnoses.category in Common."Problem List Condition Category" and exists( CancerDiagnoses.clinicalStatus.coding ClinicalStatus where ClinicalStatus.code ~ 'active' ) )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 18
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-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" or "Has Active Cancer Diagnosis on Problem List" else false
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 19
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommonConfig
extension:
  url:
    v: name
    l: name
  value: String
    v: End-Stage Disease Criteria Enabled
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // CDC 2022 General Inclusion Criteria define "End-Stage Disease Criteria Enabled": true
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 20
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSRoutines
extension:
  url:
    v: name
    l: name
  value: String
    v: Conditions Likely Terminal for Opioid Prescribing
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Conditions Likely Terminal for Opioid Prescribing": 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: 21
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSRoutines
extension:
  url:
    v: name
    l: name
  value: String
    v: CDC 2022 Guideline General Inclusion Criteria
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "CDC 2022 Guideline General Inclusion Criteria": not "Patient Age Less Than 18" and not "Condition Positive for Sickle Cell" and not "Is Active Cancer Treatment?" and not "Conditions Likely Terminal for Opioid Prescribing"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 22
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-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."CDC 2022 Guideline General Inclusion Criteria"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 23
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-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: 24
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommonConfig
extension:
  url:
    v: name
    l: name
  value: String
    v: Hospice Findings Exclusion Enabled
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // OpioidCDSCommon define "Hospice Findings Exclusion Enabled": false
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 25
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-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: 26
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-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: 27
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-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: 28
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-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: 29
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: Get MedicationRequest Medication as Code
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "Get MedicationRequest Medication as Code"(value List<MedicationRequest>): value Rx let Med: if Rx.medication is Reference then singleton from ( [Medication] M where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/'))) ) else null return MedicationRequest { id: Rx.id, status: Rx.status, intent: Rx.intent, category: Rx.category, medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept, subject: Rx.subject, authoredOn: Rx.authoredOn, recorder: Rx.recorder, dosageInstruction: Rx.dosageInstruction, dispenseRequest: Rx.dispenseRequest }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 30
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value string): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 31
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToConcept
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 32
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToCode
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 33
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToDateTime
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToDateTime(value dateTime): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 34
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: Get Active Ambulatory Medication Requests
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "Get Active Ambulatory Medication Requests" (value List<MedicationRequest>) returns List<MedicationRequest>: value Rx where Rx.status.value = 'active' and Rx.category in "Community"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 35
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

id:
  v: effective-data-requirements
url:
  v: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements
  l: crmi-effectiveDataRequirements
value: Canonical
  v: #effective-data-requirements
  l: effective-data-requirements

url:
  v: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem
  l: crmi-softwaresystem
value: Reference
  l: cqf-tooling
  reference:
    v: Device/cqf-tooling

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: 2025-08-06

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/rr7103a1.htm
  l: rr7103a1.htm
document:
  url:
    v: https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
    l: rr7103a1.htm

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation
    l: cqf-strengthOfRecommendation
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/recommendation-strength
        l: recommendation-strength
      code:
        v: weak
      display:
        v: Weak
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence
    l: cqf-qualityOfEvidence
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/evidence-quality
        l: evidence-quality
      code:
        v: low
      display:
        v: Low quality
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
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 the 2022 CDC guideline general inclusion criteria is met.
    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