opioidcds-12-patient-view
type: PlanDefinition
node role: treeRoot
id:
  v: opioidcds-12-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-12-patient-view Url: Recommendation #12 - Evidence-based Treatment for Patients with Opioid Use Disorder (patient-view) Version: 2022.1.0 Identifier: value: cdc-opioid-guidance Name: PlanDefinition_Recommendation_12_Patient_View Title: Recommendation #12 - Evidence-based Treatment for Patients with Opioid Use Disorder (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 offer or arrange treatment with evidence-based medications to treat patients with opioid use disorder. Detoxification on its own, without medications for opioid use disorder, is not recommended for opioid use disorder because of increased risks for resuming drug use, overdose, and overdose death. Logic Definitions: Library Name Name sequence OpioidCDSCommonConfig Age Less than 18 Years Is Enabled 0 // CDC 2022 General Inclusion Criteria define "Age Less than 18 Years Is Enabled": true Library Name Name sequence OpioidCDSCommon Patient 18 or Older? 1 define "Patient 18 or Older?": Config."Age Less than 18 Years Is Enabled" and AgeInYears() >= 18 Library Name Name sequence OpioidCDSCommonConfig Evidence Based Treatment Criteria For Opioid Use Disorder 2 // Recommendation 12 define "Evidence Based Treatment Criteria For Opioid Use Disorder": true Library Name Name sequence OpioidCDSCommonConfig Can the implementing EHR support queries for past medications by date range? 3 // Subroutine 2 - Past Medications define "Can the implementing EHR support queries for past medications by date range?": true Library Name Name sequence OpioidCDSREC12PatientView Opioid Use Disorder Lookback Period 4 define "Opioid Use Disorder Lookback Period": Interval[Today() - 90 days, Today()] Library Name Name sequence OpioidCDSREC12PatientView Not Receiving Evidence-Based Treatment for Opioid Use Disorder 5 d…
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: Value set Buprenorphine and methadone medications
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/buprenorphine-and-methadone-medications
      l: buprenorphine-and-methadone-medications
  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 Opioid misuse disorders
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-misuse-disorders
      l: opioid-misuse-disorders
  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
  parameter:
    name:
      v: Is Recommendation Applicable?
    use:
      v: out
    min:
      v: 0
    max:
      v: 1
    type:
      v: boolean
  data requirement:
    type:
      v: Patient
    profile:
      v: http://hl7.org/fhir/StructureDefinition/Patient
      l: Patient
  data requirement:
    type:
      v: MedicationRequest
    profile:
      v: http://hl7.org/fhir/StructureDefinition/MedicationRequest
      l: MedicationRequest
    must support:
      v: medication
    must support:
      v: status
    must support:
      v: authoredOn
    code filter:
      path:
        v: medication
      value set:
        v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/buprenorphine-and-methadone-medications
        l: buprenorphine-and-methadone-medications
  data requirement:
    type:
      v: MedicationRequest
    profile:
      v: http://hl7.org/fhir/StructureDefinition/MedicationRequest
      l: MedicationRequest
    must support:
      v: medication.reference
    must support:
      v: status
    must support:
      v: authoredOn
  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: 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: recordedDate
    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
    must support:
      v: code
    must support:
      v: clinicalStatus
    must support:
      v: recordedDate
    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

v: category

v: code

v: clinicalStatus

v: recordedDate

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

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: 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: 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: Patient 18 or Older?
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Patient 18 or Older?": Config."Age Less than 18 Years Is Enabled" and AgeInYears() >= 18
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: OpioidCDSCommonConfig
extension:
  url:
    v: name
    l: name
  value: String
    v: Evidence Based Treatment Criteria For Opioid Use Disorder
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // Recommendation 12 define "Evidence Based Treatment Criteria For Opioid Use Disorder": true
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: 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: 3
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSREC12PatientView
extension:
  url:
    v: name
    l: name
  value: String
    v: Opioid Use Disorder Lookback Period
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Opioid Use Disorder Lookback Period": Interval[Today() - 90 days, Today()]
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: OpioidCDSREC12PatientView
extension:
  url:
    v: name
    l: name
  value: String
    v: Not Receiving Evidence-Based Treatment for Opioid Use Disorder
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Not Receiving Evidence-Based Treatment for Opioid Use Disorder": Config."Evidence Based Treatment Criteria For Opioid Use Disorder" and not ( if Config."Can the implementing EHR support queries for past medications by date range?" then exists ( [MedicationRequest: Common."Buprenorphine and methadone medications"] MR where MR.status in { 'active', 'completed' } and date from MR.authoredOn during day of "Opioid Use Disorder Lookback Period" ) else true /* update 2022 removes "behavioral therapy condition" or exists ( [Procedure: Common."Substance misuse behavioral counseling"] P where P.status ~ 'completed' and ( case when P.performed is FHIR.dateTime then Interval[FHIRHelpers.ToDateTime(P.performed as FHIR.dateTime), FHIRHelpers.ToDateTime(P.performed as FHIR.dateTime)] when P.performed is FHIR.Period then FHIRHelpers.ToInterval(P.performed as FHIR.Period) else null as Interval<DateTime> end ) during day of "Opioid Use Disorder Lookback Period" )*/ )
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: 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: 6
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: OpioidCDSREC12PatientView
extension:
  url:
    v: name
    l: name
  value: String
    v: Presence of Diagnosis of Opioid Use Disorder
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Presence of Diagnosis of Opioid Use Disorder": exists ( Common."US Core-Categorized Conditions" C where C.code in Common."Opioid misuse disorders" and C.clinicalStatus in Common."Active Condition" and date from C.recordedDate during day of "Opioid Use Disorder Lookback Period" )
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: OpioidCDSREC12PatientView
extension:
  url:
    v: name
    l: name
  value: String
    v: Positive Result from Opioid Use Disorder Evaluation Tool
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Positive Result from Opioid Use Disorder Evaluation Tool": true
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: OpioidCDSREC12PatientView
extension:
  url:
    v: name
    l: name
  value: String
    v: Inclusion Criteria
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Inclusion Criteria": Common."Patient 18 or Older?" and "Not Receiving Evidence-Based Treatment for Opioid Use Disorder" and "Presence of Diagnosis of Opioid Use Disorder" and "Positive Result from Opioid Use Disorder Evaluation Tool"
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: OpioidCDSREC12PatientView
extension:
  url:
    v: name
    l: name
  value: String
    v: Exclusion Criteria
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Exclusion Criteria": 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: OpioidCDSREC12PatientView
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: 11
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
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extension:
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url:
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  l: cqf-logicDefinition

extension:
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  url:
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    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:
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    l: displaySequence
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url:
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extension:
  url:
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extension:
  url:
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    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:
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url:
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extension:
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  url:
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extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value MedicationRequestStatus): value.value
extension:
  url:
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    v: 15
url:
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extension:
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  url:
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    v: ToDateTime
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  url:
    v: statement
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    v: define function ToDateTime(value dateTime): value.value
extension:
  url:
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    v: 16
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
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id:
  v: effective-data-requirements
url:
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  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_12_Patient_View

v: Recommendation #12 - Evidence-based Treatment for Patients with Opioid Use Disorder (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 offer or arrange treatment with evidence-based medications to treat patients with opioid use disorder. Detoxification on its own, without medications for opioid use disorder, is not recommended for opioid use disorder because of increased risks for resuming drug use, overdose, and overdose death.

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/1336192000
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 1336192000
    display:
      v: Opioid use disorder (disorder)

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: Medication treatment of opioid use disorder has been associated with reduced risk for overdose and overall deaths. Identification of opioid use disorder represents an opportunity for a clinician to initiate potentially life-saving interventions, and the clinician should collaborate with the patient regarding their safety to increase the likelihood of successful treatment.

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: strong
      display:
        v: Strong
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: high
      display:
        v: High quality
title:
  v: Offer Evidence-based Medications to Treat Patients with Opioid Use Disorder
description:
  v: For patients diagnosed with opioid use disorder, consider opioid agonist or partial agonist treatment with methadone or buprenorphine maintenance therapy. Detoxification on its own, without medications for opioid use disorder, is not recommended for opioid use disorder because of increased risks of resuming drug use, overdose, and overdose death. For guidance regarding diagnosing and treating opioid use disorder, see [Recommendation 12 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=evidence%20type%3A%201).-,Implementation%20Considerations,-Although%20stigma%20can). [CDC recommends against releasing patients from care due to diagnosis of opioid use disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=opioid%20use%20disorder.-,Clinicians%20should%20not%20dismiss%20patients%20from%20their%20practice%20because%20of%20opioid%20use%20disorder%20because%20this%20can%20adversely%20affect%20patient%20safety.,-Medication%20treatment%20of). [MME conversion factors should not be applied to dosage decisions related to the management of opioid use disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=These%20conversion%20factors%20should%20not%20be%20applied%20to%20dosage%20decisions%20related%20to%20the%20management%20of%20opioid%20use%20disorder.). [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](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Do%20not%20use%20the,variability%20in%20opioid%20pharmacokinetics.). Consult the FDA approved product labeling for specific guidance on medications.
priority:
  v: urgent
trigger:
  type:
    v: named-event
  name:
    v: patient-view
condition:
  kind:
    v: applicability
  expression:
    description:
      v: Check whether the patient is 18 or older with an active condition of opioid misuse disorder and doesn't have an active prescription (order) for buprenorphine or methadone medications.
    language:
      v: text/cql.identifier
    expression:
      v: Is Recommendation Applicable?
grouping behavior:
  v: visual-group
selection behavior:
  v: any
action:
  description:
    v: Snooze* - Patient already provided medication elsewhere to treat opioid use disorder, snooze 3 months
action:
  description:
    v: Snooze* - Patient declined medication therapy, snooze 3 months
action:
  description:
    v: Document - Will order medication to treat opioid use disorder
action:
  description:
    v: Refer - Will refer patient to SUD specialist
action:
  description:
    v: Snooze* - N/A see comments, snooze 3 months