opioidcds-02
type: PlanDefinition
node role: treeRoot
id:
  v: opioidcds-02
meta:
  profile:
    v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition
    link: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition
  profile:
    v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-publishableplandefinition
    link: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-publishableplandefinition
text:
  status:
    v: extensions
  div: Id: opioidcds-02 Url: Recommendation #2 - Opioid Therapy Goals Discussion Version: 2022.1.0 Identifier: value: cdc-opioid-guidance Name: PlanDefinition_Recommendation_02_Order_Sign Title: Recommendation #2 - Opioid Therapy Goals Discussion Status: draft Experimental: true Type: system: http://terminology.hl7.org/CodeSystem/plan-definition-type code: eca-rule display: ECA Rule Date: 2025-07-01 Publisher: Centers for Disease Control and Prevention (CDC) Description: Nonopioid therapies are preferred for subacute and chronic pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider initiating opioid therapy if expected benefits for pain and function are anticipated to outweigh risks to the patient. Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks. Logic Definitions: Library Name Name sequence OpioidCDSREC02 Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions 0 define "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions": ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription where Routines."Is Subacute or Chronic Pain Prescription?"( AmbulatoryOpioidPrescription ) Library Name Name sequence OpioidCDSREC02 Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential 1 define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential": exists( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" ) Library Name Name sequence OpioidCDSRoutines Patient Age Less Than 18 2 define "Patient Age Less Than 18": if (Config…
contained: Library
  id:
    v: effective-data-requirements
  name:
    v: EffectiveDataRequirements
  status:
    v: active
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/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
      link: 2022.1
      link: .0
  related artifact:
    type:
      v: depends-on
    display:
      v: Library FHIRHelpers
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1
      link: 4.0
      link: .1
  related artifact:
    type:
      v: depends-on
    display:
      v: Library Routines
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSRoutines|2022.1.0
      link: 2022.1
      link: .0
  related artifact:
    type:
      v: depends-on
    display:
      v: Library Config
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommonConfig|2022.1.0
      link: 2022.1
      link: .0
  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
      link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-analgesics-with-ambulatory-misuse-potential
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set Community
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/medicationrequest-category-community
      link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/medicationrequest-category-community
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set Pain treatment plan
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/pain-treatment-plan
      link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/pain-treatment-plan
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set Pain management procedure
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/pain-management-procedure
      link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/pain-management-procedure
  parameter:
    name:
      v: ContextPrescriptions
    use:
      v: in
    min:
      v: 0
    max:
      v: *
    type:
      v: MedicationRequest
  parameter:
    name:
      v: Is Recommendation Applicable?
    use:
      v: out
    min:
      v: 0
    max:
      v: 1
    type:
      v: boolean
  data requirement:
    type:
      v: CarePlan
    profile:
      v: http://hl7.org/fhir/StructureDefinition/CarePlan
      link: http://hl7.org/fhir/StructureDefinition/CarePlan
    must support:
      v: category
    must support:
      v: status
    must support:
      v: created
    must support:
      v: meta
    must support:
      v: meta.lastUpdated
    must support:
      v: author
    code filter:
      path:
        v: category
      value set:
        v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/pain-treatment-plan
        link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/pain-treatment-plan
  data requirement:
    type:
      v: Procedure
    profile:
      v: http://hl7.org/fhir/StructureDefinition/Procedure
      link: http://hl7.org/fhir/StructureDefinition/Procedure
    must support:
      v: code
    must support:
      v: performed
    must support:
      v: performer
    code filter:
      path:
        v: code
      value set:
        v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/pain-management-procedure
        link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/pain-management-procedure
extension:
  url:
    v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
  value: code
    v: shareable
extension:
  url:
    v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
  value: code
    v: computable
extension:
  url:
    v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
  value: code
    v: executable
extension:
  url:
    v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
  value: code
    v: publishable
extension:
  extension:
    url:
      v: libraryName
    value: string
      v: OpioidCDSREC02
  extension:
    url:
      v: name
    value: string
      v: Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions
  extension:
    url:
      v: statement
    value: string
      v: define "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions": ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription where Routines."Is Subacute or Chronic Pain Prescription?"( AmbulatoryOpioidPrescription )
  extension:
    url:
      v: displaySequence
    value: integer
      v: 0

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC02
extension:
  url:
    v: name
  value: string
    v: Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential
extension:
  url:
    v: statement
  value: string
    v: define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential": exists( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )
extension:
  url:
    v: displaySequence
  value: integer
    v: 1
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSRoutines
extension:
  url:
    v: name
  value: string
    v: Patient Age Less Than 18
extension:
  url:
    v: 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
  value: integer
    v: 2
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSRoutines
extension:
  url:
    v: name
  value: string
    v: Condition Positive for Sickle Cell
extension:
  url:
    v: 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
  value: integer
    v: 3
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSRoutines
extension:
  url:
    v: name
  value: string
    v: Is Active Cancer Treatment?
extension:
  url:
    v: 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
  value: integer
    v: 4
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSRoutines
extension:
  url:
    v: name
  value: string
    v: Conditions Likely Terminal for Opioid Prescribing
extension:
  url:
    v: 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
  value: integer
    v: 5
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSRoutines
extension:
  url:
    v: name
  value: string
    v: Is Opioid Review Useful?
extension:
  url:
    v: statement
  value: string
    v: define "Is Opioid Review Useful?": 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
  value: integer
    v: 6
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSRoutines
extension:
  url:
    v: name
  value: string
    v: Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days
extension:
  url:
    v: statement
  value: string
    v: define "Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days": if (Config."Opioid Naive Prescription Condition Is Enabled") then exists ("Opioid RX with Ambulatory Abuse Potential In Past 90 Days") else false
extension:
  url:
    v: displaySequence
  value: integer
    v: 7
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSRoutines
extension:
  url:
    v: name
  value: string
    v: Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days
extension:
  url:
    v: statement
  value: string
    v: define "Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days": if (Config."Opioid Naive Prescription Condition Is Enabled") then exists ("Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days") else false
extension:
  url:
    v: displaySequence
  value: integer
    v: 8
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSRoutines
extension:
  url:
    v: name
  value: string
    v: Is Opioid Naive?
extension:
  url:
    v: statement
  value: string
    v: // NOTE: MedicationStatement-dependent logic comment out due to bug in Publisher not supporting MedicationStatement in AllTypes. define "Is Opioid Naive?": not ("Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days") /* and not ("Has Report of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days") */ and not ("Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days")
extension:
  url:
    v: displaySequence
  value: integer
    v: 9
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSCommonConfig
extension:
  url:
    v: name
  value: string
    v: Opioid Treatment Plan Verification Enabled
extension:
  url:
    v: statement
  value: string
    v: // Recommendation 2 define "Opioid Treatment Plan Verification Enabled": true
extension:
  url:
    v: displaySequence
  value: integer
    v: 10
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC02
extension:
  url:
    v: name
  value: string
    v: Treatment Plan Lookback Period
extension:
  url:
    v: statement
  value: string
    v: define "Treatment Plan Lookback Period": Interval[Today() - 90 days, Today()]
extension:
  url:
    v: displaySequence
  value: integer
    v: 11
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC02
extension:
  url:
    v: name
  value: string
    v: Opioid Treatment Plan Creation or Update in Past 90 Days
extension:
  url:
    v: statement
  value: string
    v: define "Opioid Treatment Plan Creation or Update in Past 90 Days": [CarePlan: category in Common."Pain treatment plan"] PainTreatmentPlan where PainTreatmentPlan.status in { 'active', 'completed' } and ( FHIRHelpers.ToDateTime( PainTreatmentPlan.created ) during day of "Treatment Plan Lookback Period" or PainTreatmentPlan.meta.lastUpdated during day of "Treatment Plan Lookback Period" ) and exists( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions".recorder Recorder where Recorder ~ PainTreatmentPlan.author )
extension:
  url:
    v: displaySequence
  value: integer
    v: 12
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC02
extension:
  url:
    v: name
  value: string
    v: Had Opioid Treatment Plan Reviewed in Past 90 Days
extension:
  url:
    v: statement
  value: string
    v: define "Had Opioid Treatment Plan Reviewed in Past 90 Days": exists ( [Procedure: Common."Pain management procedure"] PainManagementProcedure where PainManagementProcedure.performed during day of "Treatment Plan Lookback Period" and exists ( PainManagementProcedure.performer Performer with "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" ChronicPainScript such that Performer.actor ~ ChronicPainScript.recorder ) )
extension:
  url:
    v: displaySequence
  value: integer
    v: 13
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC02
extension:
  url:
    v: name
  value: string
    v: No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?
extension:
  url:
    v: statement
  value: string
    v: define "No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?": Config."Opioid Treatment Plan Verification Enabled" and not ( exists ( "Opioid Treatment Plan Creation or Update in Past 90 Days" ) or "Had Opioid Treatment Plan Reviewed in Past 90 Days" )
extension:
  url:
    v: displaySequence
  value: integer
    v: 14
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC02
extension:
  url:
    v: name
  value: string
    v: Inclusion Criteria
extension:
  url:
    v: statement
  value: string
    v: define "Inclusion Criteria": "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential" and Routines."Is Opioid Review Useful?" and Routines."Is Opioid Naive?" and "No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?"
extension:
  url:
    v: displaySequence
  value: integer
    v: 15
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC02
extension:
  url:
    v: name
  value: string
    v: Is Recommendation Applicable?
extension:
  url:
    v: statement
  value: string
    v: define "Is Recommendation Applicable?": "Inclusion Criteria"
extension:
  url:
    v: displaySequence
  value: integer
    v: 16
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSCommon
extension:
  url:
    v: name
  value: string
    v: Is Opioid Analgesic with Ambulatory Misuse Potential?
extension:
  url:
    v: statement
  value: string
    v: define function "Is Opioid Analgesic with Ambulatory Misuse Potential?"(value List<MedicationRequest>): ("Get MedicationRequest Medication as Code"(value)) Rx where Rx.medication in "Opioid analgesics with ambulatory misuse potential" and Rx.category in "Community"
extension:
  url:
    v: displaySequence
  value: integer
    v: 17
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSCommon
extension:
  url:
    v: name
  value: string
    v: Get MedicationRequest Medication as Code
extension:
  url:
    v: 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
  value: integer
    v: 18
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: FHIRHelpers
extension:
  url:
    v: name
  value: string
    v: ToConcept
extension:
  url:
    v: 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
  value: integer
    v: 19
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSRoutines
extension:
  url:
    v: name
  value: string
    v: Is Subacute or Chronic Pain Prescription?
extension:
  url:
    v: statement
  value: string
    v: // End of Active Cancer Treatment Routine /* ** Routine #4 ** For Subacute or Chronic Pain Routine ** ** Definition | Answer to Proceed | Details | Data (Terminology) Requirement ** ----------------------------------------------------------------------------------------------------------------------------------- ** Order for opioid analgesic | Yes | Order for opioid analgesics with ambulatory | Opioid analgesics with ** with expected supply | | misuse potential with a supply duration of >= | ambulatory misuse potential ** duration >= 28 days | | 28 days | ** | | | ** | | - Subacute definition = order for opioid | ** | | analgesics with ambulatory misuse | ** | | potential with a supply duration of one to | ** | | two months. | ** | | - Chronic pain definition = order for opioid | ** | | analgesics with ambulatory misuse | ** | | potential with a supply duration of >= two | ** | | months. | ** ----------------------------------------------------------------------------------------------------------------------------------- ** */ define function "Is Subacute or Chronic Pain Prescription?"(prescription FHIR.MedicationRequest): "Is Subacute or Chronic Pain Using Expected Supply Duration"(prescription) or "Is Subacute or Chronic Pain Using Validity Period"(prescription)
extension:
  url:
    v: displaySequence
  value: integer
    v: 20
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSRoutines
extension:
  url:
    v: name
  value: string
    v: Is Subacute or Chronic Pain Using Expected Supply Duration
extension:
  url:
    v: statement
  value: string
    v: define function "Is Subacute or Chronic Pain Using Expected Supply Duration"(prescription FHIR.MedicationRequest): ( prescription.dispenseRequest is not null and prescription.dispenseRequest.expectedSupplyDuration is not null and ( Common.GetDurationInDays(prescription.dispenseRequest.expectedSupplyDuration) >= 28 days ) )
extension:
  url:
    v: displaySequence
  value: integer
    v: 21
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSCommon
extension:
  url:
    v: name
  value: string
    v: GetDurationInDays
extension:
  url:
    v: statement
  value: string
    v: define function GetDurationInDays(value FHIR.Duration): if value is null then null else case when value.code.value ~ 'a' then System.Quantity{ value: value.value.value * 365.0, unit: 'days' } when value.code.value ~ 'mo' then System.Quantity{ value: value.value.value * 30.0, unit: 'days' } when value.code.value ~ 'wk' then System.Quantity{ value: value.value.value * 7.0, unit: 'days' } when value.code.value ~ 'd' then System.Quantity{ value: value.value.value, unit: 'days' } when value.code.value ~ 'h' then System.Quantity{ value: value.value.value / 24.0, unit: 'days' } when value.code.value ~ 'min' then System.Quantity{ value: value.value.value / 60.0 / 24.0, unit: 'days' } when value.code.value ~ 's' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0, unit: 'days' } when value.code.value ~ 'ms' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0 / 1000.0, unit: 'days' } when value.code.value is null then Message(1000, true, 'Undefined', 'Error', 'Duration unit code is null') else Message(1000, true, 'Undefined', 'Error', 'Unsupported duration unit code: ' + value.code.value) end
extension:
  url:
    v: displaySequence
  value: integer
    v: 22
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSRoutines
extension:
  url:
    v: name
  value: string
    v: Is Subacute or Chronic Pain Using Validity Period
extension:
  url:
    v: statement
  value: string
    v: define function "Is Subacute or Chronic Pain Using Validity Period"(prescription FHIR.MedicationRequest): ( prescription.dispenseRequest is not null and prescription.dispenseRequest.validityPeriod is not null and ( days between prescription.dispenseRequest.validityPeriod.start and prescription.dispenseRequest.validityPeriod.end >= 28 ) )
extension:
  url:
    v: displaySequence
  value: integer
    v: 23
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: FHIRHelpers
extension:
  url:
    v: name
  value: string
    v: ToDateTime
extension:
  url:
    v: statement
  value: string
    v: define function ToDateTime(value dateTime): value.value
extension:
  url:
    v: displaySequence
  value: integer
    v: 24
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: FHIRHelpers
extension:
  url:
    v: name
  value: string
    v: ToString
extension:
  url:
    v: statement
  value: string
    v: define function ToString(value CarePlanStatus): value.value
extension:
  url:
    v: displaySequence
  value: integer
    v: 25
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

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

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

v: 2022.1.0

v: PlanDefinition_Recommendation_02_Order_Sign

v: Recommendation #2 - Opioid Therapy Goals Discussion

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

v: draft

v: true

v: 2025-07-01

v: Centers for Disease Control and Prevention (CDC)

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

v: Nonopioid therapies are preferred for subacute and chronic pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider initiating opioid therapy if expected benefits for pain and function are anticipated to outweigh risks to the patient. Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks.

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

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

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

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

v: Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks.

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

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/recommendation-strength
      code:
        v: strong
      display:
        v: Strong
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/evidence-quality
      code:
        v: moderate
      display:
        v: Moderate quality
title:
  v: Maximize Nonopioid Therapies as Appropriate
description:
  v: For many types of subacute and chronic pain, consider maximizing the use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate. [Recommendation 2 of the CDC 2022 Clinical Prescribing Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation2) provides nonopioid therapy recommendations for common subacute and acute pain conditions. **Nonopioid Pharmacological Therapy** - [Back pain (chronic, moderate to severe)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20moderate%20to%20severe%20chronic%20back%20pain%20or%20hip%20or%20knee%20osteoarthritis%20pain%2C%20a%20nonopioid%20strategy%20starting%20with%20acetaminophen%20or%20NSAIDs%20results%20in%20improved%20pain%20intensity%20with%20fewer%20side%20effects%20compared%20with%20a%20strategy%20starting%20with%20opioids%20(74)) - [Fibromyalgia](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=In%20patients%20with%20fibromyalgia%2C%20multiple,effectiveness%20is%20limited%20(8).) - [Hip or knee osteoarthritis pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=or%20hip%20or%20knee%20osteoarthritis%20pain%2C%20a%20nonopioid%20strategy%20starting%20with%20acetaminophen%20or%20NSAIDs%20results%20in%20improved%20pain%20intensity%20with%20fewer%20side%20effects%20compared%20with%20a%20strategy%20starting%20with%20opioids%20(74).) - [Neuropathic pain syndromes](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Tricyclic%20antidepressants%2C%20SNRI%20antidepressants%2C%20selected%20anticonvulsants%2C%20or%20transdermal%20lidocaine%20are%20recommended%20for%20neuropathic%20pain%20syndromes%20(e.g.%2C%20diabetic%20neuropathy%20or%20postherpetic%20neuralgia)%20(156).) - [Temporomandibular disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20temporomandibular%20disorder%20pain%20that%20is%20not%20sufficiently%20improved%20with%20nonpharmacologic%20interventions%2C%20NSAIDs%20can%20be%20effective%20(179%2C180).) **…
priority:
  v: urgent
trigger:
  type:
    v: named-event
  name:
    v: order-sign
condition:
  kind:
    v: applicability
  expression:
    description:
      v: Check whether the current order is for an opioid with ambulatory misuse potential, a pain treatment plan has been established or edited within the past 90 days, a pain management procedure occurred within the past 90 days, the patient is opioid naive and if an opioid review is appropriate for the patient
    language:
      v: text/cql.identifier
    expression:
      v: Is Recommendation Applicable?
grouping behavior:
  v: visual-group
selection behavior:
  v: any
action:
  description:
    v: Document - Collaborated with patient to identify treatment goals
action:
  description:
    v: Snooze* - Attempting alternate therapy, snooze 3 months
action:
  description:
    v: Order - Select alternative therapies from order select
action:
  description:
    v: Snooze* - N/A see comment, snooze 3 months
action:
  description:
    v: Remove - Will remove triggering medication order