opioidcds-03
type: PlanDefinition
node role: treeRoot
id:
  v: opioidcds-03
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-03 Url: Recommendation #3 - Opioid Immediate Release Form When Starting Opioid Therapy Version: 2022.1.0 Identifier: value: cdc-opioid-guidance Name: PlanDefinition_Recommendation_03_Order_Sign Title: Recommendation #3 - Opioid Immediate Release Form When Starting Opioid Therapy 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: When starting opioid therapy for acute, subacute, or chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release and long-acting (ER/LA) opioids. Logic Definitions: Library Name Name sequence OpioidCDSREC03 Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions 0 define "Chronic Pain Extended Release 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 ) and AmbulatoryOpioidPrescription.medication in Common."Extended release opioid with ambulatory misuse potential" Library Name Name sequence OpioidCDSREC03 Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential 1 define "Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential": exists( "Chronic Pain Extended Release 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."Age Less than 18 Years Is Enabled") then AgeInYearsAt(Today()) < 18 else false Library Name Name sequence OpioidCDSRoutines Condition Positive for Sickle Cell 3 define "Condition Positive for Sickle Cell": if (Config."Sickle Cell Check Enabl…
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: 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 Extended release opioid with ambulatory misuse potential
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/extended-release-opioid-with-ambulatory-misuse-potential
      link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/extended-release-opioid-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
      link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/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
      link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/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
      link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category
  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
      link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/conditions-likely-terminal-for-opioid-prescribing
  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
      link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-clinical-status-active
  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
      link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/limited-life-expectancy-conditions
  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: Condition
    profile:
      v: http://hl7.org/fhir/StructureDefinition/Condition
      link: http://hl7.org/fhir/StructureDefinition/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-encounter-diagnosis-category
        link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category
  data requirement:
    type:
      v: Condition
    profile:
      v: http://hl7.org/fhir/StructureDefinition/Condition
      link: http://hl7.org/fhir/StructureDefinition/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-problem-list-category
        link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category
  data requirement:
    type:
      v: Condition
    profile:
      v: http://hl7.org/fhir/StructureDefinition/Condition
      link: http://hl7.org/fhir/StructureDefinition/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
        link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/StructureDefinition/Encounter
  link: http://hl7.org/fhir/StructureDefinition/Encounter
must support:
  v: period
must support:
  v: period.start
must support:
  v: status
must support:
  v: status.value

url:
  v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
value: code
  v: shareable

url:
  v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
value: code
  v: computable

url:
  v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
value: code
  v: executable

url:
  v: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability
value: code
  v: publishable

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC03
extension:
  url:
    v: name
  value: string
    v: Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions
extension:
  url:
    v: statement
  value: string
    v: define "Chronic Pain Extended Release 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 ) and AmbulatoryOpioidPrescription.medication in Common."Extended release opioid with ambulatory misuse potential"
extension:
  url:
    v: displaySequence
  value: integer
    v: 0
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC03
extension:
  url:
    v: name
  value: string
    v: Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential
extension:
  url:
    v: statement
  value: string
    v: define "Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential": exists( "Chronic Pain Extended Release 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: OpioidCDSREC03
extension:
  url:
    v: name
  value: string
    v: Inclusion Criteria
extension:
  url:
    v: statement
  value: string
    v: define "Inclusion Criteria": "Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential" and Routines."Is Opioid Review Useful?" and Routines."Is Opioid Naive?"
extension:
  url:
    v: displaySequence
  value: integer
    v: 10
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSCommon
extension:
  url:
    v: name
  value: string
    v: US Core-Categorized Conditions
extension:
  url:
    v: 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
  value: integer
    v: 11
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSCommon
extension:
  url:
    v: name
  value: string
    v: Conditions Indicating End of Life or With Limited Life Expectancy
extension:
  url:
    v: 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
  value: integer
    v: 12
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSCommon
extension:
  url:
    v: name
  value: string
    v: Admitted/Referred/Discharged to Hospice Care
extension:
  url:
    v: 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
  value: integer
    v: 13
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSCommon
extension:
  url:
    v: name
  value: string
    v: End of Life Assessment
extension:
  url:
    v: 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
  value: integer
    v: 14
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC03
extension:
  url:
    v: name
  value: string
    v: Exclusion Criteria
extension:
  url:
    v: statement
  value: string
    v: define "Exclusion Criteria": Common."End of Life Assessment"
extension:
  url:
    v: displaySequence
  value: integer
    v: 15
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC03
extension:
  url:
    v: name
  value: string
    v: Is Recommendation Applicable?
extension:
  url:
    v: statement
  value: string
    v: define "Is Recommendation Applicable?": "Inclusion Criteria" and not "Exclusion 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

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_03_Order_Sign

v: Recommendation #3 - Opioid Immediate Release Form When Starting Opioid Therapy

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: When starting opioid therapy for acute, subacute, or chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release and long-acting (ER/LA) opioids.

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
  coding: http://snomed.info/id/274663001
    system:
      v: http://snomed.info/sct
    code:
      v: 274663001
    display:
      v: Acute 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: Clinicians should not treat acute pain with ER/LA opioids or initiate opioid treatment for subacute or chronic pain with extended-release and long-acting (ER/LA) opioids, and clinicians should not prescribe ER/LA opioids for intermittent or as-needed use.

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: very-low
      display:
        v: Very Low quality
title:
  v: When Initiating Opioid Therapy, Utilize Immediate Release Opioids
description:
  v: Recommend prescribing immediate release opioids instead of extended-release or long-acting opioids [For guidance regarding prescribing extended release/ long-acting opioids, see Recommendation 3 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation3).
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 extended-release opioid with ambulatory misuse potential, 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 - Will prescribe immediate release opioid
action:
  description:
    v: Snooze* - Benefits outweigh risks, snooze 3 months
action:
  description:
    v: Snooze* N/A see comment, snooze 3 months