Id: opioidcds-10-order-select Url: Recommendation #10 - Urine Drug Testing (order-select) Version: 2022.1.0 Identifier: value: cdc-opioid-guidance Name: PlanDefinition_Recommendation_10_Order_Select Title: Recommendation #10 - Urine Drug Testing (order-select) Status: draft Experimental: true Type: system: http://terminology.hl7.org/CodeSystem/plan-definition-type code: eca-rule display: ECA Rule Date: 2025-03-19 Publisher: Centers for Disease Control and Prevention (CDC) Description: When prescribing opioids for subacute or chronic pain, clinicians should consider the benefits and risks of toxicology testing to assess for prescribed medications as well as other prescribed and nonprescribed controlled substances. Knowledge Capability: shareable computable executable publishable Purpose: 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. Usage: Before starting opioids and periodically (at least annually) during opioid therapy, clinicians should consider the benefits and risks of toxicology testing to assess for prescribed opioids and other prescription and nonprescription controlled substances that increase risk for overdose when combined with opioids, including nonprescribed and illicit opioids and benzodiazepines. Copyright: © CDC 2016+. Related Artifacts: Documentation 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain Libraries: OpioidCDSREC10OrderSelect Actions: Consider Urine Drug Screen (UDS): &lt;ul&gt;&lt;li&gt;Urine drug screening should be done at least 1-2 times a year&lt;/li&gt;&lt;li&gt;Screening frequency should be based on assessed risk, guidelines, and regulations&lt;/li&gt;&lt;li&gt;UDS monitors opioid adherence and detects non-prescribed substances for patient safety&lt;/li&gt;&lt;li&gt;Confirmatory testing may be helpful; results may be affected by drug metabolism and dose timing&lt;/li&gt;&lt;li&gt;Discuss concerns with the patient before making therapeutic changes&lt;/li&gt;&lt;/ul&gt; When: Named Event: order-select If: Applicability: Patient has not had a urine screening in the past 12 months (Is Perform Drug Screen Recommendation Applicable?) Then: UDS 1 : Then: Definition: ActivityDefinition[http://fhir.org/guides/cdc/opioid-cds/ActivityDefinition/opioidcds-urine-screening-request-1|2022.1.0] UDS 2 : Then: Definition: ActivityDefinition[http://fhir.org/guides/cdc/opioid-cds/ActivityDefinition/opioidcds-urine-screening-request-2|2022.1.0] : Then: : Then: : Then: : Then: Patient May Have Unexpected Toxicology Test Results: Patient may have unexpected urine toxicology test results in the past year When: Named Event: order-select If: Applicability: Patient may have unexpected urine toxicology test results in the past year (Applicable Because of Unexpected Results) Then: : Then: : Then:
Value set Opioid analgesics with ambulatory misuse potential
Value set Encounter Diagnosis Condition Category
Value set Problem List Condition Category
Value set US Core Health Concern Condition Category
Value set Limited life expectancy conditions
Value set Conditions likely terminal for opioid prescribing
Is Perform Drug Screen Recommendation Applicable?
Applicable Because of Unexpected Results
Subacute or Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions
define "Subacute or 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 )
Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential
define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential": exists( "Subacute or Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )
define "Patient Age Less Than 18": if (Config."Age Less than 18 Years Is Enabled") then AgeInYearsAt(Today()) < 18 else false
define "Condition Positive for Sickle Cell": if (Config."Sickle Cell Check Enabled") then exists( Common."Positive Sickle Cell Condition" ) else false
// 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"]
Conditions Indicating End Of Life Present
define "Conditions Indicating End Of Life Present": exists ( Common."US Core-Categorized Conditions" LLEC where LLEC.code in Common."Limited life expectancy conditions" and LLEC.clinicalStatus in Common."Active Condition" )
define "Is Active Cancer Treatment?": if (Config."Active Cancer Treatment Encounters Condition Is Enabled") then "Has Two or More Encounters with Cancer Diagnosis During Encounter Period" else false
Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present
define "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present": if (Config."End-Stage Disease Criteria Enabled") then exists ( Common."US Core-Categorized Conditions" EOLC where EOLC.code in Common."Conditions likely terminal for opioid prescribing" and EOLC.clinicalStatus in Common."Active Condition" ) else false
define "Is Opioid Review Useful?": not "Patient Age Less Than 18" and not "Condition Positive for Sickle Cell" and not "Conditions Indicating End Of Life Present" and not "Is Active Cancer Treatment?" and not "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present"
Inclusion Criteria For UDS Recommendation
/* @description: Determines whether an opioid review is appropriate for the patient and whether they had a UDS performed in the past year */ define "Inclusion Criteria For UDS Recommendation": Routines."Is Opioid Review Useful?" and not exists ( if Config."Use Alternative UDS Lookback Period" then "All Opioid or Non-opioid UDS in Alternative Lookback Period" else "All Opioid or Non-opioid UDS in Lookback Period" )
Conditions Indicating End of Life or With Limited Life Expectancy
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" )
Admitted/Referred/Discharged to Hospice Care
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' } )
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" )
define "Exclusion Criteria": Common."End of Life Assessment"
define "Is Perform Drug Screen Recommendation Applicable?": "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential" and Rec10Common."Inclusion Criteria For UDS Recommendation" and not Rec10Common."Exclusion Criteria"
define "Amphetamine Simple Identifier": 'Amphetamine'
// Constants define "UDS Lookback Period": Interval[Today() - 12 months - 1 days, Today()]
All Opioid or Non-opioid UDS in Lookback Period
define "All Opioid or Non-opioid UDS in Lookback Period": ( [Observation: Common."All Drug Urine Screening"] Lab where date from Lab.effective in day of "UDS Lookback Period" and not ( Lab.status in { 'unknown', 'entered-in-error', 'cancelled' } ) ) X sort by date from effective desc
Amphetamine Screenings In Lookback Period
// Amphetamines define "Amphetamine Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Amphetamine Urine Tests"
Positive Amphetamine Screenings In Lookback Period
define "Positive Amphetamine Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Amphetamine Screenings In Lookback Period", true)
Negative Amphetamine Screenings In Lookback Period
define "Negative Amphetamine Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Amphetamine Screenings In Lookback Period", true)
define "Rx Lookback Period": Interval[Today() - 12 months - 31 days, Today()]
define "Normalize Rx In Lookback Period": Common."Get MedicationRequest Medication as Code"( [MedicationRequest: category in Common."Community"] Rx where Rx.status in { 'active', 'completed', 'stopped' } and Rx.intent = 'order' and date from Rx.authoredOn in day of "Rx Lookback Period" )
define "Amphetamine Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Amphetamine Medications"
define "Barbiturate Simple Identifier": 'Barbiturate'
Barbiturate Screenings In Lookback Period
// Barbiturates define "Barbiturate Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Barbiturate Urine Tests"
Positive Barbiturate Screenings In Lookback Period
define "Positive Barbiturate Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Barbiturate Screenings In Lookback Period", true)
Negative Barbiturate Screenings In Lookback Period
define "Negative Barbiturate Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Barbiturate Screenings In Lookback Period", true)
define "Barbiturate Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Barbiturate Medications"
define "Benzodiazepine Simple Identifier": 'Benzodiazepine'
Benzodiazepine Screenings In Lookback Period
// Benzodiazepines define "Benzodiazepine Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Benzodiazepine Urine Tests"
Positive Benzodiazepine Screenings In Lookback Period
define "Positive Benzodiazepine Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Benzodiazepine Screenings In Lookback Period", true)
Negative Benzodiazepine Screenings In Lookback Period
define "Negative Benzodiazepine Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Benzodiazepine Screenings In Lookback Period", true)
define "Benzodiazepine Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Benzodiazepine medications"
define "Buprenorphine Simple Identifier": 'Buprenorphine'
Buprenorphine Screenings In Lookback Period
// Buprenorphine define "Buprenorphine Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Buprenorphine Urine Tests"
Positive Buprenorphine Screenings In Lookback Period
define "Positive Buprenorphine Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Buprenorphine Screenings In Lookback Period", true)
Negative Buprenorphine Screenings In Lookback Period
define "Negative Buprenorphine Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Buprenorphine Screenings In Lookback Period", true)
define "Buprenorphine Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Buprenorphine Medications"
define "Cannabinoid Simple Identifier": 'Cannabinoid'
Cannabinoid Screenings In Lookback Period
// Cannabinoids define "Cannabinoid Screenings In Lookback Period": if Config."Cannabinoid Urine Screening Check Enabled" then ( "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Cannabinoid Urine Tests" ) else null
Cannabinoid Urine Screening Check Enabled
define "Cannabinoid Urine Screening Check Enabled": false
Positive Cannabinoid Screenings In Lookback Period
define "Positive Cannabinoid Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Cannabinoid Screenings In Lookback Period", Config."Cannabinoid Urine Screening Check Enabled")
Negative Cannabinoid Screenings In Lookback Period
define "Negative Cannabinoid Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Cannabinoid Screenings In Lookback Period", Config."Cannabinoid Urine Screening Check Enabled")
define "Cocaine Simple Identifier": 'Cocaine'
// Cocaine define "Cocaine Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Cocaine Urine Tests"
Positive Cocaine Screenings In Lookback Period
define "Positive Cocaine Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Cocaine Screenings In Lookback Period", true)
Negative Cocaine Screenings In Lookback Period
define "Negative Cocaine Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Cocaine Screenings In Lookback Period", true)
define "Fentanyl Simple Identifier": 'Fentanyl'
// Fentanyl define "Fentanyl Screenings In Lookback Period": if Config."Opiate Urine Screening Check Enabled" then ( "All Opioid or Non-opioid UDS in Lookback Period" AllLabs where AllLabs.code in Common."Fentanyl Urine Tests" ) else null
// Recommendation 10 define "Opiate Urine Screening Check Enabled": true
Positive Fentanyl Screenings In Lookback Period
define "Positive Fentanyl Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Fentanyl Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")
Negative Fentanyl Screenings In Lookback Period
define "Negative Fentanyl Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Fentanyl Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")
define "Fentanyl Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Fentanyl Medications"
define "Heroin Simple Identifier": 'Heroin (6-AM)'
// Heroin define "Heroin Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Heroin Urine Tests"
Positive Heroin Screenings In Lookback Period
define "Positive Heroin Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Heroin Screenings In Lookback Period", true)
Negative Heroin Screenings In Lookback Period
define "Negative Heroin Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Heroin Screenings In Lookback Period", true)
define "Methadone Simple Identifier": 'Methadone'
// Methadone define "Methadone Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Methadone Urine Tests"
Positive Methadone Screenings In Lookback Period
define "Positive Methadone Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Methadone Screenings In Lookback Period", true)
Negative Methadone Screenings In Lookback Period
define "Negative Methadone Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Methadone Screenings In Lookback Period", true)
define "Methadone Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Methadone Medications"
define "Opiate Simple Identifier": 'Opiate'
// Opiates define "Opiate Screenings In Lookback Period": if Config."Opiate Urine Screening Check Enabled" then ( "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."General Opiate Urine Tests" ) else null
Positive Opiate Screenings In Lookback Period
define "Positive Opiate Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Opiate Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")
Negative Opiate Screenings In Lookback Period
define "Negative Opiate Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Opiate Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")
define "Opiate Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Opiate Medications"
define "Oxycodone Simple Identifier": 'Oxycodone'
// Oxycodone define "Oxycodone Screenings In Lookback Period": if Config."Opiate Urine Screening Check Enabled" then ( "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Oxycodone Urine Tests" ) else null
Positive Oxycodone Screenings In Lookback Period
define "Positive Oxycodone Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Oxycodone Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")
Negative Oxycodone Screenings In Lookback Period
define "Negative Oxycodone Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Oxycodone Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")
define "Oxycodone Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Oxycodone Medications"
define "PCP Simple Identifier": 'Phencyclidine (PCP)'
// PCP define "PCP Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" AllLabs where AllLabs.code in Common."PCP Urine Tests"
Positive PCP Screenings In Lookback Period
define "Positive PCP Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("PCP Screenings In Lookback Period", true)
Negative PCP Screenings In Lookback Period
define "Negative PCP Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("PCP Screenings In Lookback Period", true)
// Details Logic define "Unexpected Details": { CreateDetailWithPossibleUnexpectedNegative( "Amphetamine Simple Identifier", "Positive Amphetamine Screenings In Lookback Period", "Negative Amphetamine Screenings In Lookback Period", "Amphetamine Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Barbiturate Simple Identifier", "Positive Barbiturate Screenings In Lookback Period", "Negative Barbiturate Screenings In Lookback Period", "Barbiturate Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Benzodiazepine Simple Identifier", "Positive Benzodiazepine Screenings In Lookback Period", "Negative Benzodiazepine Screenings In Lookback Period", "Benzodiazepine Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Buprenorphine Simple Identifier", "Positive Buprenorphine Screenings In Lookback Period", "Negative Buprenorphine Screenings In Lookback Period", "Buprenorphine Rx In Lookback Period" ), CreateDetailWithoutPossibleUnexpectedNegative( "Cannabinoid Simple Identifier", "Positive Cannabinoid Screenings In Lookback Period", "Negative Cannabinoid Screenings In Lookback Period" ), CreateDetailWithoutPossibleUnexpectedNegative( "Cocaine Simple Identifier", "Positive Cocaine Screenings In Lookback Period", "Negative Cocaine Screenings In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Fentanyl Simple Identifier", "Positive Fentanyl Screenings In Lookback Period", "Negative Fentanyl Screenings In Lookback Period", "Fentanyl Rx In Lookback Period" ), CreateDetailWithoutPossibleUnexpectedNegative( "Heroin Simple Identifier", "Positive Heroin Screenings In Lookback Period", "Negative Heroin Screenings In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Methadone Simple Identifier", "Positive Methadone Screenings In Lookback Period", "Negative Methadone Screenings In Lookback Period", "Methadone Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Opiate Simple Identifier", "Positive Opiate Screenings In Lookback Period", "Negative Opiate Screenings In Lookback Period", "Opiate Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Oxycodone Simple Identifier", "Positive Oxycodone Screenings In Lookback Period", "Negative Oxycodone Screenings In Lookback Period", "Oxycodone Rx In Lookback Period" ), CreateDetailWithoutPossibleUnexpectedNegative( "PCP Simple Identifier", "Positive PCP Screenings In Lookback Period", "Negative PCP Screenings In Lookback Period" ) }
Remove Substances Without Positive or Negative Results
define "Remove Substances Without Positive or Negative Results": "Unexpected Details" Details where (Details.posDates is not null and Length(Details.posDates) != 0) or (Details.negDates is not null and Length(Details.negDates) != 0)
Inclusion Criteria For Unexpected Results
define "Inclusion Criteria For Unexpected Results": AnyTrue( "Remove Substances Without Positive or Negative Results" Details return (exists Details.unexpectedPosDetails) or (exists Details.unexpectedNegDetails) )
define "Applicable Because of Unexpected Results": "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential" and Rec10Common."Inclusion Criteria For Unexpected Results" and not Rec10Common."Exclusion Criteria"
define "Style Header": ' \r\n .alert-body {\r\n width: 670px;\r\n font-family: segoe-ui, sans-serif;\r\n background-color: #FEFFF1;\r\n }\r\n\r\n .details-table {\r\n border-collapse:collapse;\r\n border-style: ridge;\r\n background-color: #FEFFF1;\r\n padding: 2px;\r\n }\r\n\r\n .details-caption {\r\n border-style: ridge;\r\n border-bottom: none;\r\n background-color: #FEFFF1;\r\n padding: 2px;\r\n }\r\n\r\n .details-table-header {\r\n border-style: ridge;\r\n padding: 5px;\r\n }\r\n\r\n .details-table-cell {\r\n border-style: ridge;\r\n padding: 5px;\r\n }\r\n\r\n .details-table-footer-cell {\r\n border-style: ridge;\r\n padding: 5px;\r\n font-size: small;\r\n }\r\n\r\n .details-table-cell-unexpected {\r\n border-style: ridge;\r\n padding: 5px;\r\n color: red;\r\n font-weight: bold;\r\n }\r\n\r\n .more-text {\r\n position: relative;\r\n margin-bottom: 2em;\r\n }\r\n \r\n .more {\r\n display:none;\r\n }\r\n\r\n .show-more:checked + .more {\r\n display:block;\r\n }\r\n<\/style>'
define "Unexpected Div Start": ' Patient may have unexpected urine toxicology test results<\/strong> in the past year.<\/p><\/div>'
define "Table Start": ' Urine Toxicology Results<\/caption> Substance<\/th>'
// Helpers define "All Lab Dates in Lookback Period": ( "All Opioid or Non-opioid UDS in Lookback Period" Lab return date from Lab.effective ) X sort desc
define "Table Headers": "All Lab Dates in Lookback Period" LabDate return ' ' & ToString(LabDate) & '<\/th>'
define "Generate Table Rows": "Remove Substances Without Positive or Negative Results" BOT let row: ToString(IndexOf("Remove Substances Without Positive or Negative Results", BOT) + 1) return ' ' + GetExpectedColumn(BOT.ingredient) + Combine( "All Lab Dates in Lookback Period" LabDate let col: ToString(IndexOf("All Lab Dates in Lookback Period", LabDate) + 2) return all ( if BOT.unexpectedPosDetails.date contains LabDate then GetUnexpectedColumn('pos', row & ':' & col) else if BOT.unexpectedNegDetails.udsDate contains LabDate then GetUnexpectedColumn('neg', row & ':' & col) else if BOT.posDates contains LabDate then GetExpectedColumn('pos*') else if BOT.negDates contains LabDate then GetExpectedColumn('neg*') else GetExpectedColumn('n/a') ) ) + '<\/tr>'
define "Generate Footer Rows": "Remove Substances Without Positive or Negative Results" BOT let row: ToString(IndexOf("Remove Substances Without Positive or Negative Results", BOT) + 1), colspan: Length("All Lab Dates in Lookback Period") + 1 return Combine( "All Lab Dates in Lookback Period" LabDate let col: ToString(IndexOf("All Lab Dates in Lookback Period", LabDate) + 2) return all ( if BOT.unexpectedPosDetails.date contains LabDate then Coalesce( BOT.unexpectedPosDetails PosDetail where PosDetail.date same day as LabDate return ' ' & GetFooterColumn(colspan, row & ':' & col & ' - Possible unexpected substance found: ' & PosDetail.udsDetail) & '<\/tr>' ) else if BOT.unexpectedNegDetails.udsDate contains LabDate then Coalesce( BOT.unexpectedNegDetails NegDetail where NegDetail.udsDate same day as LabDate return ' ' & GetFooterColumn(colspan, row + ':' & col & ' - Possible unexpected negative result found: prescribed ' & NegDetail.rxDetail & ' on ' & ToString(NegDetail.rxDate)) & '<\/tr>' ) else '' ) )
define "Table End": '<\/table><\/div>'
define "Details Table": "Table Start" & Combine("Table Headers") & ' ' & Combine("Generate Table Rows") & ' ' & ' ' & Combine("Generate Footer Rows") & '<\/tfoot>' & "Table End"
define "Expected Result Footnote": ' * - These are expected results based on an analysis of the patient\'s medication list 30 days prior to the corresponding lab results.<\/div>'
define "Details More Info": ' \r\n Note on false positives and unexpected negative results...<\/p>\r\n Show more\r\n \r\n An unexpectedly negative test may be due to time since last dose, diversion, intermittent use, aberrant drug use behavior, or other factors, including a false negative result. Clinicians should interpret this result in the context of the overall treatment plan.<\/p>\r\n\r\n Positive results may be a false positives or could represent occasional use or possible substance use disorder.<br\/><br\/>For a review regarding interpreting possible false positive urine toxicology results, see http:\/\/pubmed.ncbi.nlm.nih.gov\/24986836<\/a>. It is unknown if the findings reported in this article can be extrapolated to other laboratory analyzers that were not used in the referenced studies.<br\/><br\/>For guidance regarding evaluating and addressing unexpected toxicology tests results, see Recommendation 10 of the 22 CDC Clinical Practice Guideiline<\/a>.<\/p><\/div>\r\n<\/div>'
// HTML Generation define "Get HTML Details": Common."Style Header" & "Unexpected Div Start" & "Details Table" & "Expected Result Footnote" & "Details More Info" & "Div End"
define "Detail": Rec10Common."Get HTML Details"
Recommendation #10 - Urine Drug Testing (order-select)
Centers for Disease Control and Prevention (CDC)
When prescribing opioids for subacute or chronic pain, clinicians should consider the benefits and risks of toxicology testing to assess for prescribed medications as well as other prescribed and nonprescribed controlled substances.
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.
Before starting opioids and periodically (at least annually) during opioid therapy, clinicians should consider the benefits and risks of toxicology testing to assess for prescribed opioids and other prescription and nonprescription controlled substances that increase risk for overdose when combined with opioids, including nonprescribed and illicit opioids and benzodiazepines.
2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain
Urine drug screening should be done at least 1-2 times a year Screening frequency should be based on assessed risk, guidelines, and regulations UDS monitors opioid adherence and detects non-prescribed substances for patient safety Confirmatory testing may be helpful; results may be affected by drug metabolism and dose timing Discuss concerns with the patient before making therapeutic changes
Patient has not had a urine screening in the past 12 months
Snooze - Patient declines, snooze 3 months
Snooze - Alert triggered in error, snooze 1 year
Patient May Have Unexpected Toxicology Test Results
Patient may have unexpected urine toxicology test results in the past year
Snooze* - Alert triggered in error, snooze for 1 year