opioidcds-11-order-select
type: PlanDefinition
node role: treeRoot
id:
  v: opioidcds-11-order-select
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-11-order-select Url: Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (order-select) Version: 2022.1.0 Identifier: value: cdc-opioid-guidance Name: PlanDefinition_Recommendation_11_Order_Select Title: Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (order-select) 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: Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently and consider whether benefits outweigh risks of concurrent prescribing of opioids and other central nervous system depressants. Logic Definitions: Library Name Name sequence OpioidCDSREC11OrderSelect Opioid Analgesic with Ambulatory Misuse Potential Prescriptions 0 define "Opioid Analgesic with Ambulatory Misuse Potential Prescriptions": Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) Library Name Name sequence OpioidCDSREC11OrderSelect Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential 1 define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential": exists( "Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" ) Library Name Name sequence OpioidCDSCommon Active Ambulatory Benzodiazepine or CNS Depressant Rx 2 define "Active Ambulatory Benzodiazepine or CNS Depressant Rx": if Config."Can the implementing EHR support queries for past medications by date range?" then ( "Get MedicationRequest Medication as Code"("Active Medication List") ) Rx where date from Rx.authoredOn 2 years or less on or before Today() and Rx.medication in "Benzodiazepine medications" or Rx.medication in "CNS Depressant Medications" else List<FHIR.MedicationRequest>{} Library Name Name sequence OpioidCDSREC11OrderSelect Benzodiazepine or CNS Depressa…
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 Benzodiazepine medications
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/benzodiazepine-medications
      link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/benzodiazepine-medications
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set CNS Depressant Medications
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/cns-depressant-medications
      link: http://fhir.org/guides/cdc/opioid-cds/ValueSet/cns-depressant-medications
  related artifact:
    type:
      v: depends-on
    display:
      v: Value set Encounter Diagnosis Condition Category
    resource:
      v: http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category
      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

v: clinicalStatus

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: OpioidCDSREC11OrderSelect
extension:
  url:
    v: name
  value: string
    v: Opioid Analgesic with Ambulatory Misuse Potential Prescriptions
extension:
  url:
    v: statement
  value: string
    v: define "Opioid Analgesic with Ambulatory Misuse Potential Prescriptions": Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions )
extension:
  url:
    v: displaySequence
  value: integer
    v: 0
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC11OrderSelect
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( "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: OpioidCDSCommon
extension:
  url:
    v: name
  value: string
    v: Active Ambulatory Benzodiazepine or CNS Depressant Rx
extension:
  url:
    v: statement
  value: string
    v: define "Active Ambulatory Benzodiazepine or CNS Depressant Rx": if Config."Can the implementing EHR support queries for past medications by date range?" then ( "Get MedicationRequest Medication as Code"("Active Medication List") ) Rx where date from Rx.authoredOn 2 years or less on or before Today() and Rx.medication in "Benzodiazepine medications" or Rx.medication in "CNS Depressant Medications" else List<FHIR.MedicationRequest>{}
extension:
  url:
    v: displaySequence
  value: integer
    v: 2
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC11OrderSelect
extension:
  url:
    v: name
  value: string
    v: Benzodiazepine or CNS Depressant Prescriptions
extension:
  url:
    v: statement
  value: string
    v: define "Benzodiazepine or CNS Depressant Prescriptions": Common."Is Benzodiazepine or CNS Depressant?"( ContextPrescriptions )
extension:
  url:
    v: displaySequence
  value: integer
    v: 3
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC11OrderSelect
extension:
  url:
    v: name
  value: string
    v: Patient Is Being Prescribed Benzodiazepine or CNS Depressant
extension:
  url:
    v: statement
  value: string
    v: define "Patient Is Being Prescribed Benzodiazepine or CNS Depressant": exists( "Benzodiazepine or CNS Depressant Prescriptions" )
extension:
  url:
    v: displaySequence
  value: integer
    v: 4
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSCommon
extension:
  url:
    v: name
  value: string
    v: Active Ambulatory Opioid Rx
extension:
  url:
    v: statement
  value: string
    v: define "Active Ambulatory Opioid Rx": if Config."Can the implementing EHR support queries for past medications by date range?" then ( "Get MedicationRequest Medication as Code"("Get Active Ambulatory Medication Requests"([MedicationRequest])) ) Rx where date from Rx.authoredOn 2 years or less on or before Today() and Rx.medication in "Opioid analgesics with ambulatory misuse potential" else List<FHIR.MedicationRequest>{}
extension:
  url:
    v: displaySequence
  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: 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: 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: 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: 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: 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: 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: 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: 9
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: 10
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC11OrderSelect
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 exists Common."Active Ambulatory Benzodiazepine or CNS Depressant Rx" ) or ( "Patient Is Being Prescribed Benzodiazepine or CNS Depressant" and exists Common."Active Ambulatory Opioid Rx" ) ) and Routines."Is Opioid Review Useful?"
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: 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: 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: 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: 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: 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: 14
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: 15
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC11OrderSelect
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: 16
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

extension:
  url:
    v: libraryName
  value: string
    v: OpioidCDSREC11OrderSelect
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: 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: 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: 18
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: 19
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: 20
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 Benzodiazepine or CNS Depressant?
extension:
  url:
    v: statement
  value: string
    v: define function "Is Benzodiazepine or CNS Depressant?"(value List<MedicationRequest>): ("Get MedicationRequest Medication as Code"(value)) Rx where Rx.medication in "Benzodiazepine medications" or Rx.medication in "CNS Depressant Medications" and Rx.category in "Community"
extension:
  url:
    v: displaySequence
  value: integer
    v: 21
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: 22
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_11_Order_Select

v: Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (order-select)

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: Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently and consider whether benefits outweigh risks of concurrent prescribing of opioids and other central nervous system depressants.

code:
  system:
    v: http://terminology.hl7.org/CodeSystem/usage-context-type
  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)

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

v: Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently. In addition, clinicians should consider whether benefits outweigh risks for concurrent use of opioids with other central nervous system depressants.

v: © CDC 2016+.

text:
  v: Opioid Prescribing

name:
  v: Kensaku Kawamoto, MD, PhD, MHS

name:
  v: Bryn Rhodes

name:
  v: Floyd Eisenberg, MD, MPH

name:
  v: Robert McClure, MD, MPH

type:
  v: documentation
display:
  v: 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain
url:
  v: https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
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: weak
      display:
        v: Weak
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/evidence-quality
      code:
        v: low
      display:
        v: Low quality
title:
  v: Use Particular Caution When Prescribing Opioid Pain Medication and Benzodiazepines or Other CNS Depressants Concurrently
description:
  v: Consider whether the benefits outweigh the risks of concurrently prescribing opioids and benzodiazepines, or other central nervous system depressant medications. When co-prescribing risks outweigh benefits, consult [Recommendation 11 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=evidence%20type%3A%203).-,Implementation%20Considerations,-Although%20in%20some) for further guidance. [For patients being treated for opioid use disorder who are also taking benzodiazepines or other medications that depress the central nervous system, the CDC recommends not withholding buprenorphine or methadone](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=gabapentin%20and%20pregabalin).-,Buprenorphine%20or%20methadone%20for%20opioid%20use%20disorder%20should%20not%20be%20withheld%20from%20patients%20taking%20benzodiazepines%20or%20other%20medications%20that%20depress%20the%20central%20nervous%20system.,-Clinicians%20should%20check). If the decision is made to taper benzodiazepine medications, [the CDC recommends tapering benzodiazepines gradually prior to discontinuation](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20taper%20benzodiazepines%20gradually%20before%20discontinuation%20because%20abrupt%20withdrawal%20can%20be%20associated%20with%20rebound%20anxiety%2C%20hallucinations%2C%20seizures%2C%20delirium%20tremens%2C%20and%2C%20rarely%2C%20death.%20The%20rate%20of%20tapering%20should%20be%20individualized).
priority:
  v: urgent
trigger:
  type:
    v: named-event
  name:
    v: order-select
condition:
  kind:
    v: applicability
  expression:
    description:
      v: Check whether the current order results in the concurrent use of opioid pain medication and benzodiazepines or other central nervous system depressants 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 modify prescription
action:
  description:
    v: Snooze* - Benefits outweigh risks, snooze 3 months
action:
  description:
    v: Snooze* - N/A see comments, snooze 3 months