2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide
2022.1.0 - CI Build

2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide, published by Centers for Disease Control and Prevention (CDC). This guide is not an authorized publication; it is the continuous build for version 2022.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/opioid-cds-r4/ and changes regularly. See the Directory of published versions

Recommendation #1 - Nonpharmacologic and Nonopioid Pharmacologic Therapy Consideration

CDC Guideline: 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain
Recommendation Topic: Determining Whether or Not to Initiate Opioids for Pain (Source)
Recommendation Description: Nonopioid therapies are at least as effective as opioids for many common types of acute pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient. Before prescribing opioid therapy for acute pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy. (Source)
Recommendation Category: B
Evidence Type: 3
Recommendation01-flow.png
Flow Diagram for Recommendation 1

  • When
    • Provider is prescribing an opioid analgesic with ambulatory misuse potential in the outpatient setting
    • Prescription is for treating acute pain.
    • Opioid review is useful for this patient:
      • Patient is 18 or over
      • Patient does not have evidence of sickle cell disease
      • Patient does not have findings indicating limited life expectancy
      • Patient does not have orders for therapies indicating end of life care
      • Patient is not undergoing active cancer treatment:
        • Patient has had at least 2 office visits within the past 12 months with an oncology specialist present, or
        • Patient has had at least 2 office visits within the past 12 months with a CDC malignant cancer condition diagnosis
      • Patient does not have conditions likely terminal for opioid prescribing present
    • Patient is opioid naive:
      • No indication of opioid use in the past 90 days from a prescription, self report (for future implementation), or a dispensing event (for future implementation)
  • Then
    • Consider Nonopioid Treatment Options for Acute Pain:
      • Document - Record reason for opioid therapy
      • Snooze - Attempt alternative therapy, snooze 3 months
      • Order - Select alternative therapies from order set
      • Snooze - N/A see comment, snooze 3 months
      • Remove - Will remove triggering medication order
The following table describes the flowchart decisions and sub-routines for the recommendation
Definition Answer to Proceed Details Data (Terminology) Requirement Profile Path
Opioid order for acute pain? Yes See For Acute Pain sub-routine
Opioid review useful? Yes See Opioid Review Useful sub-routine
Opioid naïve? Yes See Opioid Naïve sub-routine

Effective Data Requirements

The following artifacts formalize the description of the logic and behavior defined by this recommendation.

Resource Type Description
2022 CDC Clinical Practice Guideline Recommendation #1 PlanDefinition Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #1
Recommendation #1 - Nonpharmacologic and Nonopioid Pharmacologic Therapy Consideration Library Defines the data requirements to support evaluation of recommendation #1
Opioid Terminology Management Knowledge-base Data (OMTK) LibraryLibraryCQL Library that provides logic for implementation of opioid management functionality including Milligram Morphine Equivalents (MME).
Opioid Terminology Management Knowledge-base (OMTK) LibraryLibraryCQL Library that provides logic for implementation of opioid management functionality including Milligram Morphine Equivalents (MME).
Common Opioid Decision Support LogicLibraryCQL Library that provides common logic for the recommendations
Common OpioidCDS Configuration LogicLibraryCQL Library that provides common configuration logic for the recommendations
Common OpioidCDS Routines LogicLibraryCQL Library that provides common routines logic for the recommendations
FHIRHelpers Conversion LogicLibraryCQL Library that defines functions to convert between FHIR data types and CQL system-defined types, as well as functions to support FHIRPath implementation
Description CDS Hooks Request Expected Response
Patient is 18 years or older and has an outpatient Medication Request of Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) authored "Today" as well as a Medication Statement 95 days prior to today which will result in recommendation inclusion in addition to Opioid Naive & Opioid Review Useful inclusion. Patients "Dosage Instructions" are 1 Film per day for 30 days. This should result in a summary message: "Recommend use of nonpharmacologic therapy and nonopioid pharmacologic therapy as alternative." Request JSON Response JSON
Patient is 18 years or older and has an inpatient Medication Request of Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603). Patients "Dosage Instructions" are 1 Film per day for 30 days. This will result in an empty set of cards due to the Medication Request being inpatient. Request JSON Response JSON
  • When
    • Provider is prescribing an opioid analgesic with ambulatory misuse potential in the outpatient setting
    • Prescription is for treating acute pain.
    • Opioid review is useful for this patient:
      • Patient is 18 or over
      • Patient does not have evidence of sickle cell disease
      • Patient does not have findings indicating limited life expectancy
      • Patient does not have orders for therapies indicating end of life care
      • Patient is not undergoing active cancer treatment:
        • Patient has had at least 2 office visits within the past 12 months with an oncology specialist present, or
        • Patient has had at least 2 office visits within the past 12 months with a CDC malignant cancer condition diagnosis
      • Patient does not have conditions likely terminal for opioid prescribing present
    • Patient is opioid naive:
      • No indication of opioid use in the past 90 days from a prescription, self report (for future implementation), or a dispensing event (for future implementation)
  • Then
    • Consider Nonopioid Treatment Options for Acute Pain:
      • Document - Record reason for opioid therapy
      • Snooze - Attempt alternative therapy, snooze 3 months
      • Order - Select alternative therapies from order set
      • Snooze - N/A see comment, snooze 3 months
      • Remove - Will remove triggering medication order

The following table describes the flowchart decisions and sub-routines for the recommendation
Definition Answer to Proceed Details Data (Terminology) Requirement Profile Path
Opioid order for acute pain? Yes See For Acute Pain sub-routine
Opioid review useful? Yes See Opioid Review Useful sub-routine
Opioid naïve? Yes See Opioid Naïve sub-routine

Effective Data Requirements

The following artifacts formalize the description of the logic and behavior defined by this recommendation.

Resource Type Description
2022 CDC Clinical Practice Guideline Recommendation #1 PlanDefinition Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #1
Recommendation #1 - Nonpharmacologic and Nonopioid Pharmacologic Therapy Consideration Library Defines the data requirements to support evaluation of recommendation #1
Opioid Terminology Management Knowledge-base Data (OMTK) LibraryLibraryCQL Library that provides logic for implementation of opioid management functionality including Milligram Morphine Equivalents (MME).
Opioid Terminology Management Knowledge-base (OMTK) LibraryLibraryCQL Library that provides logic for implementation of opioid management functionality including Milligram Morphine Equivalents (MME).
Common Opioid Decision Support LogicLibraryCQL Library that provides common logic for the recommendations
Common OpioidCDS Configuration LogicLibraryCQL Library that provides common configuration logic for the recommendations
Common OpioidCDS Routines LogicLibraryCQL Library that provides common routines logic for the recommendations
FHIRHelpers Conversion LogicLibraryCQL Library that defines functions to convert between FHIR data types and CQL system-defined types, as well as functions to support FHIRPath implementation

Description CDS Hooks Request Expected Response
Patient is 18 years or older and has an outpatient Medication Request of Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) authored "Today" as well as a Medication Statement 95 days prior to today which will result in recommendation inclusion in addition to Opioid Naive & Opioid Review Useful inclusion. Patients "Dosage Instructions" are 1 Film per day for 30 days. This should result in a summary message: "Recommend use of nonpharmacologic therapy and nonopioid pharmacologic therapy as alternative." Request JSON Response JSON
Patient is 18 years or older and has an inpatient Medication Request of Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603). Patients "Dosage Instructions" are 1 Film per day for 30 days. This will result in an empty set of cards due to the Medication Request being inpatient. Request JSON Response JSON