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 #2 - Opioid Therapy Goals Discussion

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 preferred for subacute and chronic pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider initiating opioid therapy if expected benefits for pain and function are anticipated to outweigh risks to the patient. Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks. (Source)
Recommendation Category: A
Evidence Type: 2
Recommendation02-flow.png
Flow Diagram for Recommendation 2

  • When
    • Provider is prescribing an opioid with ambulatory misuse potential in the outpatient setting
    • Prescription is for treating subacute and/or chronic 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)
    • Pain management procedure in past 90 days is not present and
    • Pain treatment plan created, edited, or reviewed by the prescribing physician in past 90 days is not present
  • Then
    • Maximize Nonopioid Therapies as Appropriate:
      • Document - Collaborated with patient to identify treatment goals
      • Snooze - Attempting alternate therapy, snooze 3 months
      • Order - Select alternative therapies from order select
      • 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 subacute or chronic pain? Yes See For Subacute or Chronic Pain sub-routine
Opioid review useful? Yes See Opioid Review Useful sub-routine
Opioid naïve? Yes See Opioid Naïve sub-routine
Pain treatment plan created or edited in past 90 days? No Look for a pain treatment plan that has been established or edited within the past 90 days (including the day of the visit).
The following criteria should be met:
• the treatment plan has an initiation date or an edited date within the past 90 days.
• the treatment plan should have been created or reviewed within the past 90 days by the same individual who is writing the new prescription. 		Pain treatment plan CarePlan CarePlan.category, CarePlan.status, CarePlan.created, CarePlan.lastUpdated, and CarePlan.author
Pain management procedure in past 90 days? No Look for a pain management procedure (including the procedure to review a pain management treatment plan) that occurred within the past 90 days (including the day of the visit). Pain management procedure Procedure and MedicationRequest Procedure.performed, Procedure.performer.actor, and MedicationRequest.recorder

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 #2 PlanDefinition Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #2
Recommendation #2 - Opioid Therapy Goals Discussion Library Defines the data requirements to support evaluation of recommendation #2
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
DescriptionCDS Hooks RequestExpected 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 an Opioid Treatment Care Plan updated 89 days prior to today. Patients "Dosage Instructions" are 1 Film per day for 30 days. This patient will not trigger any cards and there should not be a recommendation message. Request JSON example-rec-02-in-careplan-revisited Response JSON example-rec-02-in-careplan-revisited
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 Care Plan most recently updated 120 days prior to today. Patients "Dosage Instructions" are 1 Film per day for 30 days. Due to the most recent review of the Care Plan having been conducted more than 89 days prior to today this will result in a summary message: "Recommend creation, review or update of opioid treatment plan." Request JSON example-rec-02-out-careplan-not-revisited Response JSON example-rec-02-out-careplan-not-revisited
  • When
    • Provider is prescribing an opioid with ambulatory misuse potential in the outpatient setting
    • Prescription is for treating subacute and/or chronic 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)
    • Pain management procedure in past 90 days is not present and
    • Pain treatment plan created, edited, or reviewed by the prescribing physician in past 90 days is not present
  • Then
    • Maximize Nonopioid Therapies as Appropriate:
      • Document - Collaborated with patient to identify treatment goals
      • Snooze - Attempting alternate therapy, snooze 3 months
      • Order - Select alternative therapies from order select
      • 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 subacute or chronic pain? Yes See For Subacute or Chronic Pain sub-routine
Opioid review useful? Yes See Opioid Review Useful sub-routine
Opioid naïve? Yes See Opioid Naïve sub-routine
Pain treatment plan created or edited in past 90 days? No Look for a pain treatment plan that has been established or edited within the past 90 days (including the day of the visit).
The following criteria should be met:
• the treatment plan has an initiation date or an edited date within the past 90 days.
• the treatment plan should have been created or reviewed within the past 90 days by the same individual who is writing the new prescription. 		Pain treatment plan CarePlan CarePlan.category, CarePlan.status, CarePlan.created, CarePlan.lastUpdated, and CarePlan.author
Pain management procedure in past 90 days? No Look for a pain management procedure (including the procedure to review a pain management treatment plan) that occurred within the past 90 days (including the day of the visit). Pain management procedure Procedure and MedicationRequest Procedure.performed, Procedure.performer.actor, and MedicationRequest.recorder

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 #2 PlanDefinition Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #2
Recommendation #2 - Opioid Therapy Goals Discussion Library Defines the data requirements to support evaluation of recommendation #2
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

DescriptionCDS Hooks RequestExpected 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 an Opioid Treatment Care Plan updated 89 days prior to today. Patients "Dosage Instructions" are 1 Film per day for 30 days. This patient will not trigger any cards and there should not be a recommendation message. Request JSON example-rec-02-in-careplan-revisited Response JSON example-rec-02-in-careplan-revisited
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 Care Plan most recently updated 120 days prior to today. Patients "Dosage Instructions" are 1 Film per day for 30 days. Due to the most recent review of the Care Plan having been conducted more than 89 days prior to today this will result in a summary message: "Recommend creation, review or update of opioid treatment plan." Request JSON example-rec-02-out-careplan-not-revisited Response JSON example-rec-02-out-careplan-not-revisited