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 #3 - Opioid Immediate Release Form When Starting Opioid Therapy

CDC Guideline: 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain
Recommendation Topic: Selecting Opioids and Determining Opioid Dosages (Source)
Recommendation 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. (Source)
Recommendation Category: A
Evidence Type: 4
Recommendation03-flow.png
Flow Diagram for Recommendation 3

  • When
    • Provider is prescribing an extended release opioid analgesic with ambulatory misuse potential in the outpatient setting
    • 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
    • When Initiating Opioid Therapy, Utilize Immediate Release Opioids:
      • Document - Will prescribe immediate release opioid
      • Snooze - Benefits outweigh risks, snooze 3 months
      • Snooze - N/A see comment, snooze 3 months
The following table describes the flowchart decisions and sub-routines for the recommendation
Definition Answer to Proceed Details Data (Terminology) Requirement Profile Path
Is this order for extended-release opioid analgesics with ambulatory misuse potential? Yes Look for a new prescription for extended release opioids. [Ideally the order should be selected prior to being committed to the system] Extended-release opioid analgesics with ambulatory misuse potential MedicationRequest MedicationRequest.medication
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 #3 PlanDefinition Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #3
Recommendation #3 - prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids Library Defines the data requirements to support evaluation of recommendation #3
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 a Medication Request authored "Today" for 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet which is an "Extended Release Opioid with Ambulatory Abuse Potential". This will result in a recommendation message: "Recommend use of immediate-release opioids instead of extended release/long acting opioids when starting patient on opioids." Request JSON Response JSON
Patient is 18 years or older and has a Medication Request authored "Today" for Buprenorphine 2 MG / Naloxone 0.5 MG Oral Strip which is not an "Extended Release Opioid". This will not result in any recommendation messages. Request JSON Response JSON
Patient is 18 years or older and has a Medication Request authored "Today" for Buprenorphine 2 MG / Naloxone 0.5 MG Oral Strip which is not an "Extended Release Opioid". Additionally, the patient has an active Medication Request for 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet which is an "Extended Release Opioid with Ambulatory Abuse Potential". This will not result in any recommendation messages. Request JSON Response JSON
  • When
    • Provider is prescribing an extended release opioid analgesic with ambulatory misuse potential in the outpatient setting
    • 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
    • When Initiating Opioid Therapy, Utilize Immediate Release Opioids:
      • Document - Will prescribe immediate release opioid
      • Snooze - Benefits outweigh risks, snooze 3 months
      • Snooze - N/A see comment, snooze 3 months

The following table describes the flowchart decisions and sub-routines for the recommendation
Definition Answer to Proceed Details Data (Terminology) Requirement Profile Path
Is this order for extended-release opioid analgesics with ambulatory misuse potential? Yes Look for a new prescription for extended release opioids. [Ideally the order should be selected prior to being committed to the system] Extended-release opioid analgesics with ambulatory misuse potential MedicationRequest MedicationRequest.medication
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 #3 PlanDefinition Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #3
Recommendation #3 - prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids Library Defines the data requirements to support evaluation of recommendation #3
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 a Medication Request authored "Today" for 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet which is an "Extended Release Opioid with Ambulatory Abuse Potential". This will result in a recommendation message: "Recommend use of immediate-release opioids instead of extended release/long acting opioids when starting patient on opioids." Request JSON Response JSON
Patient is 18 years or older and has a Medication Request authored "Today" for Buprenorphine 2 MG / Naloxone 0.5 MG Oral Strip which is not an "Extended Release Opioid". This will not result in any recommendation messages. Request JSON Response JSON
Patient is 18 years or older and has a Medication Request authored "Today" for Buprenorphine 2 MG / Naloxone 0.5 MG Oral Strip which is not an "Extended Release Opioid". Additionally, the patient has an active Medication Request for 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet which is an "Extended Release Opioid with Ambulatory Abuse Potential". This will not result in any recommendation messages. Request JSON Response JSON