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 #7 - Opioid Therapy Risk Assessment

CDC Guideline: 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain
Recommendation Topic: Deciding Duration of Initial Opioid Prescription and Conducting Follow-Up (Source)
Recommendation Description: Clinicians should evaluate benefits and risks with patients within 1-4 weeks of starting opioid therapy for subacute or chronic pain or of dosage escalation. Clinicians should regularly reevaluate benefits and risks of continued opioid therapy with patients. (Source)
Recommendation Category: A
Evidence Type: 4
Recommendation07-flow.png
Flow Diagram for Recommendation 7

  • When
    • Provider is prescribing an opioid analgesic 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
    • Opioid risk benefit assessment has not been performed in the past 90 days
  • Then
    • Regularly Evaluate the Benefits and Risks of Opioid Therapy:
      • Document - Conducted benefit and risk assessment
      • Snooze - Conducted assessment, 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
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 risk - benefit assessment procedure not performed in last 90 days? Yes Absence of an opioid treatment assessment procedure in the last 90 days Opioid treatment assessment procedure Procedure Procedure.code, and Procedure.performed

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 #7 PlanDefinition Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #7
Recommendation #7 - benefits and harms of starting and/or continuing opioid therapy for subacute or chronic pain Library Defines the data requirements to support evaluation of recommendation #7
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 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502).one tablet per day for 30 days. Patient is also being prescribed maCarbinoxamineleate 0.4 MG/ML / Hydrocodone Bitartrate 1 MG/ML / Pseudoephedrine Hydrochloride 6 MG/ML Oral Solution (RXNorm 1012727) 3 tablets per day for 30 days. The patient will be excluded and no message will be triggered - an empty set of cards will be returned. Request JSON Response JSON
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) 1 tablet per day for 30 days. The patient will be excluded and no message will be triggered - an empty set of cards will be returned. Request JSON Response JSON
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) one tablet per 1 day for 7 days. Patient has also been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm one tablet per 1 day for 7 days. "Assessment of risk for opioid use procedure." Patients on opioid therapy should be evaluated for benefits and harms within 1 to 4 weeks of starting opioid therapy and every 3 months or more subsequently. Assessment of risk for opioid abuse (procedure) Request JSON Response JSON
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet. (RXNorm 1049502) one tablet per 1 day for 6 days. Patient has also been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (Rxnorm 0149502) one tablet per 1 day for 6 days.The patient will be excluded and no message will be triggered - an empty set of cards will be returned. Request JSON Response JSON
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) one tablet per 1 day for 30 days. Patient has also been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) one tablet per 1 day for 63 days. This will trigger the message "No evaluation for benefits and harms associated with opioid therapy has been performed for the patient in the past 3 months" Patients on opioid therapy should be evaluated for benefits and harms within 1 to 4 weeks of starting opioid therapy and every 3 months or more subsequently. Request JSON Response JSON
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) 1 tablet per 1 day for 30 days. Patient has also been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) 1 tablet per 1 day for 62 days. The patient will be excluded and no message will be triggered - an empty set of cards will be returned. Request JSON Response JSON
  • When
    • Provider is prescribing an opioid analgesic 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
    • Opioid risk benefit assessment has not been performed in the past 90 days
  • Then
    • Regularly Evaluate the Benefits and Risks of Opioid Therapy:
      • Document - Conducted benefit and risk assessment
      • Snooze - Conducted assessment, 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
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 risk - benefit assessment procedure not performed in last 90 days? Yes Absence of an opioid treatment assessment procedure in the last 90 days Opioid treatment assessment procedure Procedure Procedure.code, and Procedure.performed

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 #7 PlanDefinition Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #7
Recommendation #7 - benefits and harms of starting and/or continuing opioid therapy for subacute or chronic pain Library Defines the data requirements to support evaluation of recommendation #7
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 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502).one tablet per day for 30 days. Patient is also being prescribed maCarbinoxamineleate 0.4 MG/ML / Hydrocodone Bitartrate 1 MG/ML / Pseudoephedrine Hydrochloride 6 MG/ML Oral Solution (RXNorm 1012727) 3 tablets per day for 30 days. The patient will be excluded and no message will be triggered - an empty set of cards will be returned. Request JSON Response JSON
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) 1 tablet per day for 30 days. The patient will be excluded and no message will be triggered - an empty set of cards will be returned. Request JSON Response JSON
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) one tablet per 1 day for 7 days. Patient has also been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm one tablet per 1 day for 7 days. "Assessment of risk for opioid use procedure." Patients on opioid therapy should be evaluated for benefits and harms within 1 to 4 weeks of starting opioid therapy and every 3 months or more subsequently. Assessment of risk for opioid abuse (procedure) Request JSON Response JSON
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet. (RXNorm 1049502) one tablet per 1 day for 6 days. Patient has also been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (Rxnorm 0149502) one tablet per 1 day for 6 days.The patient will be excluded and no message will be triggered - an empty set of cards will be returned. Request JSON Response JSON
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) one tablet per 1 day for 30 days. Patient has also been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) one tablet per 1 day for 63 days. This will trigger the message "No evaluation for benefits and harms associated with opioid therapy has been performed for the patient in the past 3 months" Patients on opioid therapy should be evaluated for benefits and harms within 1 to 4 weeks of starting opioid therapy and every 3 months or more subsequently. Request JSON Response JSON
Patient is 18 or older. Patient has been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) 1 tablet per 1 day for 30 days. Patient has also been prescribed 12 HR Oxycodone Hydrochloride 10 MG Extended Release Oral Tablet (RXNorm 1049502) 1 tablet per 1 day for 62 days. The patient will be excluded and no message will be triggered - an empty set of cards will be returned. Request JSON Response JSON