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

2022 CDC Clinical Practice Guideline - Subroutines

For Acute Pain

Definition	Answer to Proceed	Details	Data (Terminology) Requirement	Profile	Path
Order for opioid analgesics with ambulatory misuse potential of duration < 28 days	Yes	Look for an existing prescription (order) for opioid analgesics with ambulatory misuse potential of duration < 28 days	Opioid analgesics with ambulatory misuse potential	MedicationRequest	MedicationRequest.medication, MedicationRequest.category, and MedicationRequest.dispenseRequest.expectedSupplyDuration

For more information see the acute pain documentation

For Subacute or Chronic Pain

Definition	Answer to Proceed	Details	Data (Terminology) Requirement	Profile	Path
Order for opioid analgesic with expected supply duration ≥ 28 days	Yes	Order for opioid analgesics with ambulatory misuse potential with a supply duration ≥ 28 days • Subacute definition = order for opioid analgesic with ambulatory misuse potential with a supply duration of one to two months • Chronic pain definition = order for opioid analgesic with ambulatory misuse potential with a supply duration of ≥ two months	Opioid analgesics with ambulatory misuse potential	MedicationRequest	MedicationRequest.medication and MedicationRequest.dispenseRequest.expectedSupplyDuration

For more information see the subacute and/or chronic pain documentation

Opioid Review Useful

• 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

Definition	Answer to Proceed	Details	Data (Terminology) Requirement	Profile	Path
Age < 18 years?	No	Calculate age from date of birth; exclude patients with age less than 18 years at the time of the prescription	Date of birth	Patient	Patient.birthDate
Evidence of sickle cell disease?	No	Look for patients with a diagnosis or problem list entry indicating sickle cell disease	Sickle cell disease condition	Condition	Condition.category, Condition.code, and Condition.clinicalStatus
Limited life expectancy conditions present?	No	Look for documented findings consistent with those listed in the limited life expectancy value set (terminal illness, bad prognosis, pre-terminal)	Limited life expectancy conditions	Condition	Condition.category and Condition.code
Order for therapies indicating end of life care in past 90 days?	No	Look for patients with an existing order for therapies indicating end of life care written within past 90 days	Therapies indicating end of life care	ServiceRequest	ServiceRequest.status, ServiceRequest.intent, ServiceRequest.authoredOn, and ServiceRequest.code
Active cancer treatment?	No	See Active Cancer Treatment sub-routine	See Active Cancer Treatment sub-routine
Conditions Likely Terminal for opioid prescribing present?	No	Look for patients with active conditions in the value set end-of-life-conditions	Conditions likely terminal for opioid prescribing	Condition	Condition.category, Condition.code, and Condition.clinicalStatus

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

Definition	Answer to Proceed	Details	Data (Terminology) Requirement	Profile	Path
Two office visits within the past 12 months?	No	Look for a minimum of two distinct encounters within 12 months of the date of the current visit for which each of the following is true: • the encounter diagnosis (primary or secondary or co-morbidity diagnosis) is listed in the CDC Malignant Cancer Conditions value set	Office Visit	Encounter	Encounter.class and Encounter.period.start
Office visits with an oncology specialist present?	No	• The encounter is performed by an oncologist as defined in the oncology specialty designations using the National Uniform Claim Committee (NUCC) classifications	Oncology specialty designations (NUCC)	PractitionerRole and Encounter	PractitionerRole.specialty, Encounter.participant.type, and Encounter.participant.individual
Office visits including CDC malignant cancer condition?	No	• The encounter diagnosis (primary or secondary or co-morbidity diagnosis) is listed in the CDC Malignant Cancer Conditions value set	CDC malignant cancer conditions	Condition and Encounter	Condition.category, Condition.code, and Encounter.diagnosis

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)

Definition	Answer to Proceed	Details	Data (Terminology) Requirement	Profile	Path
Opioid analgesics with ambulatory misuse potential prescription in past 90 days excluding the last 24 hours?	No	Look for an existing prescription (order) for opioid that is in the value set for opioid with ambulatory misuse potential authored within the past 90 days (excluding the last 24 hours)	Opioid analgesics with ambulatory misuse potential	MedicationRequest	MedicationRequest.medication, MedicationRequest.category, and MedicationRequest.authoredOn
Opioid analgesics with ambulatory misuse potential reported as being taken excluding the last 24 hours?*	No	Look for evidence of active medication on the medication list that is in the value set for opioid with ambulatory care misuse potential (excluding the last 24 hours)	Opioid analgesics with ambulatory misuse potential	MedicationStatement	MedicationStatement.medication, MedicationStatement.status, and MedicationStatement.effective
Opioid analgesics with ambulatory misuse potential dispensing event in past 90 days excluding the last 24 hours?*	No	Look for evidence of a dispensing event for medication that is in the value set for opioid with ambulatory use potential occurring within the past 90 days (excluding the last 24 hours)	Opioid analgesics with ambulatory misuse potential	MedicationDispense	MedicationDispense.medication, MedicationDispense.status, and MedicationDispense.whenHandedOver
* Future consideration: Current algorithm addresses only orders (prescriptions). 1 - Implement one global configuration point to set all past medication queries at each particular site: “Can the implementing EHR support queries for past medications by date range? Yes or No”. An evaluation to determine if a patient is opioid naive is not possible when a EHR system does not support queries for past medications by date range. 2 - orders use RxNorm, but medication lists and dispensed medication will require an NDC value set and/or local mapping of NDC to RxNorm to enable this element