FHIR © HL7.org  |  Server Home  |  FHIR Server FHIR Server 3.7.16  |  FHIR Version n/a  User: [n/a]

Resource PlanDefinition/FHIR Server from package fhir.cdc.opioid-cds-r4#current (110 ms)

Package fhir.cdc.opioid-cds-r4
Type PlanDefinition
Id Id
FHIR Version R4
Source http://fhir.org/guides/cdc/opioid-cds/https://build.fhir.org/ig/cqframework/opioid-cds-r4/PlanDefinition-opioidcds-11-order-select.html
Url http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-11-order-select
Version 2022.1.0
Status draft
Date 2025-04-24
Name PlanDefinition_Recommendation_11_Order_Select
Title Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (order-select)
Experimental True
Realm us
Authority hl7
Description Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently and consider whether benefits outweigh risks of concurrent prescribing of opioids and other central nervous system depressants.
Purpose The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.
Copyright © CDC 2016+.

Resources that use this resource

No resources found


Resources that this resource uses

No resources found



Narrative

Note: links and images are rebased to the (stated) source

Id: opioidcds-11-order-select
Url: Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (order-select)
Version: 2022.1.0
Identifier:

value: cdc-opioid-guidance

Name: PlanDefinition_Recommendation_11_Order_Select
Title: Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (order-select)
Status: draft
Experimental: true
Type:

system: http://terminology.hl7.org/CodeSystem/plan-definition-type

code: eca-rule

display: ECA Rule

Date: 2025-04-24
Publisher: Centers for Disease Control and Prevention (CDC)
Description: Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently and consider whether benefits outweigh risks of concurrent prescribing of opioids and other central nervous system depressants.
Logic Definitions:
Library NameNamesequence
OpioidCDSREC11OrderSelect Opioid Analgesic with Ambulatory Misuse Potential Prescriptions 0
define "Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
  Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions )


Library NameNamesequence
OpioidCDSREC11OrderSelect Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential 1
define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential":
  exists( "Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )


Library NameNamesequence
OpioidCDSCommon Active Ambulatory Benzodiazepine or CNS Depressant Rx 2
define "Active Ambulatory Benzodiazepine or CNS Depressant Rx":
    if Config."Can the implementing EHR support queries for past medications by date range?" then
      (
        "Get MedicationRequest Medication as Code"("Active Medication List")
      ) Rx
        where date from Rx.authoredOn 2 years or less on or before Today()
          and Rx.medication in "Benzodiazepine medications"
          or  Rx.medication in "CNS Depressant Medications"
    else
         List<FHIR.MedicationRequest>{}


Library NameNamesequence
OpioidCDSREC11OrderSelect Benzodiazepine or CNS Depressant Prescriptions 3
define "Benzodiazepine or CNS Depressant Prescriptions":
  Common."Is Benzodiazepine or CNS Depressant?"( ContextPrescriptions )


Library NameNamesequence
OpioidCDSREC11OrderSelect Patient Is Being Prescribed Benzodiazepine or CNS Depressant 4
define "Patient Is Being Prescribed Benzodiazepine or CNS Depressant":
  exists( "Benzodiazepine or CNS Depressant Prescriptions" )


Library NameNamesequence
OpioidCDSCommon Active Ambulatory Opioid Rx 5
define "Active Ambulatory Opioid Rx":
    if Config."Can the implementing EHR support queries for past medications by date range?" then
      (
        "Get MedicationRequest Medication as Code"("Get Active Ambulatory Medication Requests"([MedicationRequest]))
      ) Rx
        where date from Rx.authoredOn 2 years or less on or before Today()
          and Rx.medication in "Opioid analgesics with ambulatory misuse potential"
    else
        List<FHIR.MedicationRequest>{}


Library NameNamesequence
OpioidCDSRoutines Patient Age Less Than 18 6
define "Patient Age Less Than 18":
  if (Config."Age Less than 18 Years Is Enabled") then
    AgeInYearsAt(Today()) < 18
  else false


Library NameNamesequence
OpioidCDSRoutines Condition Positive for Sickle Cell 7
define "Condition Positive for Sickle Cell":
  if (Config."Sickle Cell Check Enabled") then
    exists(
      Common."Positive Sickle Cell Condition"
    ) 
  else false


Library NameNamesequence
OpioidCDSRoutines Is Active Cancer Treatment? 8
define "Is Active Cancer Treatment?":
  if (Config."Active Cancer Treatment Encounters Condition Is Enabled") 
    then "Has Two or More Encounters with Cancer Diagnosis During Encounter Period"
      or "Has Active Cancer Diagnosis on Problem List"
  else false


Library NameNamesequence
OpioidCDSRoutines Conditions Likely Terminal for Opioid Prescribing 9
define "Conditions Likely Terminal for Opioid Prescribing":
  if (Config."End-Stage Disease Criteria Enabled") then
    exists (
      Common."US Core-Categorized Conditions" EOLC
        where EOLC.code in Common."Conditions likely terminal for opioid prescribing"
          // and EOLC.clinicalStatus in Common."Active Condition"
    )
  else false


Library NameNamesequence
OpioidCDSRoutines Is Opioid Review Useful? 10
define "Is Opioid Review Useful?":
  not "Patient Age Less Than 18"
    and not "Condition Positive for Sickle Cell"
    and not "Is Active Cancer Treatment?"
    and not "Conditions Likely Terminal for Opioid Prescribing"


Library NameNamesequence
OpioidCDSREC11OrderSelect Inclusion Criteria 11
define "Inclusion Criteria":
  (
    (
      "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
        and exists Common."Active Ambulatory Benzodiazepine or CNS Depressant Rx"
    )
      or (
        "Patient Is Being Prescribed Benzodiazepine or CNS Depressant"
          and exists Common."Active Ambulatory Opioid Rx"
      )
  )
    and Routines."Is Opioid Review Useful?"


Library NameNamesequence
OpioidCDSCommon US Core-Categorized Conditions 12
// 3. Medications indicating end of life
    /* or exists (
      "Medications Indicating End of Life"
    ) */

define "US Core-Categorized Conditions":
  [Condition: category in "Encounter Diagnosis Condition Category"]
    union [Condition: category in "Problem List Condition Category"]
    union [Condition: category in "US Core Health Concern Condition Category"]


Library NameNamesequence
OpioidCDSCommon Conditions Indicating End of Life or With Limited Life Expectancy 13
define "Conditions Indicating End of Life or With Limited Life Expectancy":
  (
    "US Core-Categorized Conditions" C
      where C.code in "Conditions likely terminal for opioid prescribing"
        and C.clinicalStatus in "Active Condition"
  )
  union
  (
    "US Core-Categorized Conditions" C
      where C.code in "Limited life expectancy conditions"
        and C.clinicalStatus in "Active Condition"
  )


Library NameNamesequence
OpioidCDSCommon Admitted/Referred/Discharged to Hospice Care 14
define "Admitted/Referred/Discharged to Hospice Care":
  (
    if (Config."Hospice Findings Exclusion Enabled") then
      [Observation: code in "Hospice Finding Codes"] O
        where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })
    else
      {}
  )
  union
  (
    [Encounter] E
      where date from E.period.start 1 year or less on or before Today()
        and (
          if E.hospitalization.dischargeDisposition.coding is null
              or not exists (E.hospitalization.dischargeDisposition.coding)
            then false
          else E.hospitalization.dischargeDisposition in "Hospice Disposition"
        )
        and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }
  )


Library NameNamesequence
OpioidCDSCommon End of Life Assessment 15
define "End of Life Assessment":
    // 1. Conditions indicating end of life or with limited life expectancy
    exists (
      "Conditions Indicating End of Life or With Limited Life Expectancy"
    )
    // 2. Admitted/referred/discharged to hospice care
    or exists (
      "Admitted/Referred/Discharged to Hospice Care"
    )


Library NameNamesequence
OpioidCDSREC11OrderSelect Exclusion Criteria 16
define "Exclusion Criteria":
  Common."End of Life Assessment"


Library NameNamesequence
OpioidCDSREC11OrderSelect Is Recommendation Applicable? 17
define "Is Recommendation Applicable?":
  "Inclusion Criteria"
    and not "Exclusion Criteria"


Library NameNamesequence
OpioidCDSCommon Is Opioid Analgesic with Ambulatory Misuse Potential? 18
define function "Is Opioid Analgesic with Ambulatory Misuse Potential?"(value List<MedicationRequest>):
  ("Get MedicationRequest Medication as Code"(value)) Rx
    where Rx.medication in "Opioid analgesics with ambulatory misuse potential" 
      and Rx.category in "Community"


Library NameNamesequence
OpioidCDSCommon Get MedicationRequest Medication as Code 19
define function "Get MedicationRequest Medication as Code"(value List<MedicationRequest>):
  value Rx
    let Med: 
      if Rx.medication is Reference then singleton from (
        [Medication] M
          where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))
      ) else null
    return 
      MedicationRequest {
        id: Rx.id,
        status: Rx.status,
        intent: Rx.intent,
        category: Rx.category,
        medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept,
        subject: Rx.subject,
        authoredOn: Rx.authoredOn,
        recorder: Rx.recorder,
        dosageInstruction: Rx.dosageInstruction,
        dispenseRequest: Rx.dispenseRequest
      }


Library NameNamesequence
FHIRHelpers ToConcept 20
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }


Library NameNamesequence
OpioidCDSCommon Is Benzodiazepine or CNS Depressant? 21
define function "Is Benzodiazepine or CNS Depressant?"(value List<MedicationRequest>):
  ("Get MedicationRequest Medication as Code"(value)) Rx
    where Rx.medication in "Benzodiazepine medications"
      or Rx.medication in "CNS Depressant Medications"
      and Rx.category in "Community"


Library NameNamesequence
FHIRHelpers ToDateTime 22
define function ToDateTime(value dateTime): value.value


Knowledge Capability: shareable computable executable publishable
Use Context:
codevaluedisplay
focus 182888003 Medication requested (situation)
focus 82423001 Chronic pain (finding)
Purpose:

The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.

Usage: Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently. In addition, clinicians should consider whether benefits outweigh risks for concurrent use of opioids with other central nervous system depressants.
Copyright:

© CDC 2016+.

Related Artifacts:

Documentation

Libraries:
Library - Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines
Actions:
Use Particular Caution When Prescribing Opioid Pain Medication and Benzodiazepines or Other CNS Depressants Concurrently: Consider whether the benefits outweigh the risks of concurrently prescribing opioids and benzodiazepines, or other central nervous system depressant medications. When co-prescribing risks outweigh benefits, consult [Recommendation 11 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=evidence%20type%3A%203).-,Implementation%20Considerations,-Although%20in%20some) for further guidance. [For patients being treated for opioid use disorder who are also taking benzodiazepines or other medications that depress the central nervous system, the CDC recommends not withholding buprenorphine or methadone](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=gabapentin%20and%20pregabalin).-,Buprenorphine%20or%20methadone%20for%20opioid%20use%20disorder%20should%20not%20be%20withheld%20from%20patients%20taking%20benzodiazepines%20or%20other%20medications%20that%20depress%20the%20central%20nervous%20system.,-Clinicians%20should%20check). If the decision is made to taper benzodiazepine medications, [the CDC recommends tapering benzodiazepines gradually prior to discontinuation](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20taper%20benzodiazepines%20gradually%20before%20discontinuation%20because%20abrupt%20withdrawal%20can%20be%20associated%20with%20rebound%20anxiety%2C%20hallucinations%2C%20seizures%2C%20delirium%20tremens%2C%20and%2C%20rarely%2C%20death.%20The%20rate%20of%20tapering%20should%20be%20individualized).
When: Named Event: order-select
If: Applicability: Check whether the current order results in the concurrent use of opioid pain medication and benzodiazepines or other central nervous system depressants and if an opioid review is appropriate for the patient. (Is Recommendation Applicable?)
Then:
: Document - Will modify prescription
Then:
: Snooze* - Benefits outweigh risks, snooze 3 months
Then:
: Snooze* - N/A see comments, snooze 3 months
Then:

Source

{
  "resourceType" : "PlanDefinition",
  "id" : "opioidcds-11-order-select",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition",
      "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-publishableplandefinition"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <table class=\"grid dict\">\n \n <tr>\n <th scope=\"row\"><b>Id: </b></th>\n <td style=\"padding-left: 4px;\">opioidcds-11-order-select</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Url: </b></th>\n <td style=\"padding-left: 4px;\"><a href=\"PlanDefinition-opioidcds-11-order-select.html\">Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (order-select)</a></td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Version: </b></th>\n <td style=\"padding-left: 4px;\">2022.1.0</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Identifier: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <b>value: </b> <span>cdc-opioid-guidance</span>\n </p>\n \n </td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Name: </b></th>\n <td style=\"padding-left: 4px;\">PlanDefinition_Recommendation_11_Order_Select</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Title: </b></th>\n <td style=\"padding-left: 4px;\">Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (order-select)</td>\n </tr>\n \n \n \n <tr>\n <th scope=\"row\"><b>Status: </b></th>\n <td style=\"padding-left: 4px;\">draft</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Experimental: </b></th>\n <td style=\"padding-left: 4px;\">true</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n \n <p style=\"margin-bottom: 5px;\">\n <b>system: </b> <span><a href=\"http://terminology.hl7.org/6.4.0/CodeSystem-plan-definition-type.html\">http://terminology.hl7.org/CodeSystem/plan-definition-type</a></span>\n </p>\n \n \n <p style=\"margin-bottom: 5px;\">\n <b>code: </b> <span>eca-rule</span>\n </p>\n \n \n <p style=\"margin-bottom: 5px;\">\n <b>display: </b> <span>ECA Rule</span>\n </p>\n \n \n \n \n </td>\n </tr>\n \n \n \n <tr>\n <th scope=\"row\"><b>Date: </b></th>\n <td style=\"padding-left: 4px;\">2025-04-24</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Publisher: </b></th>\n <td style=\"padding-left: 4px;\">Centers for Disease Control and Prevention (CDC)</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Description: </b></th>\n <td style=\"padding-left: 4px;\">Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently and consider whether benefits outweigh risks of concurrent prescribing of opioids and other central nervous system depressants.</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><a name=\"effective-data-requirements\"> </a><b>Logic Definitions: </b></th>\n <td style=\"padding-left: 4px;\">\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC11OrderSelect</td>\n \n \n <td>Opioid Analgesic with Ambulatory Misuse Potential Prescriptions</td>\n \n \n <td>0</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Opioid Analgesic with Ambulatory Misuse Potential Prescriptions&quot;:\n Common.&quot;Is Opioid Analgesic with Ambulatory Misuse Potential?&quot;( ContextPrescriptions )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC11OrderSelect</td>\n \n \n <td>Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential</td>\n \n \n <td>1</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential&quot;:\n exists( &quot;Opioid Analgesic with Ambulatory Misuse Potential Prescriptions&quot; )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>Active Ambulatory Benzodiazepine or CNS Depressant Rx</td>\n \n \n <td>2</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Active Ambulatory Benzodiazepine or CNS Depressant Rx&quot;:\n if Config.&quot;Can the implementing EHR support queries for past medications by date range?&quot; then\n (\n &quot;Get MedicationRequest Medication as Code&quot;(&quot;Active Medication List&quot;)\n ) Rx\n where date from Rx.authoredOn 2 years or less on or before Today()\n and Rx.medication in &quot;Benzodiazepine medications&quot;\n or Rx.medication in &quot;CNS Depressant Medications&quot;\n else\n List&lt;FHIR.MedicationRequest&gt;{}</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC11OrderSelect</td>\n \n \n <td>Benzodiazepine or CNS Depressant Prescriptions</td>\n \n \n <td>3</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Benzodiazepine or CNS Depressant Prescriptions&quot;:\n Common.&quot;Is Benzodiazepine or CNS Depressant?&quot;( ContextPrescriptions )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC11OrderSelect</td>\n \n \n <td>Patient Is Being Prescribed Benzodiazepine or CNS Depressant</td>\n \n \n <td>4</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Patient Is Being Prescribed Benzodiazepine or CNS Depressant&quot;:\n exists( &quot;Benzodiazepine or CNS Depressant Prescriptions&quot; )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>Active Ambulatory Opioid Rx</td>\n \n \n <td>5</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Active Ambulatory Opioid Rx&quot;:\n if Config.&quot;Can the implementing EHR support queries for past medications by date range?&quot; then\n (\n &quot;Get MedicationRequest Medication as Code&quot;(&quot;Get Active Ambulatory Medication Requests&quot;([MedicationRequest]))\n ) Rx\n where date from Rx.authoredOn 2 years or less on or before Today()\n and Rx.medication in &quot;Opioid analgesics with ambulatory misuse potential&quot;\n else\n List&lt;FHIR.MedicationRequest&gt;{}</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Patient Age Less Than 18</td>\n \n \n <td>6</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Patient Age Less Than 18&quot;:\n if (Config.&quot;Age Less than 18 Years Is Enabled&quot;) then\n AgeInYearsAt(Today()) &lt; 18\n else false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Condition Positive for Sickle Cell</td>\n \n \n <td>7</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Condition Positive for Sickle Cell&quot;:\n if (Config.&quot;Sickle Cell Check Enabled&quot;) then\n exists(\n Common.&quot;Positive Sickle Cell Condition&quot;\n ) \n else false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Is Active Cancer Treatment?</td>\n \n \n <td>8</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Is Active Cancer Treatment?&quot;:\n if (Config.&quot;Active Cancer Treatment Encounters Condition Is Enabled&quot;) \n then &quot;Has Two or More Encounters with Cancer Diagnosis During Encounter Period&quot;\n or &quot;Has Active Cancer Diagnosis on Problem List&quot;\n else false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Conditions Likely Terminal for Opioid Prescribing</td>\n \n \n <td>9</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Conditions Likely Terminal for Opioid Prescribing&quot;:\n if (Config.&quot;End-Stage Disease Criteria Enabled&quot;) then\n exists (\n Common.&quot;US Core-Categorized Conditions&quot; EOLC\n where EOLC.code in Common.&quot;Conditions likely terminal for opioid prescribing&quot;\n // and EOLC.clinicalStatus in Common.&quot;Active Condition&quot;\n )\n else false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Is Opioid Review Useful?</td>\n \n \n <td>10</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Is Opioid Review Useful?&quot;:\n not &quot;Patient Age Less Than 18&quot;\n and not &quot;Condition Positive for Sickle Cell&quot;\n and not &quot;Is Active Cancer Treatment?&quot;\n and not &quot;Conditions Likely Terminal for Opioid Prescribing&quot;</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC11OrderSelect</td>\n \n \n <td>Inclusion Criteria</td>\n \n \n <td>11</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Inclusion Criteria&quot;:\n (\n (\n &quot;Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential&quot;\n and exists Common.&quot;Active Ambulatory Benzodiazepine or CNS Depressant Rx&quot;\n )\n or (\n &quot;Patient Is Being Prescribed Benzodiazepine or CNS Depressant&quot;\n and exists Common.&quot;Active Ambulatory Opioid Rx&quot;\n )\n )\n and Routines.&quot;Is Opioid Review Useful?&quot;</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>US Core-Categorized Conditions</td>\n \n \n <td>12</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">// 3. Medications indicating end of life\n /* or exists (\n &quot;Medications Indicating End of Life&quot;\n ) */\n\ndefine &quot;US Core-Categorized Conditions&quot;:\n [Condition: category in &quot;Encounter Diagnosis Condition Category&quot;]\n union [Condition: category in &quot;Problem List Condition Category&quot;]\n union [Condition: category in &quot;US Core Health Concern Condition Category&quot;]</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>Conditions Indicating End of Life or With Limited Life Expectancy</td>\n \n \n <td>13</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Conditions Indicating End of Life or With Limited Life Expectancy&quot;:\n (\n &quot;US Core-Categorized Conditions&quot; C\n where C.code in &quot;Conditions likely terminal for opioid prescribing&quot;\n and C.clinicalStatus in &quot;Active Condition&quot;\n )\n union\n (\n &quot;US Core-Categorized Conditions&quot; C\n where C.code in &quot;Limited life expectancy conditions&quot;\n and C.clinicalStatus in &quot;Active Condition&quot;\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>Admitted/Referred/Discharged to Hospice Care</td>\n \n \n <td>14</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Admitted/Referred/Discharged to Hospice Care&quot;:\n (\n if (Config.&quot;Hospice Findings Exclusion Enabled&quot;) then\n [Observation: code in &quot;Hospice Finding Codes&quot;] O\n where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })\n else\n {}\n )\n union\n (\n [Encounter] E\n where date from E.period.start 1 year or less on or before Today()\n and (\n if E.hospitalization.dischargeDisposition.coding is null\n or not exists (E.hospitalization.dischargeDisposition.coding)\n then false\n else E.hospitalization.dischargeDisposition in &quot;Hospice Disposition&quot;\n )\n and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>End of Life Assessment</td>\n \n \n <td>15</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;End of Life Assessment&quot;:\n // 1. Conditions indicating end of life or with limited life expectancy\n exists (\n &quot;Conditions Indicating End of Life or With Limited Life Expectancy&quot;\n )\n // 2. Admitted/referred/discharged to hospice care\n or exists (\n &quot;Admitted/Referred/Discharged to Hospice Care&quot;\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC11OrderSelect</td>\n \n \n <td>Exclusion Criteria</td>\n \n \n <td>16</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Exclusion Criteria&quot;:\n Common.&quot;End of Life Assessment&quot;</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC11OrderSelect</td>\n \n \n <td>Is Recommendation Applicable?</td>\n \n \n <td>17</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Is Recommendation Applicable?&quot;:\n &quot;Inclusion Criteria&quot;\n and not &quot;Exclusion Criteria&quot;</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>Is Opioid Analgesic with Ambulatory Misuse Potential?</td>\n \n \n <td>18</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function &quot;Is Opioid Analgesic with Ambulatory Misuse Potential?&quot;(value List&lt;MedicationRequest&gt;):\n (&quot;Get MedicationRequest Medication as Code&quot;(value)) Rx\n where Rx.medication in &quot;Opioid analgesics with ambulatory misuse potential&quot; \n and Rx.category in &quot;Community&quot;</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>Get MedicationRequest Medication as Code</td>\n \n \n <td>19</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function &quot;Get MedicationRequest Medication as Code&quot;(value List&lt;MedicationRequest&gt;):\n value Rx\n let Med: \n if Rx.medication is Reference then singleton from (\n [Medication] M\n where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))\n ) else null\n return \n MedicationRequest {\n id: Rx.id,\n status: Rx.status,\n intent: Rx.intent,\n category: Rx.category,\n medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept,\n subject: Rx.subject,\n authoredOn: Rx.authoredOn,\n recorder: Rx.recorder,\n dosageInstruction: Rx.dosageInstruction,\n dispenseRequest: Rx.dispenseRequest\n }</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>FHIRHelpers</td>\n \n \n <td>ToConcept</td>\n \n \n <td>20</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function ToConcept(concept FHIR.CodeableConcept):\n if concept is null then\n null\n else\n System.Concept {\n codes: concept.coding C return ToCode(C),\n display: concept.text.value\n }</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>Is Benzodiazepine or CNS Depressant?</td>\n \n \n <td>21</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function &quot;Is Benzodiazepine or CNS Depressant?&quot;(value List&lt;MedicationRequest&gt;):\n (&quot;Get MedicationRequest Medication as Code&quot;(value)) Rx\n where Rx.medication in &quot;Benzodiazepine medications&quot;\n or Rx.medication in &quot;CNS Depressant Medications&quot;\n and Rx.category in &quot;Community&quot;</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>FHIRHelpers</td>\n \n \n <td>ToDateTime</td>\n \n \n <td>22</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function ToDateTime(value dateTime): value.value</code></pre>\n \n <br/><br/>\n \n </td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Knowledge Capability: </b></th>\n <td style=\"padding-left: 4px;\">\n shareable computable executable publishable \n </td>\n </tr>\n \n \n \n <tr>\n <th scope=\"row\"><b>Use Context: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr><th><b>code</b></th><th><b>value</b></th><th><b>display</b></th></tr>\n \n <tr>\n <td>focus</td>\n <td>182888003</td>\n <td>Medication requested (situation)</td>\n </tr>\n \n <tr>\n <td>focus</td>\n <td>82423001</td>\n <td>Chronic pain (finding)</td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n \n \n <tr>\n <th scope=\"row\"><b>Purpose: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.</p>\n</div></td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Usage: </b></th>\n <td style=\"padding-left: 4px;\">Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently. In addition, clinicians should consider whether benefits outweigh risks for concurrent use of opioids with other central nervous system depressants.</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Copyright: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>© CDC 2016+.</p>\n</div></td>\n </tr>\n \n \n \n \n \n \n <tr>\n <th scope=\"row\"><b>Related Artifacts: </b></th>\n <td style=\"padding-left: 4px;\">\n \n <p><b>Documentation</b></p>\n <ul>\n \n <li>\n <a href=\"https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm\"> 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain</a>\n </li>\n \n </ul>\n \n \n \n \n \n \n \n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Libraries: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n \n <tr><td><a href=\"Library-OpioidCDSREC11OrderSelect.html\">Library - Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines</a></td></tr>\n \n </table>\n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Actions: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n \n <tr>\n <td>\n <b> Use Particular Caution When Prescribing Opioid Pain Medication and Benzodiazepines or Other CNS Depressants Concurrently:</b> Consider whether the benefits outweigh the risks of concurrently prescribing opioids and benzodiazepines, or other central nervous system depressant medications.\r\n\r\nWhen co-prescribing risks outweigh benefits, consult [Recommendation 11 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=evidence%20type%3A%203).-,Implementation%20Considerations,-Although%20in%20some) for further guidance.\r\n\r\n[For patients being treated for opioid use disorder who are also taking benzodiazepines or other medications that depress the central nervous system, the CDC recommends not withholding buprenorphine or methadone](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=gabapentin%20and%20pregabalin).-,Buprenorphine%20or%20methadone%20for%20opioid%20use%20disorder%20should%20not%20be%20withheld%20from%20patients%20taking%20benzodiazepines%20or%20other%20medications%20that%20depress%20the%20central%20nervous%20system.,-Clinicians%20should%20check).\r\n\r\nIf the decision is made to taper benzodiazepine medications, [the CDC recommends tapering benzodiazepines gradually prior to discontinuation](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20taper%20benzodiazepines%20gradually%20before%20discontinuation%20because%20abrupt%20withdrawal%20can%20be%20associated%20with%20rebound%20anxiety%2C%20hallucinations%2C%20seizures%2C%20delirium%20tremens%2C%20and%2C%20rarely%2C%20death.%20The%20rate%20of%20tapering%20should%20be%20individualized).<br/>\n <b>When:</b> <i>Named Event:</i> order-select<br/>\n <b>If:</b> <i>Applicability:</i> Check whether the current order results in the concurrent use of opioid pain medication and benzodiazepines or other central nervous system depressants and if an opioid review is appropriate for the patient. <i>(Is Recommendation Applicable?)</i><br/>\n <b>Then:</b>\n \n <table class=\"grid-dict\">\n \n <tr>\n <td>\n <b> :</b> Document - Will modify prescription<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n <b> :</b> Snooze* - Benefits outweigh risks, snooze 3 months<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n <b> :</b> Snooze* - N/A see comments, snooze 3 months<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n </table>\n \n </td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n </table>\n</div>"
  },
  "contained" : [
    {
      "resourceType" : "Library",
      "id" : "effective-data-requirements",
      "name" : "EffectiveDataRequirements",
      "status" : "active",
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/library-type",
            "code" : "module-definition"
          }
        ]
      },
      "relatedArtifact" : [
        {
          "type" : "depends-on",
          "display" : "Library Common",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommon|2022.1.0"
        },
        {
          "type" : "depends-on",
          "display" : "Library FHIRHelpers",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1"
        },
        {
          "type" : "depends-on",
          "display" : "Library Routines",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSRoutines|2022.1.0"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Opioid analgesics with ambulatory misuse potential",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-analgesics-with-ambulatory-misuse-potential"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Community",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/medicationrequest-category-community"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Benzodiazepine medications",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/benzodiazepine-medications"
        },
        {
          "type" : "depends-on",
          "display" : "Value set CNS Depressant Medications",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/cns-depressant-medications"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Encounter Diagnosis Condition Category",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Problem List Condition Category",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category"
        },
        {
          "type" : "depends-on",
          "display" : "Value set US Core Health Concern Condition Category",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Conditions likely terminal for opioid prescribing",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/conditions-likely-terminal-for-opioid-prescribing"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Active Condition",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-clinical-status-active"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Limited life expectancy conditions",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/limited-life-expectancy-conditions"
        }
      ],
      "parameter" : [
        {
          "name" : "ContextPrescriptions",
          "use" : "in",
          "min" : 0,
          "max" : "*",
          "type" : "MedicationRequest"
        },
        {
          "name" : "Is Recommendation Applicable?",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "boolean"
        }
      ],
      "dataRequirement" : [
        {
          "type" : "Condition",
          "profile" : [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport" : [
            "category",
            "code",
            "clinicalStatus"
          ],
          "codeFilter" : [
            {
              "path" : "category",
              "valueSet" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category"
            }
          ]
        },
        {
          "type" : "Condition",
          "profile" : [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport" : [
            "category",
            "code",
            "clinicalStatus"
          ],
          "codeFilter" : [
            {
              "path" : "category",
              "valueSet" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category"
            }
          ]
        },
        {
          "type" : "Condition",
          "profile" : [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport" : [
            "category",
            "code",
            "clinicalStatus"
          ],
          "codeFilter" : [
            {
              "path" : "category",
              "valueSet" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category"
            }
          ]
        },
        {
          "type" : "Encounter",
          "profile" : [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport" : [
            "period",
            "period.start",
            "status",
            "status.value"
          ]
        }
      ]
    }
  ],
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability",
      "valueCode" : "shareable"
    },
    {
      "url" : "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability",
      "valueCode" : "computable"
    },
    {
      "url" : "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability",
      "valueCode" : "executable"
    },
    {
      "url" : "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability",
      "valueCode" : "publishable"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC11OrderSelect"
        },
        {
          "url" : "name",
          "valueString" : "Opioid Analgesic with Ambulatory Misuse Potential Prescriptions"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\":\n Common.\"Is Opioid Analgesic with Ambulatory Misuse Potential?\"( ContextPrescriptions )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 0
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC11OrderSelect"
        },
        {
          "url" : "name",
          "valueString" : "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential\":\n exists( \"Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\" )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 1
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSCommon"
        },
        {
          "url" : "name",
          "valueString" : "Active Ambulatory Benzodiazepine or CNS Depressant Rx"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Active Ambulatory Benzodiazepine or CNS Depressant Rx\":\n if Config.\"Can the implementing EHR support queries for past medications by date range?\" then\n (\n \"Get MedicationRequest Medication as Code\"(\"Active Medication List\")\n ) Rx\n where date from Rx.authoredOn 2 years or less on or before Today()\n and Rx.medication in \"Benzodiazepine medications\"\n or Rx.medication in \"CNS Depressant Medications\"\n else\n List<FHIR.MedicationRequest>{}"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 2
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC11OrderSelect"
        },
        {
          "url" : "name",
          "valueString" : "Benzodiazepine or CNS Depressant Prescriptions"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Benzodiazepine or CNS Depressant Prescriptions\":\n Common.\"Is Benzodiazepine or CNS Depressant?\"( ContextPrescriptions )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 3
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC11OrderSelect"
        },
        {
          "url" : "name",
          "valueString" : "Patient Is Being Prescribed Benzodiazepine or CNS Depressant"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Patient Is Being Prescribed Benzodiazepine or CNS Depressant\":\n exists( \"Benzodiazepine or CNS Depressant Prescriptions\" )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 4
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSCommon"
        },
        {
          "url" : "name",
          "valueString" : "Active Ambulatory Opioid Rx"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Active Ambulatory Opioid Rx\":\n if Config.\"Can the implementing EHR support queries for past medications by date range?\" then\n (\n \"Get MedicationRequest Medication as Code\"(\"Get Active Ambulatory Medication Requests\"([MedicationRequest]))\n ) Rx\n where date from Rx.authoredOn 2 years or less on or before Today()\n and Rx.medication in \"Opioid analgesics with ambulatory misuse potential\"\n else\n List<FHIR.MedicationRequest>{}"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 5
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSRoutines"
        },
        {
          "url" : "name",
          "valueString" : "Patient Age Less Than 18"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Patient Age Less Than 18\":\n if (Config.\"Age Less than 18 Years Is Enabled\") then\n AgeInYearsAt(Today()) < 18\n else false"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 6
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSRoutines"
        },
        {
          "url" : "name",
          "valueString" : "Condition Positive for Sickle Cell"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Condition Positive for Sickle Cell\":\n if (Config.\"Sickle Cell Check Enabled\") then\n exists(\n Common.\"Positive Sickle Cell Condition\"\n ) \n else false"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 7
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSRoutines"
        },
        {
          "url" : "name",
          "valueString" : "Is Active Cancer Treatment?"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Is Active Cancer Treatment?\":\n if (Config.\"Active Cancer Treatment Encounters Condition Is Enabled\") \n then \"Has Two or More Encounters with Cancer Diagnosis During Encounter Period\"\n or \"Has Active Cancer Diagnosis on Problem List\"\n else false"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 8
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSRoutines"
        },
        {
          "url" : "name",
          "valueString" : "Conditions Likely Terminal for Opioid Prescribing"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Conditions Likely Terminal for Opioid Prescribing\":\n if (Config.\"End-Stage Disease Criteria Enabled\") then\n exists (\n Common.\"US Core-Categorized Conditions\" EOLC\n where EOLC.code in Common.\"Conditions likely terminal for opioid prescribing\"\n // and EOLC.clinicalStatus in Common.\"Active Condition\"\n )\n else false"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 9
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSRoutines"
        },
        {
          "url" : "name",
          "valueString" : "Is Opioid Review Useful?"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Is Opioid Review Useful?\":\n not \"Patient Age Less Than 18\"\n and not \"Condition Positive for Sickle Cell\"\n and not \"Is Active Cancer Treatment?\"\n and not \"Conditions Likely Terminal for Opioid Prescribing\""
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 10
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC11OrderSelect"
        },
        {
          "url" : "name",
          "valueString" : "Inclusion Criteria"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Inclusion Criteria\":\n (\n (\n \"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential\"\n and exists Common.\"Active Ambulatory Benzodiazepine or CNS Depressant Rx\"\n )\n or (\n \"Patient Is Being Prescribed Benzodiazepine or CNS Depressant\"\n and exists Common.\"Active Ambulatory Opioid Rx\"\n )\n )\n and Routines.\"Is Opioid Review Useful?\""
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 11
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSCommon"
        },
        {
          "url" : "name",
          "valueString" : "US Core-Categorized Conditions"
        },
        {
          "url" : "statement",
          "valueString" : "// 3. Medications indicating end of life\n /* or exists (\n \"Medications Indicating End of Life\"\n ) */\n\ndefine \"US Core-Categorized Conditions\":\n [Condition: category in \"Encounter Diagnosis Condition Category\"]\n union [Condition: category in \"Problem List Condition Category\"]\n union [Condition: category in \"US Core Health Concern Condition Category\"]"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 12
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSCommon"
        },
        {
          "url" : "name",
          "valueString" : "Conditions Indicating End of Life or With Limited Life Expectancy"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Conditions Indicating End of Life or With Limited Life Expectancy\":\n (\n \"US Core-Categorized Conditions\" C\n where C.code in \"Conditions likely terminal for opioid prescribing\"\n and C.clinicalStatus in \"Active Condition\"\n )\n union\n (\n \"US Core-Categorized Conditions\" C\n where C.code in \"Limited life expectancy conditions\"\n and C.clinicalStatus in \"Active Condition\"\n )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 13
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSCommon"
        },
        {
          "url" : "name",
          "valueString" : "Admitted/Referred/Discharged to Hospice Care"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Admitted/Referred/Discharged to Hospice Care\":\n (\n if (Config.\"Hospice Findings Exclusion Enabled\") then\n [Observation: code in \"Hospice Finding Codes\"] O\n where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })\n else\n {}\n )\n union\n (\n [Encounter] E\n where date from E.period.start 1 year or less on or before Today()\n and (\n if E.hospitalization.dischargeDisposition.coding is null\n or not exists (E.hospitalization.dischargeDisposition.coding)\n then false\n else E.hospitalization.dischargeDisposition in \"Hospice Disposition\"\n )\n and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }\n )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 14
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSCommon"
        },
        {
          "url" : "name",
          "valueString" : "End of Life Assessment"
        },
        {
          "url" : "statement",
          "valueString" : "define \"End of Life Assessment\":\n // 1. Conditions indicating end of life or with limited life expectancy\n exists (\n \"Conditions Indicating End of Life or With Limited Life Expectancy\"\n )\n // 2. Admitted/referred/discharged to hospice care\n or exists (\n \"Admitted/Referred/Discharged to Hospice Care\"\n )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 15
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC11OrderSelect"
        },
        {
          "url" : "name",
          "valueString" : "Exclusion Criteria"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Exclusion Criteria\":\n Common.\"End of Life Assessment\""
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 16
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC11OrderSelect"
        },
        {
          "url" : "name",
          "valueString" : "Is Recommendation Applicable?"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Is Recommendation Applicable?\":\n \"Inclusion Criteria\"\n and not \"Exclusion Criteria\""
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 17
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSCommon"
        },
        {
          "url" : "name",
          "valueString" : "Is Opioid Analgesic with Ambulatory Misuse Potential?"
        },
        {
          "url" : "statement",
          "valueString" : "define function \"Is Opioid Analgesic with Ambulatory Misuse Potential?\"(value List<MedicationRequest>):\n (\"Get MedicationRequest Medication as Code\"(value)) Rx\n where Rx.medication in \"Opioid analgesics with ambulatory misuse potential\" \n and Rx.category in \"Community\""
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 18
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSCommon"
        },
        {
          "url" : "name",
          "valueString" : "Get MedicationRequest Medication as Code"
        },
        {
          "url" : "statement",
          "valueString" : "define function \"Get MedicationRequest Medication as Code\"(value List<MedicationRequest>):\n value Rx\n let Med: \n if Rx.medication is Reference then singleton from (\n [Medication] M\n where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))\n ) else null\n return \n MedicationRequest {\n id: Rx.id,\n status: Rx.status,\n intent: Rx.intent,\n category: Rx.category,\n medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept,\n subject: Rx.subject,\n authoredOn: Rx.authoredOn,\n recorder: Rx.recorder,\n dosageInstruction: Rx.dosageInstruction,\n dispenseRequest: Rx.dispenseRequest\n }"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 19
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "FHIRHelpers"
        },
        {
          "url" : "name",
          "valueString" : "ToConcept"
        },
        {
          "url" : "statement",
          "valueString" : "define function ToConcept(concept FHIR.CodeableConcept):\n if concept is null then\n null\n else\n System.Concept {\n codes: concept.coding C return ToCode(C),\n display: concept.text.value\n }"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 20
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSCommon"
        },
        {
          "url" : "name",
          "valueString" : "Is Benzodiazepine or CNS Depressant?"
        },
        {
          "url" : "statement",
          "valueString" : "define function \"Is Benzodiazepine or CNS Depressant?\"(value List<MedicationRequest>):\n (\"Get MedicationRequest Medication as Code\"(value)) Rx\n where Rx.medication in \"Benzodiazepine medications\"\n or Rx.medication in \"CNS Depressant Medications\"\n and Rx.category in \"Community\""
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 21
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "FHIRHelpers"
        },
        {
          "url" : "name",
          "valueString" : "ToDateTime"
        },
        {
          "url" : "statement",
          "valueString" : "define function ToDateTime(value dateTime): value.value"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 22
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "id" : "effective-data-requirements",
      "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueCanonical" : "#effective-data-requirements"
    },
    {
      "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem",
      "valueReference" : {
        "reference" : "Device/cqf-tooling"
      }
    }
  ],
  "url" : "http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-11-order-select",
  "identifier" : [
    {
      "use" : "official",
      "value" : "cdc-opioid-guidance"
    }
  ],
  "version" : "2022.1.0",
  "name" : "PlanDefinition_Recommendation_11_Order_Select",
  "title" : "Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (order-select)",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
        "code" : "eca-rule",
        "display" : "ECA Rule"
      }
    ]
  },
  "status" : "draft",
  "experimental" : true,
  "date" : "2025-04-24",
  "publisher" : "Centers for Disease Control and Prevention (CDC)",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "https://www.cdc.gov"
        }
      ]
    }
  ],
  "description" : "Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently and consider whether benefits outweigh risks of concurrent prescribing of opioids and other central nervous system depressants.",
  "useContext" : [
    {
      "code" : {
        "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code" : "focus",
        "display" : "Clinical Focus"
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://snomed.info/sct",
            "code" : "182888003",
            "display" : "Medication requested (situation)"
          }
        ]
      }
    },
    {
      "code" : {
        "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code" : "focus",
        "display" : "Clinical Focus"
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://snomed.info/sct",
            "code" : "82423001",
            "display" : "Chronic pain (finding)"
          }
        ]
      }
    }
  ],
  "purpose" : "The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.",
  "usage" : "Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently. In addition, clinicians should consider whether benefits outweigh risks for concurrent use of opioids with other central nervous system depressants.",
  "copyright" : "© CDC 2016+.",
  "topic" : [
    {
      "text" : "Opioid Prescribing"
    }
  ],
  "author" : [
    {
      "name" : "Kensaku Kawamoto, MD, PhD, MHS"
    },
    {
      "name" : "Bryn Rhodes"
    },
    {
      "name" : "Floyd Eisenberg, MD, MPH"
    },
    {
      "name" : "Robert McClure, MD, MPH"
    }
  ],
  "relatedArtifact" : [
    {
      "type" : "documentation",
      "display" : "2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain",
      "url" : "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm",
      "document" : {
        "url" : "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm"
      }
    }
  ],
  "library" : [
    "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSREC11OrderSelect"
  ],
  "action" : [
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/recommendation-strength",
                "code" : "weak",
                "display" : "Weak"
              }
            ]
          }
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/evidence-quality",
                "code" : "low",
                "display" : "Low quality"
              }
            ]
          }
        }
      ],
      "title" : "Use Particular Caution When Prescribing Opioid Pain Medication and Benzodiazepines or Other CNS Depressants Concurrently",
      "description" : "Consider whether the benefits outweigh the risks of concurrently prescribing opioids and benzodiazepines, or other central nervous system depressant medications.\r\n\r\nWhen co-prescribing risks outweigh benefits, consult [Recommendation 11 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=evidence%20type%3A%203).-,Implementation%20Considerations,-Although%20in%20some) for further guidance.\r\n\r\n[For patients being treated for opioid use disorder who are also taking benzodiazepines or other medications that depress the central nervous system, the CDC recommends not withholding buprenorphine or methadone](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=gabapentin%20and%20pregabalin).-,Buprenorphine%20or%20methadone%20for%20opioid%20use%20disorder%20should%20not%20be%20withheld%20from%20patients%20taking%20benzodiazepines%20or%20other%20medications%20that%20depress%20the%20central%20nervous%20system.,-Clinicians%20should%20check).\r\n\r\nIf the decision is made to taper benzodiazepine medications, [the CDC recommends tapering benzodiazepines gradually prior to discontinuation](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20taper%20benzodiazepines%20gradually%20before%20discontinuation%20because%20abrupt%20withdrawal%20can%20be%20associated%20with%20rebound%20anxiety%2C%20hallucinations%2C%20seizures%2C%20delirium%20tremens%2C%20and%2C%20rarely%2C%20death.%20The%20rate%20of%20tapering%20should%20be%20individualized).",
      "priority" : "urgent",
      "trigger" : [
        {
          "type" : "named-event",
          "name" : "order-select"
        }
      ],
      "condition" : [
        {
          "kind" : "applicability",
          "expression" : {
            "description" : "Check whether the current order results in the concurrent use of opioid pain medication and benzodiazepines or other central nervous system depressants and if an opioid review is appropriate for the patient.",
            "language" : "text/cql.identifier",
            "expression" : "Is Recommendation Applicable?"
          }
        }
      ],
      "groupingBehavior" : "visual-group",
      "selectionBehavior" : "any",
      "action" : [
        {
          "description" : "Document - Will modify prescription"
        },
        {
          "description" : "Snooze* - Benefits outweigh risks, snooze 3 months"
        },
        {
          "description" : "Snooze* - N/A see comments, snooze 3 months"
        }
      ]
    }
  ]
}

XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.