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-patient-view.html |
| Url | http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-11-patient-view |
| Version | 2022.1.0 |
| Status | draft |
| Date | 2025-04-24 |
| Name | PlanDefinition_Recommendation_11_Patient_View |
| Title | Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (patient-view) |
| 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
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Narrative
Note: links and images are rebased to the (stated) source
| Id: |
opioidcds-11-patient-view |
| Url: |
Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (patient-view) |
| Version: |
2022.1.0 |
| Identifier: |
value: cdc-opioid-guidance
|
| Name: |
PlanDefinition_Recommendation_11_Patient_View |
| Title: |
Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (patient-view) |
| 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 Name | Name | sequence |
|---|
| OpioidCDSCommon |
Active Ambulatory Benzodiazepine or CNS Depressant Rx |
0 |
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 Name | Name | sequence |
|---|
| OpioidCDSCommon |
Active Ambulatory Opioid Rx |
1 |
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 Name | Name | sequence |
|---|
| OpioidCDSRoutines |
Patient Age Less Than 18 |
2 |
define "Patient Age Less Than 18":
if (Config."Age Less than 18 Years Is Enabled") then
AgeInYearsAt(Today()) < 18
else false
| Library Name | Name | sequence |
|---|
| OpioidCDSRoutines |
Condition Positive for Sickle Cell |
3 |
define "Condition Positive for Sickle Cell":
if (Config."Sickle Cell Check Enabled") then
exists(
Common."Positive Sickle Cell Condition"
)
else false
| Library Name | Name | sequence |
|---|
| OpioidCDSRoutines |
Is Active Cancer Treatment? |
4 |
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 Name | Name | sequence |
|---|
| OpioidCDSRoutines |
Conditions Likely Terminal for Opioid Prescribing |
5 |
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 Name | Name | sequence |
|---|
| OpioidCDSRoutines |
Is Opioid Review Useful? |
6 |
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 Name | Name | sequence |
|---|
| OpioidCDSREC11PatientView |
Inclusion Criteria |
7 |
define "Inclusion Criteria":
(
exists (Common."Active Ambulatory Benzodiazepine or CNS Depressant Rx")
and exists (Common."Active Ambulatory Opioid Rx")
) and Routines."Is Opioid Review Useful?"
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
US Core-Categorized Conditions |
8 |
// 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 Name | Name | sequence |
|---|
| OpioidCDSCommon |
Conditions Indicating End of Life or With Limited Life Expectancy |
9 |
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 Name | Name | sequence |
|---|
| OpioidCDSCommon |
Admitted/Referred/Discharged to Hospice Care |
10 |
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 Name | Name | sequence |
|---|
| OpioidCDSCommon |
End of Life Assessment |
11 |
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 Name | Name | sequence |
|---|
| OpioidCDSREC11PatientView |
Exclusion Criteria |
12 |
define "Exclusion Criteria":
Common."End of Life Assessment"
| Library Name | Name | sequence |
|---|
| OpioidCDSREC11PatientView |
Is Recommendation Applicable? |
13 |
define "Is Recommendation Applicable?":
"Inclusion Criteria"
and not "Exclusion Criteria"
| Library Name | Name | sequence |
|---|
| FHIRHelpers |
ToConcept |
14 |
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 Name | Name | sequence |
|---|
| FHIRHelpers |
ToDateTime |
15 |
define function ToDateTime(value dateTime): value.value
|
| Knowledge Capability: |
shareable computable executable publishable
|
| Use Context: |
| code | value | display |
|---|
| 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: |
|
| Related Artifacts: |
Documentation
|
| Libraries: |
|
| 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: patient-view
If: Applicability: Check whether the patient is using opioids concurrently with benzodiazepines or other central nervous system depressants and if an opioid review is appropriate. (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-patient-view",
"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-patient-view</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-patient-view.html\">Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (patient-view)</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_Patient_View</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 (patient-view)</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>OpioidCDSCommon</td>\n \n \n <td>Active Ambulatory Benzodiazepine or CNS Depressant Rx</td>\n \n \n <td>0</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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>{}</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>1</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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>{}</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>2</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Patient Age Less Than 18":\n if (Config."Age Less than 18 Years Is Enabled") then\n AgeInYearsAt(Today()) < 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>3</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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</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>4</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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</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>5</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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</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>6</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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"</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>OpioidCDSREC11PatientView</td>\n \n \n <td>Inclusion Criteria</td>\n \n \n <td>7</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Inclusion Criteria":\n (\n exists (Common."Active Ambulatory Benzodiazepine or CNS Depressant Rx")\n and exists (Common."Active Ambulatory Opioid Rx")\n ) and Routines."Is Opioid Review Useful?"</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>8</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 "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"]</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>9</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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 )</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>10</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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 )</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>11</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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 )</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>OpioidCDSREC11PatientView</td>\n \n \n <td>Exclusion Criteria</td>\n \n \n <td>12</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Exclusion Criteria":\n Common."End of Life Assessment"</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>OpioidCDSREC11PatientView</td>\n \n \n <td>Is Recommendation Applicable?</td>\n \n \n <td>13</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Is Recommendation Applicable?":\n "Inclusion Criteria"\n and not "Exclusion Criteria"</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>14</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>FHIRHelpers</td>\n \n \n <td>ToDateTime</td>\n \n \n <td>15</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-OpioidCDSREC11PatientView.html\">Library - Recommendation #11 Patient View - 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> patient-view<br/>\n <b>If:</b> <i>Applicability:</i> Check whether the patient is using opioids concurrently with benzodiazepines or other central nervous system depressants and if an opioid review is appropriate. <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",
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}
]
},
"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 Routines",
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},
{
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"resource" : "http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1"
},
{
"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",
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},
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"display" : "Value set Conditions likely terminal for opioid prescribing",
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},
{
"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" : [
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"name" : "Is Recommendation Applicable?",
"use" : "out",
"min" : 0,
"max" : "1",
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"dataRequirement" : [
{
"type" : "Condition",
"profile" : [
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"mustSupport" : [
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"codeFilter" : [
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{
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"valueCode" : "shareable"
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"valueCode" : "computable"
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{
"url" : "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability",
"valueCode" : "publishable"
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{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
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{
"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>{}"
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"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>{}"
},
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{
"extension" : [
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{
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{
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{
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"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"
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{
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"valueString" : "OpioidCDSRoutines"
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{
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"valueString" : "Is Active Cancer Treatment?"
},
{
"url" : "statement",
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{
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{
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"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
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{
"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 )"
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],
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},
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{
"url" : "statement",
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},
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}
],
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{
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"url" : "libraryName",
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{
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},
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}
],
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},
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},
{
"id" : "effective-data-requirements",
"url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
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{
"url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem",
"valueReference" : {
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],
"url" : "http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-11-patient-view",
"identifier" : [
{
"use" : "official",
"value" : "cdc-opioid-guidance"
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],
"version" : "2022.1.0",
"name" : "PlanDefinition_Recommendation_11_Patient_View",
"title" : "Recommendation #11 - Concurrent Use of Opioids and Benzodiazepines (patient-view)",
"type" : {
"coding" : [
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"code" : "eca-rule",
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"status" : "draft",
"experimental" : true,
"date" : "2025-04-24",
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"contact" : [
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"telecom" : [
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"system" : "url",
"value" : "https://www.cdc.gov"
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],
"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" : [
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"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"
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],
"author" : [
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},
{
"name" : "Bryn Rhodes"
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{
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}
],
"library" : [
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],
"action" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/recommendation-strength",
"code" : "weak",
"display" : "Weak"
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},
{
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"valueCodeableConcept" : {
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"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",
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"name" : "patient-view"
}
],
"condition" : [
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"kind" : "applicability",
"expression" : {
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"language" : "text/cql.identifier",
"expression" : "Is Recommendation Applicable?"
}
}
],
"groupingBehavior" : "visual-group",
"selectionBehavior" : "any",
"action" : [
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{
"description" : "Snooze* - Benefits outweigh risks, snooze 3 months"
},
{
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}
]
}
]
}
XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.
FHIR