Id: opioidcds-12-patient-view Url: Recommendation #12 - Evidence-based Treatment for Patients with Opioid Use Disorder (patient-view) Version: 2022.1.0 Identifier: value: cdc-opioid-guidance Identifier: value: urn:oid:2.16.840.1.114222.34.15 Name: PlanDefinition_Recommendation_12_Patient_View Title: Recommendation #12 - Evidence-based Treatment for Patients with Opioid Use Disorder (patient-view) Status: active Experimental: false Type: system: http://terminology.hl7.org/CodeSystem/plan-definition-type code: eca-rule display: ECA Rule Date: 2025-08-06 Publisher: CDC / Security Risk Solutions, Inc. (SRS) Description: Clinicians should offer or arrange treatment with evidence-based medications to treat patients with opioid use disorder. Detoxification on its own, without medications for opioid use disorder, is not recommended for opioid use disorder because of increased risks for resuming drug use, overdose, and overdose death. Logic Definitions: Library Name Name sequence OpioidCDSCommonConfig Age Less than 18 Years Is Enabled 0 // CDC 2022 General Inclusion Criteria define "Age Less than 18 Years Is Enabled": true Library Name Name sequence OpioidCDSCommon Patient 18 or Older? 1 define "Patient 18 or Older?": Config."Age Less than 18 Years Is Enabled" and AgeInYears() >= 18 Library Name Name sequence OpioidCDSCommonConfig Evidence Based Treatment Criteria For Opioid Use Disorder 2 // Recommendation 12 define "Evidence Based Treatment Criteria For Opioid Use Disorder": true Library Name Name sequence OpioidCDSCommonConfig Can the implementing EHR support queries for past medications by date range? 3 // Subroutine 2 - Past Medications define "Can the implementing EHR support queries for past medications by date range?": true Library Name Name sequence OpioidCDSREC12PatientView Opioid Use Disorder Lookback Period 4 define "Opioid Use Disorder Lookback Period": Interval[Today() - 90 days, Today()] Library Name Name sequence OpioidCDSREC12PatientView Not Receiving Evidence-Based Treatment for Opioid Use Disorder 5 define "Not Receiving Evidence-Based Treatment for Opioid Use Disorder": Config."Evidence Based Treatment Criteria For Opioid Use Disorder" and not ( if Config."Can the implementing EHR support queries for past medications by date range?" then exists ( [MedicationRequest: Common."Buprenorphine and methadone medications"] MR where MR.status in { 'active', 'completed' } and date from MR.authoredOn during day of "Opioid Use Disorder Lookback Period" ) else true /* update 2022 removes "behavioral therapy condition" or exists ( [Procedure: Common."Substance misuse behavioral counseling"] P where P.status ~ 'completed' and ( case when P.performed is FHIR.dateTime then Interval[FHIRHelpers.ToDateTime(P.performed as FHIR.dateTime), FHIRHelpers.ToDateTime(P.performed as FHIR.dateTime)] when P.performed is FHIR.Period then FHIRHelpers.ToInterval(P.performed as FHIR.Period) else null as Interval<DateTime> end ) during day of "Opioid Use Disorder Lookback Period" )*/ ) Library Name Name sequence OpioidCDSCommon US Core-Categorized Conditions 6 // 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 OpioidCDSREC12PatientView Presence of Diagnosis of Opioid Use Disorder 7 define "Presence of Diagnosis of Opioid Use Disorder": exists ( Common."US Core-Categorized Conditions" C where C.code in Common."Opioid misuse disorders" and C.clinicalStatus in Common."Active Condition" and date from C.recordedDate during day of "Opioid Use Disorder Lookback Period" ) Library Name Name sequence OpioidCDSREC12PatientView Positive Result from Opioid Use Disorder Evaluation Tool 8 define "Positive Result from Opioid Use Disorder Evaluation Tool": true Library Name Name sequence OpioidCDSREC12PatientView Inclusion Criteria 9 define "Inclusion Criteria": Common."Patient 18 or Older?" and "Not Receiving Evidence-Based Treatment for Opioid Use Disorder" and "Presence of Diagnosis of Opioid Use Disorder" and "Positive Result from Opioid Use Disorder Evaluation Tool" Library Name Name sequence OpioidCDSREC12PatientView Exclusion Criteria 10 define "Exclusion Criteria": false Library Name Name sequence OpioidCDSREC12PatientView Is Recommendation Applicable? 11 define "Is Recommendation Applicable?": "Inclusion Criteria" and not "Exclusion Criteria" Library Name Name sequence FHIRHelpers ToString 12 define function ToString(value string): value.value Library Name Name sequence FHIRHelpers ToConcept 13 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 ToCode 14 define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value } Library Name Name sequence FHIRHelpers ToString 15 define function ToString(value MedicationRequestStatus): value.value Library Name Name sequence FHIRHelpers ToDateTime 16 define function ToDateTime(value dateTime): value.value Knowledge Capability: shareable computable executable publishable Use Context: code value display focus 1336192000 Opioid use disorder (disorder) 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: Medication treatment of opioid use disorder has been associated with reduced risk for overdose and overall deaths. Identification of opioid use disorder represents an opportunity for a clinician to initiate potentially life-saving interventions, and the clinician should collaborate with the patient regarding their safety to increase the likelihood of successful treatment. Copyright: © CDC 2016+. Related Artifacts: Documentation 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain Libraries: Library - Recommendation #12 (patient-view) - Evidence-based Treatment for Patients with Opioid Use Disorder Actions: Offer Evidence-based Medications to Treat Patients with Opioid Use Disorder: For patients diagnosed with opioid use disorder, consider opioid agonist or partial agonist treatment with methadone or buprenorphine maintenance therapy. Detoxification on its own, without medications for opioid use disorder, is not recommended for opioid use disorder because of increased risks of resuming drug use, overdose, and overdose death. #xD; #xD; For guidance regarding diagnosing and treating opioid use disorder, see [Recommendation 12 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=evidence%20type%3A%201).-,Implementation%20Considerations,-Although%20stigma%20can).#xD; #xD; [CDC recommends against releasing patients from care due to diagnosis of opioid use disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=opioid%20use%20disorder.-,Clinicians%20should%20not%20dismiss%20patients%20from%20their%20practice%20because%20of%20opioid%20use%20disorder%20because%20this%20can%20adversely%20affect%20patient%20safety.,-Medication%20treatment%20of).#xD; #xD; [MME conversion factors should not be applied to dosage decisions related to the management of opioid use disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=These%20conversion%20factors%20should%20not%20be%20applied%20to%20dosage%20decisions%20related%20to%20the%20management%20of%20opioid%20use%20disorder.).#xD; #xD; [Do not use the calculated dose in MMEs to determine the doses to use when converting one opioid to another; when converting opioids, the new opioid is typically dosed at a substantially lower dose than the calculated MME dose to avoid overdose because of incomplete cross-tolerance and individual variability in opioid pharmacokinetics](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Do%20not%20use%20the,variability%20in%20opioid%20pharmacokinetics.). Consult the FDA approved product labeling for specific guidance on medications. When: Named Event: patient-view If: Applicability: Check whether the patient is 18 or older with an active condition of opioid misuse disorder and doesn't have an active prescription (order) for buprenorphine or methadone medications. (Is Recommendation Applicable?) Then: : Snooze* - Patient already provided medication elsewhere to treat opioid use disorder, snooze 3 months Then: : Snooze* - Patient declined medication therapy, snooze 3 months Then: : Document - Will order medication to treat opioid use disorder Then: : Refer - Will refer patient to SUD specialist Then: : Snooze* - N/A see comments, snooze 3 months Then:
Value set Buprenorphine and methadone medications
Value set Encounter Diagnosis Condition Category
Value set Problem List Condition Category
Value set US Core Health Concern Condition Category
// CDC 2022 General Inclusion Criteria define "Age Less than 18 Years Is Enabled": true
define "Patient 18 or Older?": Config."Age Less than 18 Years Is Enabled" and AgeInYears() >= 18
Evidence Based Treatment Criteria For Opioid Use Disorder
// Recommendation 12 define "Evidence Based Treatment Criteria For Opioid Use Disorder": true
Can the implementing EHR support queries for past medications by date range?
// Subroutine 2 - Past Medications define "Can the implementing EHR support queries for past medications by date range?": true
define "Opioid Use Disorder Lookback Period": Interval[Today() - 90 days, Today()]
Not Receiving Evidence-Based Treatment for Opioid Use Disorder
define "Not Receiving Evidence-Based Treatment for Opioid Use Disorder": Config."Evidence Based Treatment Criteria For Opioid Use Disorder" and not ( if Config."Can the implementing EHR support queries for past medications by date range?" then exists ( [MedicationRequest: Common."Buprenorphine and methadone medications"] MR where MR.status in { 'active', 'completed' } and date from MR.authoredOn during day of "Opioid Use Disorder Lookback Period" ) else true /* update 2022 removes "behavioral therapy condition" or exists ( [Procedure: Common."Substance misuse behavioral counseling"] P where P.status ~ 'completed' and ( case when P.performed is FHIR.dateTime then Interval[FHIRHelpers.ToDateTime(P.performed as FHIR.dateTime), FHIRHelpers.ToDateTime(P.performed as FHIR.dateTime)] when P.performed is FHIR.Period then FHIRHelpers.ToInterval(P.performed as FHIR.Period) else null as Interval<DateTime> end ) during day of "Opioid Use Disorder Lookback Period" )*/ )
// 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"]
Presence of Diagnosis of Opioid Use Disorder
define "Presence of Diagnosis of Opioid Use Disorder": exists ( Common."US Core-Categorized Conditions" C where C.code in Common."Opioid misuse disorders" and C.clinicalStatus in Common."Active Condition" and date from C.recordedDate during day of "Opioid Use Disorder Lookback Period" )
Positive Result from Opioid Use Disorder Evaluation Tool
define "Positive Result from Opioid Use Disorder Evaluation Tool": true
define "Inclusion Criteria": Common."Patient 18 or Older?" and "Not Receiving Evidence-Based Treatment for Opioid Use Disorder" and "Presence of Diagnosis of Opioid Use Disorder" and "Positive Result from Opioid Use Disorder Evaluation Tool"
define "Is Recommendation Applicable?": "Inclusion Criteria" and not "Exclusion Criteria"
define function ToString(value string): value.value
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 }
define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
define function ToString(value MedicationRequestStatus): value.value
define function ToDateTime(value dateTime): value.value
Recommendation #12 - Evidence-based Treatment for Patients with Opioid Use Disorder (patient-view)
CDC / Security Risk Solutions, Inc. (SRS)
Clinicians should offer or arrange treatment with evidence-based medications to treat patients with opioid use disorder. Detoxification on its own, without medications for opioid use disorder, is not recommended for opioid use disorder because of increased risks for resuming drug use, overdose, and overdose death.
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.
Medication treatment of opioid use disorder has been associated with reduced risk for overdose and overall deaths. Identification of opioid use disorder represents an opportunity for a clinician to initiate potentially life-saving interventions, and the clinician should collaborate with the patient regarding their safety to increase the likelihood of successful treatment.
2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain
Offer Evidence-based Medications to Treat Patients with Opioid Use Disorder
For patients diagnosed with opioid use disorder, consider opioid agonist or partial agonist treatment with methadone or buprenorphine maintenance therapy. Detoxification on its own, without medications for opioid use disorder, is not recommended for opioid use disorder because of increased risks of resuming drug use, overdose, and overdose death. For guidance regarding diagnosing and treating opioid use disorder, see [Recommendation 12 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=evidence%20type%3A%201).-,Implementation%20Considerations,-Although%20stigma%20can). [CDC recommends against releasing patients from care due to diagnosis of opioid use disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=opioid%20use%20disorder.-,Clinicians%20should%20not%20dismiss%20patients%20from%20their%20practice%20because%20of%20opioid%20use%20disorder%20because%20this%20can%20adversely%20affect%20patient%20safety.,-Medication%20treatment%20of). [MME conversion factors should not be applied to dosage decisions related to the management of opioid use disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=These%20conversion%20factors%20should%20not%20be%20applied%20to%20dosage%20decisions%20related%20to%20the%20management%20of%20opioid%20use%20disorder.). [Do not use the calculated dose in MMEs to determine the doses to use when converting one opioid to another; when converting opioids, the new opioid is typically dosed at a substantially lower dose than the calculated MME dose to avoid overdose because of incomplete cross-tolerance and individual variability in opioid pharmacokinetics](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Do%20not%20use%20the,variability%20in%20opioid%20pharmacokinetics.). Consult the FDA approved product labeling for specific guidance on medications.
Check whether the patient is 18 or older with an active condition of opioid misuse disorder and doesn't have an active prescription (order) for buprenorphine or methadone medications.
Snooze* - Patient already provided medication elsewhere to treat opioid use disorder, snooze 3 months
Snooze* - Patient declined medication therapy, snooze 3 months
Document - Will order medication to treat opioid use disorder
Refer - Will refer patient to SUD specialist
Snooze* - N/A see comments, snooze 3 months