{
  "resourceType": "PlanDefinition",
  "id": "opioidcds-08",
  "url": "http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-08",
  "identifier": [
    {
      "use": "official",
      "value": "cdc-opioid-guidance"
    }
  ],
  "version": "0.1.0",
  "name": "cdc-opioid-08",
  "title": "CDC Opioid Prescribing Guideline Recommendation #8",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/plan-definition-type",
        "code": "eca-rule",
        "display": "ECA Rule"
      }
    ]
  },
  "status": "draft",
  "date": "2018-03-19",
  "publisher": "Centers for Disease Control and Prevention (CDC)",
  "description": "Clinicians should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present.",
  "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)"
          }
        ]
      }
    }
  ],
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US",
          "display": "United States of America"
        }
      ]
    }
  ],
  "purpose": "CDC’s Guideline for Prescribing Opioids for Chronic Pain is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder and overdose. The Guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.",
  "usage": "Before starting and periodically during continuation of opioid therapy, clinicians should evaluate risk factors for opioid-related harms.",
  "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": "CDC guideline for prescribing opioids for chronic pain",
      "url": "https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420"
    },
    {
      "type": "documentation",
      "display": "MME Conversion Tables",
      "url": "https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"
    }
  ],
  "library": [
    "Library/opioidcds-recommendation-08"
  ],
  "action": [
    {
      "title": "Existing patient exhibits risk factors for opioid-related harms.",
      "description": "Checking if the trigger prescription meets the inclusion criteria for recommendation #8 workflow.",
      "documentation": [
        {
          "type": "documentation",
          "document": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation",
                "valueCodeableConcept": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/recommendation-strength",
                      "code": "strong",
                      "display": "Strong"
                    }
                  ]
                }
              },
              {
                "url": "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence",
                "valueCodeableConcept": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/evidence-quality",
                      "code": "low",
                      "display": "Low quality"
                    }
                  ]
                }
              }
            ]
          }
        }
      ],
      "trigger": [
        {
          "type": "named-event",
          "name": "medication-prescribe"
        }
      ],
      "condition": [
        {
          "kind": "applicability",
          "expression": {
            "description": "Check whether the existing patient exhibits risk factors for opioid-related harms, such as concurrent use with benzodiazepine, a history of substance abuse, and/or an average MME greater than 50 mg/day.",
            "language": "text/cql",
            "expression": "Inclusion Criteria"
          }
        }
      ],
      "groupingBehavior": "visual-group",
      "selectionBehavior": "exactly-one",
      "dynamicValue": [
        {
          "path": "action.description",
          "expression": {
            "language": "text/cql",
            "expression": "Get Detail"
          }
        },
        {
          "path": "action.title",
          "expression": {
            "language": "text/cql",
            "expression": "Get Summary"
          }
        },
        {
          "path": "action.extension",
          "expression": {
            "language": "text/cql",
            "expression": "Get Indicator"
          }
        }
      ],
      "action": [
        {
          "description": "Will offer Naloxone instead"
        },
        {
          "description": "Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"
        },
        {
          "description": "N/A - see comment; snooze 3 mo"
        }
      ]
    }
  ]
}