Jessica Scott, Belmont Law, Class of 2021
Pharmacies try to do their part during the opioid crisis to track data of patients’ usage and find those who are at-risk. Technology is a huge part of helping pharmacists track down those who are at risk for substance misuse or abuse. Appriss Health created NarxCare, an analytic system that helps pharmacists quickly identify at risk patients. NarxCare was integrated into Walmart and Sam’s Club pharmacies, towards the end of 2018 and Rite Aid recently integrated NarxCare directly into their analytics.
NarxCare goes beyond tracking patients’ usage and prescription history but gives an objective insight into who may be an at-risk patient for substance misuse and abuse. NarxCare provides what is known as a Narx Report, the report includes a patient’s NarxScores, Predictive Risk Scores, Red Flags, Rx Graph, and State Prescription Drug Monitoring Programs (PDMP). The NarxScore are a quantified representation of the data in the PDMP ranging from 000-999, the higher the number the more likely one is to be at risk for misuse or abuse. The NarxScores take multiple factors into consideration including the number of prescribers, morphine milligram equivalents, pharmacies, and overlapping prescriptions. If Red Flags appear in a patient’s profile, then that patient could be at risk of an unintentional overdose or other adverse events.
While most pharmacists already have access to PDMP information, NarxCare has gone a step further to make the information easier for pharmacists to analyze and keep them from overlooking potential at risk patients. NarxCare may become an essential tool for pharmacists to “identify potential problems up front, in real-time, for every customer, every time they consider a controlled substance dispensation.”
NarxCare is a step in the right direction for keeping those from taking advantage of their local pharmacies to gain access to Opioids and other controlled substances. Some find that NarxCare gives pharmacists access to more patient information than needed, the main problem is not the abuse of the pharmacies to access Opioids, and the focus should be those who are purchasing drugs illegally. However, NarxCare could be the much needed step in preventing those from misuse and abuse of the pharmacies and hopefully curving the Opioid crisis in the United States.
Hi,
I am a chronic pain patient who recently read this article. I also used to teach data science to undergrads at a Big Ten university and even though I don’t have a PhD, I have enough understanding to know the bias that can be inherently built in this algorithm.
The reason I am writing is that the process at my current pain management clinic is to first see a doctor/anesthesiologist to arrive at an appropriate dosage, get it stabilized to ensure there are no potential harmful consequences, and then we see APRN’s to refill our prescriptions. Since the first of the year, I have had 4 different APRN’s write opioid prescriptions for me as well as the anesthesiologist that I originally saw. Also, given that I live in a rural area and have heard that the distance travelled to see the doctor may be an indication of “doctor shopping” I have another “strike” against me because to see an APRN I travel 20 miles monthly and to see the anesthesiologist I travel 45 miles.
Based on what I have read in other articles as well, this basically means I’m screwed. Is there any recourse for patients who are in similar situations as I am? I don’t even know if my pharmacy uses NarxCare but I do know that my pain management clinic uses phreesia which I would imagine contains similar functionality.
Even aside from algorithms such as these, I can’t help but question whether other assessment tools used to “predict” opioid use disorder or overdose were ever even intended to be used on chronic pain patients specifically but are designed more for the general public so the validity and reliability of even those assessments are questionable leading to patients being diagnosed as being at risk when they may not be.
I just wanted to get your thoughts on these topics and what we, as chronic pain patients, not receiving proper treatment can do. I written and attempted to set up meetings with state and federal legislators as well as our governor but have not received so much as an email reply. Any ideas on next steps I could take would be helpful, because this is just going to become a greater issue.