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Killer Computation

Michael Leach CCMA By Michael Leach | Last Updated: 19 September 2023
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The Drug Epidemic During the Pandemic

America’s drug epidemic has taken its toll on us. As a country, we’ve suffered the loss of so many lives and endured a wave of addiction that seems unending. Opioids are still the biggest killer, causing the majority of drug overdose deaths we see each year. This has led to the implementation of some very unusual solutions. And some of these “solutions” have hurt minorities and people with a history of trauma, abuse, and…, pets?

In 2020, amid the Covid-19 pandemic, the US saw its worst year on record for lives lost to substance abuse. More than 93,000 people died of drug overdoses, an almost 30 percent increase from 2019. Figures like these have made the country desperate for solutions, and we’re grasping at straws. One of these straws is that the problem is prescription opioids.

The Solution Caused a Problem

Certainly, the overuse of prescription opioids like Oxycontin was responsible for starting the opioid epidemic in the late 1990s and early 2000s. But while the total amount of opioids prescribed fell by 60 percent between 2011 and 2020, the already record-level overdose death rate more than doubled. Currently, we see the worst overdose death rates in American history.

This is easily explained by the fact that once people became addicted to prescription opioids, which were then restricted, they moved on to other opioids. Sadly, addiction usually worsens without intervention, so most people switched to opioids that were easier to find, cheaper, and stronger. This means that illicit drugs like heroin and now synthetic fentanyl skyrocketed in popularity, and demand sharply increased. Because these drugs are far deadlier than most prescription opioids, overdose rates have continued to climb despite concerted efforts to reduce opioid prescriptions.

Part of these efforts includes the continued development of a program to monitor prescriptions and a database that can be accessed to help physicians and pharmacists avoid overprescribing. This program, now known as NarxCare, is designed to identify a patient’s risk of misusing opioids. NarxCare is described as an analytics tool and care management platform by its manufacturer, a company known as Appriss.

Since the opioid epidemic was identified as a significant continuing public health threat, the US Department of Justice has poured hundreds of millions of dollars into developing state-level prescription drug databases that can give authorities a set of eyes onto the pharmaceutical market. All states except for Missouri utilize these Prescription Drug Monitoring Programs, also known as PDMPs. And Missouri won’t be an exception for much longer.

NarxCare draws upon this information, along with “other data,” to assign each patient an Overdose Risk Score that hospitals and physicians can use to help inform their decision about the use of opioid pain medications. This sounds like a good thing, but there’s a flip side to this coin.

The Downside to Accountability & Responsibility 

Doctors have become nervous about prescribing opioids due to the backlash from their role in the epidemic. Many of them were prosecuted and are still continually monitored and compared to their peers for irregular opioid prescribing practices. They’re gun-shy and prone to simply defer to NarxCare’s risk score calculator to avoid putting themselves or the patient at risk. 

To make things worse, physicians can be held accountable for the platform’s recommendations or their lack of adherence to these and other warnings. That’s because NarxCare is primarily funded by the government and is trusted as an accurate index of a patient’s risk for becoming addicted to the very pills that doctors may prescribe them. 

But the problem is, it isn’t accurate.

The platform is only as good as the data it uses in its algorithms. And we’re not exactly sure where all of that data comes from, or even what it is.

Because Appriss uses a “proprietary” method of gathering data and arriving at the score assigned to a patient, they aren’t required by law to disclose the complete process. But we know something is wrong.

NarxCare has become highly criticized for erroneously labeling patients as “high-risk” due to discriminating factors like race, socioeconomic status, history of sexual abuse, and even a person’s pets.

That’s because the platform uses data from a person’s criminal history, pharmacy records, medical history, and other sources only known to Appriss. And the computing software looks for things like arrests, the distance driven to doctors and pharmacies, past sexual trauma, and other factors linked to the increased risk of opioid abuse. This can lead to some not-so-funny mix-ups, like a person being flagged at the pharmacy and turned away because all of their pet’s anti-seizure medications are under the owner’s name.

For example, it assumes that if a person is driving far for the medication of medical services, they may be doctor shopping. These “risk factors,” along with others, work to form the score assigned to each person seeking medical care in a state, hospital, or pharmacy that uses the NarxCare platform. But it is also well-documented that minority races are much more likely to be involved in the criminal justice system and charged and convicted of drug crimes despite representing a disproportionately smaller population. So, this can lead to people being labeled as addicts based on discrimination and people addicted to opioids not being identified simply because of their race.

The Unforeseen Consequences of Regulation

Unfortunately, addiction isn’t that simple. While opioid misuse is undoubtedly a significant problem, many people are surprised to learn that around 70 percent of adults have taken medical opioids. Yet, only 0.5 percent suffer from opioid use disorder. Even within the age group at highest risk, only one out of every 314 privately insured patients who have been prescribed opioids misuse them.

Too much stock is being placed in the NarxCare platform. What was supposed to help physicians inform their decision has become a default authority on whether or not a patient is given pain medication, and in many cases, treated with dignity.

The internet is filled with stories of people who have been kicked out of hospitals, dropped by their doctors, and accused of being addicts after they were identified as “high-risk,” yet had legitimate pain. This is happening because people who have more substantial medical histories are more likely to be flagged. Instead of turning away new drug seekers and doctor shoppers, the NarxCare platform frequently misses these high-risk individuals and instead labels life-long chronic pain patients as high-risk. And like we found with Oxycontin when pain medications are restricted, overdoses get worse. Among patients with long-term opioid prescriptions, research has shown that stopping those prescriptions without providing effective alternative care is associated with nearly triple the risk of overdose death.

Sadly, the NarxCare screening tool is an effort in the wrong direction, and a poor one at that. If prescription opioids were more than a catalyst to the problem, they might be more effective. And even if it were the right target, much more care would need to be taken in its use to ensure ethical use.

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Michael Leach is a Certified Clinical Medical Assistant, who has over 5 years of experience working in the field of addiction. He spent his career working under the board-certified Addictionologist Dr. Rohit Adi. His experience includes working with families during their loved one’s stay in treatment, helping those with substance abuse issues find treatment, and teaching life skills to patients in a recovery atmosphere. Though he has worked in many different areas of rehabilitation, the majority of his time was spent working one on one with patients who were actively withdrawing from drugs. Withdrawal and the fear of going through it is one biggest reason why an addict continues to use and can be the most difficult part of the rehabilitation process. His experience in the withdrawal atmosphere has taught him that regardless of what approach a person takes to get off drugs, there are always mental and emotional obstacles that need to be overcome. He believes having someone there to help a person through these obstacles can make all the difference during the withdrawal process.