Can Not Compute

How popular patient screening software may be contributing to our nation’s drug problem.

For the last two decades, we’ve been entrenched in a battel against the opioid epidemic. Addiction has taken so many lives, that it has even caused the US life expectancy rate to drop for consecutive years. In 2020, we saw it get even worse as more than 93,000 people died from drug overdoses in America, a nearly 30% rise from an already climbing statistic. This has led to some extreme measures and unusual solutions in the War on Drugs, but perhaps none as head-scratching as the continued use of the NarxCare prescription drug screening tool.

NarxCare is a platform that is utilized by hospitals, pharmacies, and physicians’ offices in all states except Missouri. It’s created by the company Appriss, who describes it as “an analytics tool and care management platform.”

The platform piggybacks of the already existing databases that the US Department of Justice has been implementing in each state to monitor prescribing of narcotic drug, namely opioids. This was a response to the growing opioid epidemic and a way for authorities to see where the drugs were going at any given moment. It uses this, along with other data, to assign each person an Overdose Risk Score. Much like a credit score, this number is supposed to help physicians make informed decisions and avoid fueling addiction by prescribing opioids to someone who may misuse them.

The problem with this idea is that a computer is only as good as the data it is given. The NarxCare platform also draws upon information like criminal records, sexual abuse history, and even pet prescriptions to formulate and assign as risk score to each person, and this can lead to discrimination. Minorities have been historically targeted for drug crimes and arrested at higher rates than whites, for example. And other sources of data are undisclosed since Appriss uses a “proprietary” method of analysis.

But the bigger problem is with how this data is used. Physicians have largely been blamed for fueling the opioid epidemic by overprescribing drug like Oxycontin, so are very hesitant to prescribe to someone who has a high Overdose Risk Score, regardless of the accuracy of that score. For example, many people have complained that they’ve been kicked out of hospitals, denied needed medications, and had to suffer for nonsensical reasons such as being flagged due to multiple prescriptions that were actually for their pets.

Some chronic pain sufferers to turn to more dangerous illegal supplies or to suicide when turned away for “drug seeking”. 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.

Because NarxCare is largely funded by the government, it is also trusted as a standard which doctors are measured against. In other words, they can be prosecuted if it’s found that they negligently gave opioids to someone that the platform had identified as a high risk. This has led many physicians to simply default to the computer to make their decision for them.

We’re not selecting the right target. This system is inherently flawed because it places the responsibility for addiction on the patient. People aren’t a number, and we cannot rely on computer to make life-and-death decisions.

Instead, let’s look to regulate the pharmaceutical companies that deceive doctors and patients into thinking they need drugs, and that drugs are safe. Let’s train doctors to identify addiction and properly help patients who may be drug-seeking, rather than turning them away.

People aren’t a risk-score. They need help.

Michael Leach has spent most of his career as a health care professional specializing in Substance Use Disorder and addiction recovery. He is a regular contributor to the healthcare website and a Certified Clinical Medical Assistant