Elizabeth Amirault had never heard of a Narx Score. But she said she learned last year the tool had been used to track her medication use.<\/p>\n

During an August 2022 visit to a hospital in Fort Wayne, Indiana, Amirault told a nurse practitioner she was in severe pain, she said. She received a puzzling response.<\/p>\n

\u201cYour Narx Score is so high, I can\u2019t give you any narcotics,\u201d she recalled the man saying, as she waited for an MRI before a hip replacement.<\/p>\n

Tools like Narx Scores are used to help medical providers review controlled substance prescriptions. They influence, and can limit, the prescribing of painkillers, similar to a credit score influencing the terms of a loan. Narx Scores and an algorithm-generated overdose risk rating are produced by health care technology company Bamboo Health (formerly Appriss Health) in its NarxCare platform.<\/p>\n

Such systems are designed to fight the nation\u2019s opioid epidemic, which has led to an alarming number of overdose deaths. The platforms draw on data about prescriptions for controlled substances that states collect to identify patterns of potential problems involving patients and physicians. State and federal health agencies, law enforcement officials, and health care providers have enlisted these tools, but the mechanics behind the formulas used are generally not shared with the public.<\/p>\n

\n\t<\/iframe>\n<\/p>\nArtificial intelligence is working its way into more parts of American life. As <a href=\"https:\/\/kffhealthnews.org\/news\/article\/chatgpt-generative-ai-chatbot-doctors-office-patient-privacy-health-industry\/\">AI spreads within the health care<\/a> landscape, it brings familiar concerns of bias and accuracy and whether government regulation can keep up with rapidly advancing technology.<\/p>\nThe use of systems to analyze opioid-prescribing data has sparked questions over whether they have undergone enough independent testing outside of the companies that developed them, making it hard to know how they work.<\/p>\nLacking the ability to see inside these systems leaves only clues to their potential impact. Some patients say they have been cut off from needed care. Some doctors say their ability to practice medicine has been unfairly threatened. Researchers warn that such technology \u2014 despite its benefits \u2014 can have unforeseen consequences if it improperly flags patients or doctors.<\/p>\n\u201cWe need to see what\u2019s going on to make sure we\u2019re not doing more harm than good,\u201d said Jason Gibbons, a health economist at the Colorado School of Public Health at the University of Colorado\u2019s Anschutz Medical Campus. \u201cWe\u2019re concerned that it\u2019s not working as intended, and it\u2019s harming patients.\u201d<\/p>\nAmirault, 34, said she has dealt for years with chronic pain from health conditions such as sciatica, degenerative disc disease, and avascular necrosis, which results from restricted blood supply to the bones.<\/p>\nThe opioid Percocet offers her some relief. She\u2019d been denied the medication before, but never had been told anything about a Narx Score, she said.<\/p>\nIn a chronic pain support group on Facebook, she found others posting about NarxCare, which scores patients based on their supposed risk of prescription drug misuse. She\u2019s convinced her ratings negatively influenced her care.<\/p>\n\u201cApparently being sick and having a bunch of surgeries and different doctors, all of that goes against me,\u201d Amirault said.<\/p>\nDatabase-driven tracking has <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27269021\/\">been linked to<\/a> a decline in opioid prescriptions, but evidence is mixed on its impact on curbing the epidemic. Overdose deaths continue to plague the country, and patients like Amirault have said the <a href=\"https:\/\/www.healthinjustice.org\/prescription-drug-monitoring\">monitoring systems<\/a> leave them feeling stigmatized as well as cut off from pain relief.<\/p>\nThe Centers for Disease Control and Prevention <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/72\/wr\/mm7215a1.htm#:~:text=During%202021%2C%20an%20estimated%2020.9%25%20of%20U.S.%20adults%20experienced%20chronic,(8.0%25)%20(5).\">estimated that in 2021 about 52 million<\/a> American adults suffered from chronic pain, and about 17 million people lived with pain so severe it limited their daily activities. To manage the pain, <a href=\"https:\/\/www.cdc.gov\/nchs\/data\/nhsr\/nhsr162-508.pdf\">many use prescription opioids<\/a>, which are tracked in nearly every state through electronic databases known as <a href=\"https:\/\/www.cdc.gov\/drugoverdose\/pdmp\/index.html\">prescription drug monitoring programs<\/a> (PDMPs).<\/p>\nThe last state to adopt a program, Missouri, is still getting it up and running.<\/p>\nMore than 40 states and territories use the technology from Bamboo Health to run PDMPs. That data can be fed into NarxCare, a separate suite of tools to help medical professionals make decisions. Hundreds of health care facilities and five of the top six major pharmacy retailers also use NarxCare, the company said.<\/p>\nThe platform generates three Narx Scores based on a patient\u2019s prescription activity involving narcotics, sedatives, and stimulants. <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0376871621005627\">A peer-reviewed study<\/a> showed the \u201cNarx Score metric could serve as a useful initial universal prescription opioid-risk screener.\u201d<\/p>\nNarxCare\u2019s algorithm-generated \u201cOverdose Risk Score\u201d draws on a patient\u2019s medication information from PDMPs \u2014 such as the number of doctors writing prescriptions, the number of pharmacies used, and drug dosage \u2014 to help medical providers assess a patient\u2019s risk of opioid overdose.<\/p>\nBamboo Health did not share the specific formula behind the algorithm or address questions about the accuracy of its Overdose Risk Score but said it continues to review and validate the algorithm behind it, based on current overdose trends.<\/p>\n<a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/71\/rr\/rr7103a1.htm\">Guidance from the CDC<\/a> advised clinicians to consult PDMP data before prescribing pain medications. But the agency warned that \u201cspecial attention should be paid to ensure that PDMP information is not used in a way that is harmful to patients.\u201d<\/p>\nThis prescription-drug data has led patients to be dismissed from clinician practices, the CDC said, which could leave patients at risk of being untreated or undertreated for pain. The agency further warned that risk scores may be generated by \u201cproprietary algorithms that are not publicly available\u201d and could lead to biased results.<\/p>\nBamboo Health said that NarxCare can show providers all of a patient\u2019s scores on one screen, but that these tools should never replace decisions made by physicians.<\/p>\nSome patients say the tools have had an outsize impact on their treatment.<\/p>\nBev Schechtman, 47, who lives in North Carolina, said she has occasionally used opioids to manage pain flare-ups from Crohn\u2019s disease. As vice president of the Doctor Patient Forum, a chronic pain patient advocacy group, she said she has heard from others reporting medication access problems, many of which she worries are caused by red flags from databases.<\/p>\n\u201cThere\u2019s a lot of patients cut off without medication,\u201d according to Schechtman, who said some have turned to illicit sources when they can\u2019t get their prescriptions. \u201cSome patients say to us, \u2018It\u2019s either suicide or the streets.\u2019\u201d<\/p>\n<figure class=\"wp-block-image size-full\"><figcaption class=\"wp-element-caption\">Elizabeth Amirault of Indiana has dealt with chronic pain for years. She believes a tool that tracks her prescription drug use negatively influenced her ability to get the medication she needs. (Nicholas Amirault)<\/span><\/figcaption><\/figure>\nThe stakes are high for pain patients. <a href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2793293\">Research shows<\/a> rapid dose changes can increase the risk of withdrawal, depression, anxiety, and even suicide.<\/p>\nSome doctors who treat chronic pain patients say they, too, have been flagged by data systems and then lost their license to practice and were prosecuted.<\/p>\nLesly Pompy, a pain medicine and addiction specialist in Monroe, Michigan, believes such systems were involved in a legal case against him.<\/p>\nHis medical office was raided by a mix of local and federal law enforcement agencies in 2016 because of his patterns in prescribing pain medicine. A year after the raid, Pompy\u2019s medical license <a href=\"https:\/\/www.michigan.gov\/-\/media\/Project\/Websites\/lara\/bpl\/Folder21\/Pompy_Lesly_MD_Summary_Suspension.pdf?rev=11a386e4de744010b94ecf5515df68b7\">was suspended<\/a>. In 2018, he was <a href=\"https:\/\/www.justice.gov\/usao-edmi\/pr\/monroe-area-doctor-charged-illegal-distribution-prescription-drugs-and-health-care\">indicted on charges<\/a> of illegally distributing opioid pain medication and health care fraud.<\/p>\n\u201cI knew I was taking care of patients in good faith,\u201d he said. A federal jury in January acquitted him of all charges. He said he\u2019s working to have his license restored.<\/p>\nOne firm, Qlarant, a Maryland-based technology company, said it has developed algorithms \u201cto identify questionable behavior patterns and interactions for controlled substances, and for opioids in particular,\u201d involving medical providers.<\/p>\nThe company, in an <a href=\"https:\/\/www.qlarant.com\/wp-content\/uploads\/2019\/03\/Data-Science-and-Technology-Reports_03_4_2019_web.pdf\">online brochure<\/a>, said its \u201cextensive government work\u201d includes partnerships with state and federal enforcement entities such as the Department of Health and Human Services\u2019 Office of Inspector General, the FBI, and the Drug Enforcement Administration.<\/p>\nIn <a href=\"https:\/\/youtu.be\/u5H5PkxW8S4\">a promotional video<\/a>, the company said its algorithms can \u201canalyze a wide variety of data sources,\u201d including court records, insurance claims, drug monitoring data, property records, and incarceration data to flag providers.<\/p>\nWilliam Mapp, the company\u2019s chief technology officer, stressed the final decision about what to do with that information is left up to people \u2014 not the algorithms.<\/p>\nMapp said that \u201cQlarant\u2019s algorithms are considered proprietary and our intellectual property\u201d and that they have not been independently peer-reviewed.<\/p>\n\u201cWe do know that there\u2019s going to be some percentage of error, and we try to let our customers know,\u201d Mapp said. \u201cIt sucks when we get it wrong. But we\u2019re constantly trying to get to that point where there are fewer things that are wrong.\u201d<\/p>\nProsecutions against doctors through the use of prescribing data have attracted the attention of the American Medical Association.<\/p>\n\u201cThese unknown and unreviewed algorithms have resulted in physicians having their prescribing privileges immediately suspended without due process or review by a state licensing board \u2014 often harming patients in pain because of delays and denials of care,\u201d said Bobby Mukkamala, chair of the AMA\u2019s Substance Use and Pain Care Task Force.<\/p>\nEven critics of drug-tracking systems and algorithms say there is a place for data and artificial intelligence systems in reducing the harms of the opioid crisis.<\/p>\n\u201cIt\u2019s just a matter of making sure that the technology is working as intended,\u201d said health economist Gibbons.<\/p>\n<aside class=\"meta-authors meta\">\n\n\t\t\t\t\t\t\t\t\t\t\tAndy Miller: <\/span> \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/kffhealthnews.org\/news\/article\/artificial-intelligence-pain-medication-narx-score\/mailto:amiller@kff.org\">amiller@kff.org<\/a>,\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/twitter.com\/gahealthnews\" target=\"_blank\" rel=\"noopener\"> \n\t\t\t\t\t\t\t@gahealthnews<\/a>\n\t\t\t\t\t\t\t\t\t<\/p>\n\n\t\t\t\t\t\t\t\t\t\t\tSam Whitehead: <\/span> \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/kffhealthnews.org\/news\/article\/artificial-intelligence-pain-medication-narx-score\/mailto:swhitehead@kff.org\">swhitehead@kff.org<\/a>,\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/twitter.com\/sclaudwhitehead\" target=\"_blank\" rel=\"noopener\"> \n\t\t\t\t\t\t\t@sclaudwhitehead<\/a>\n\t\t\t\t\t\t\t\t\t<\/p>\n<\/aside>\n<section class=\"block--category-tag-list \">\n<div class=\"category-tag-list__content-wrapper\">\n<h3 class=\"block--category-tag-list__title\">\n\t\t\t\tRelated Topics\t\t\t<\/h3>\n\t\t\t\t<a class=\"category-tag-list__contact-link\" href=\"https:\/\/kffhealthnews.org\/contact-us\/\"> \n\t\t\tContact Us\t\t<\/a> \n\t\t<a class=\"category-tag-list__tip-link\" href=\"https:\/\/kffhealthnews.org\/tips\/\"> \n\t\t\tSubmit a Story Tip\t\t<\/a>\n\t<\/div>\n<\/section><\/div>\n<script async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n","protected":false},"excerpt":{"rendered":"Elizabeth Amirault had never heard of a Narx Score. But she said she learned last year the tool had been used to track her medication use. During an August 2022 visit to a hospital in Fort Wayne, Indiana, Amirault told a nurse practitioner she was in severe pain, she said. She received a puzzling response. 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