Walmart and Sam’s Club recently announced that by the end of August their pharmacists will start using NarxCare, a prescription tracking tool that analyzes real-time data about opioids and other controlled substances from Prescription Drug Monitoring Programs (PDMP’s).

Recent studies question the value of PDMP’s, but 49 states have implemented them so that physicians, pharmacists and insurers can see a patient’s medication history. Granted, there is a need for monitoring the select few who doctor shop and/or abuse their medications, albeit that number is only in the 2 percent range.

What is NarxCare? Appriss Health developed NarxCare as a “robust analytics tool” to help “care teams” (doctors, pharmacists, etc.) identify patients with substance use disorders. Each patient is evaluated and given a “risk score” based on their prescription drug history. According to Appriss, a patient is much more willing to discuss their substance abuse issues once they are red flagged as a possible abuser.

www.apprisshealth.com/solutions/narxcare/

Sounds great doesn’t it? Except prescription drugs are not the problem and never really have been. Illicit drug use has, is, and will continue to be the main cause of the addiction and overdose crisis. 

Even the name NarxCare has a negative connotation. “Narx” stands for narcotics. And in today’s environment, narcotics is a very negative word. NarxCare makes me feel like a narcotics police officer is just around the corner.

Each patient evaluated by NarxCare gets a “Narx Report” that includes their NarxScores, Overdose Risk Score, Rx Graph, PDMP Data and my favorite, the Red Flags. The scores are based on the past two years of a patient’s prescription history, as well as their medical claims, electronic health records and even their criminal history.

Ohio, Michigan, Indiana, Iowa, and several other states are using NarxCare to supplement their own PDMPs. And Walmart isn’t the only big retail company to adopt it. Kroger, Ralphs, Kmart, CVS, Rite Aid and Walgreens are already using NarxCare. There’s a good chance your prescriptions are already being tracked by NarxCare and you don’t even know it.

But NarxCare doesn’t just analyze opioid prescriptions. It also tracks other controlled substances, such as antidepressants, sedatives and stimulants. If a patient is on any combination of those drugs, their risk scores and their chances of being red flagged will be higher – even if they’ve been safely taking the medications for years.

There are several other ways a patient can be red flagged, such as having multiple doctors or pharmacies. But what if you moved and changed physicians? What if you had the same physician for many years and he/she retired or moved away? What if your pharmacy refused to fill your prescription and you had to go pharmacy hunting every month? What if you had dental surgery and your dentist placed you on a short-term pain medication?

Unfortunately, the NarxCare scores do not reflect any of that. How can raw data on prescription medications be an indicator of abuse? I believe there is some merit in tracking and weeding out the rare abuser, but NarxCare doesn’t factor in all the “what if’s” that can happen to law-abiding and responsible patients. 

As pain patients, we need to be acutely aware of the negative impact this analytics tool can have. Many of us have already been required to sign pain contracts, take drugs tests, and undergo pill counts. In 2019, Medicare will adopt policies making it even harder for patients to get high doses of opioid medication. Some insurers are already doing it. We’re already being policed enough as it is.

I intend to ask my physician, pharmacist and case manager if they utilize NarxCare. So should you. If they say yes, ask them why. Ask your doctor if they believe you are at risk for substance use disorder. Why is their judgement and treatment of you being second guessed by anyone?

This is the same company that sold a “bill of goods” to a number of states on using their database on the sale of Sudfed ( pseudoephedrine) used in making Meth.  The first time I used it … I said out loud … this is a stupid system… it won’t work… there is no validation of the driver’s license and once a person got a fake driver’s license past one pharmacist/tech… all you had to do was put in the driver’s license number and all the rest of the data lines auto filled .. and the Rx dept staff dropped into confirmation bias mode… and if the correct time had lapsed since the last purchase… it was approved to sell..  So the person with multiple fake driver’s license move on to the next pharmacy … gave them a different license and bought more… it took the state of Indiana several years for the legislature to figure this out and get out of the program and implement a new law.. that is slowing down the sale of Sudafed, but all along.  about 80% of meth was being imported from Mexico… so if nothing else it reduced the number of local meth labs.

I have heard all to often from pts about pharmacist being all about “the numbers” … this is just one more step for the corporate pharmacy chains to rescind the pharmacist’s professional discretion and dictate if this system shows certain data/parameters… the pharmacists is to refuse to fill.. won’t make any difference if the data is wrong or the artificial intelligence (AI) behind the determination is faulty…  all of these factors means “just say no”…..

Just imagine, all the sensational national news reports you have heard about these new self driving cars…  a few have crashed, one hit a pedestrian dressed in dark clothing walking across a unlighted multiple lane road at night…  How many cars crash in California.. how many make national news – all that is made by TELSA… that have semi-autonomous drive capability. At last count I think that the total TESLA fatal car crashes is 3 or4 and everyone made national news.

When this AI algorithm fails… it won’t make national news… because it will just be a denial of care… it will just be potentially throwing a pt into cold turkey withdrawal. The AI failures may never even be recognized because there will be no immediate/direct body count to make sensational national news ?

Since this appears to be a drive mostly by the chain pharmacies… this is just another good reason to move all your prescriptions to a independent pharmacy… where the pharmacist/owner may or may not be using it.. .but.. it will be his/her professional discretion as to believe what this AI program determines is red flags or not red flags and won’t have some corporate edict and threat of being fired if they don’t follow the corporate edict to the letter … no matter what their own professional opinion tells them is the right thing to do…

Here is a website to help anyone find a independent pharmacy by zip code https://ncpa.org/pharmacy-locator