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Read our FAQ's on NarxCare and our NarxCare article, If you need a little refresher on what it is.
As you know, one of our issues with NarxCare is that it has never been externally validated. Bamboo Health/Appriss held a webinar on October 27, 2021. The webinar was named "External Validation of NarxCare as Useful Clinical Decision Support Tool." Here is a recording in case you're interested in watching the 30-minute webinar. They state the aim of the paper the webinar was based on is to "validate the NS metric compared to WHO ASSIST and identify high, moderate and low opioid risk thresholds and to provide actionable data."
Before I go into detail about this webinar, I want to tell you a story about a hypothetical patient named Rachel.
Rachel has had the same prescriber for years, but is moving across the country and has to find a new doctor. According to Rachel's Narcotic Score (NS), Rachel now has two prescribers. This new doctor has a PA in his office that sometimes writes Rachel's prescriptions. Rachel now has 3 prescribers within the last two years. Six months after Rachel started seeing this new doctor, he is raided by the DEA and can no longer prescribe. Rachel finds a new doctor. She now has had 4 prescribers. Rachel's new doctor gives her the first two prescriptions and then transfers her to his NP. This would be Rachel's 5th prescriber. Sadly,18 months after Rachel moved, she is in a terrible car accident and is admitted to the hospital for 4 weeks. Upon discharge, the nurse has Rachel's prescriptions filled at the hospital pharmacy for Rachel so she doesn't have to stop on the way home. This would now be a 6th prescriber. According to the PDMP and NarxCare, she will be flagged as a doctor shopper.
Let's talk about Rachel's pharmacies. Once Rachel moves, she obviously has to get a new pharmacy. Rachel now has 2 pharmacies showing in the PDMP. Rachel's new pharmacy is CVS. CVS starts to give Rachel a hard time about getting her prescriptions filled and her doctor suggests she start going to a small mom and pop pharmacy. Rachel now has 3 pharmacies listed in her PDMP NarxCare score. After a few months, her current pharmacy tells Rachel that due to DEA quota cuts, they can't keep filling her meds consistently and suggests she go to a different, larger pharmacy. Rachel does, and now has 4 pharmacies listed in her PDMP. Remember Rachel's terrible car accident she was in? The pharmacy at the hospital would be Rachel's 5th pharmacy in the past two years. According to her Narcotic Score, she will be flagged as a pharmacy hopper.
After Rachel's nearly fatal car accident, she is given a prescription for sleeping pills because she has a really hard time sleeping. She also is given 10 Ativan because she has PTSD from her accident and gets panic attacks every time she gets in the car to drive to PT. Both of these medications increase her NarxCare Narcotic Score even though they aren't opioids.
Rachel sees her doctor after being discharged from the hospital and he tells her that her Narcotic Score is too high and he can no longer prescribe. Her NS skyrocketed bc she had 6 prescribers, 5 pharmacies, a prescription for sleeping pills and a prescription for Ativan. The only medication her doctor is now willing to prescribe is Suboxone, which means she would now have a diagnosis of Opioid Use Disorder in her EHR. Rachel declines and thankfully, she is able to find a new pain doctor. Her NS now shows she has had a total of 7 prescribers in the last 2 years. Her new doctor receives a warning letter because he is prescribing controlled substances to someone with a very high NS. Rachel's new doctor dismisses her from his office saying he's not willing to risk his license for her. Not only is Rachel unable to find a new pain doctor, she can't even find a regular doctor.
So, was this Narcotic Score helpful? In black and white it looks like Rachel is playing games and has definite signs of OUD. The reality is, she doesn't struggle with addiction, but is now medically abandoned and her only option for pain relief is to go to the streets and hope to get pills that aren't laced with illicit fentanyl. Since Rachel is too afraid to do that, she has to quit her job and file for SSDI since she is no longer able to work due to uncontrolled pain and anxiety.
Now let's discuss this webinar.
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Here is the link to the show about NarxCare and the struggles pain patients face. Please share with as many media outlets as you can. The show aired November 11 at 10am EST, NPR show 1A had a panel with our VP Bev Schechtman, Maia, and the CMO of Appriss (now Bamboo Health).
As you know, Maia Szalavitz wrote an article about NarxCare that was printed in Wired. NPR picked up the story!
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An article in Reason came out yesterday about the ruling for the Defendants (four drug companies-Teva, Johnson & Johnson, AbbVie, and Endo) in opioid litigation. This is huge for our community. The Judge said the Plaintiffs failed to prove the charges of public nuisance and false advertising. Superior Court Judge, Peter J. Wilson wrote a 42 page ruling. This was the first of thousands of cases filed across the country regarding the "opioid crisis," filed in 2014. The Plaintiffs' claims were:
- The companies used false advertising
- They engaged in unlawful business practices
- They created a public nuisance
Judge Wilson ruled the Plaintiffs failed to prove any of these claims. Some direct quotes from Judge Wilson's ruling:
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A crucial precedent has just been set. Brent Sloane took his life in 2017 due to a lack of pain medication, and his family decided to sue. In August of 2021 that family was awarded $7 million. Brent Sloane's family said he ended his life because a doctor denied his prescription for opioid medication that he desperately needed. Brent sent a text to his wife that said "they denied script, im done love you." Thirty minutes later, he took his life. This article from 2018 explains the lawsuit. “The intention of the lawsuit is to bring light to that fact that people who experience pain should not be disregarded and tossed aside,” said an attorney for the family of Slone. Why is this lawsuit so important? Until now, chronic pain patients haven't been very successful when trying to sue a doctor for medically abandoning them or forcing them to taper off of opioid medication. This win can set a very important precedent.
So, let's talk about suicide due to pain. First, keep in mind what anti-opioid zealot, Andrew Kolodny, had to say about suicides from pain. He called the suicide claim “totally bogus,” saying suicide can result from the severe anxiety and panic attacks associated with drug withdrawal -- a problem that stems from addiction to painkillers, he said, not failure to treat pain appropriately. This is the man who is called the "opioid prophet," and who has dictated drug policy since 2011 when he started PROP.
Thankfully, not everyone listens to Andrew Kolodny. In 2020, University of Alabama funded a study led by Dr. Stefan Kertesz looking at suicides from patients cut off from opioids. “When we see patients die in ways that involve our care, we are obligated to dive in and investigate it,” Kertesz said. If you know of people who may have taken their lives due to being cut off from pain medication, please let the family know about the study. Dr. Kertesz has explained that even when patients are on "high doses of opioids" that may exceed the CDC Guidelines, that it may be more dangerous to stop them than to keep them on their medication. Anne Fuqua, an RN and pain patient, is also assisting in this study. "Fuqua said she has collected about 111 suicides on her own. She has identified another 500 potential cases from social media." If you know of anyone who may be interested in the study, please direct them go.uab.edu/csiopioids. Or they can email csiopioids@uabmc.edu.
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AMA (American Medical Association) has been vocal about their view of the 2016 CDC Opioid Prescribing Guidelines and the changes they feel are necessary. On September 21, 2021, AMA released a report showing that while there has been a 44.4% decrease in opioid prescribing, the drug overdose epidemic has never been worse. The press release for the new report can be found here. The report also discusses how as PDMP use has greatly increased, overdoses and deaths skyrocketed. Does that mean the PDMP actually increases deaths? It's possible. This issue is discussed further in this Reason article by policy analyst, Jacob James Rich. The DOJ has put hundreds of millions of dollars into funding the PDMP. Will they stop funding the PDMP since the results are definitely less than impressive? Doubtful, but we'll see. Contrary to what anti-opioid zealots like Andrew Kolodny from PROP and Gary Mendell from Shatterproof want people to believe, AMA President Gerald E. Harmon, M.D. said “The nation’s drug overdose and death epidemic has never just been about prescription opioids.”
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When our VP, Bev Schechtman, was denied adequate pain medication when hospitalized for kidney stones due to having been a victim of sexual abuse, she became obsessed with researching how this could happen. She learned about NarxCare and the Opioid Risk Tool. We, at The Doctor Patient Forum/Don't Punish Pain, have been researching these topics for the past four years. We've reached out to countless investigative journalists only to be shot down. Thankfully, Maia Szalavitz, an author and leader in harm reduction, was interested in telling the story of NarxCare and other risk tools. This was our first piece of national media, and we are so excited to share it with you. We suggest holding on to this article and sharing it with your local legislators. About half of the states use NarxCare, and this article can help you fight against it. Read about how our country has tried to help the "opioid crisis" by using a risk score algorithm, yet it seems they're only making matters worse.
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Truth Out published an article on October, 1, 2021 regarding the DEA's recent public safety alert about the abundance of counterfeit prescription pills. Mike Ludwig's article is part of the series "The Policing of Pain: Inside the Deadly War on Opioids." This increase demand for prescription pills is largely due to a crackdown on prescribing of controlled substances. Mike explains that the link between "overprescribing" and the overdose crisis is greatly exaggerated, citing the fact that opioid prescribing has plummeted to the lowest it has been in a decade as overdoses have skyrocketed. Claudia Merandi, Founder and President of The Doctor Patient Forum, was interviewed for this article.
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An extremely important article was just posted last week on September 17, 2021. We at The Doctor Patient Forum/Don't Punish Pain have been researching the CDC Guidelines and how they were written. We specifically have focused on one of the main authors, Dr. Roger Chou. We had the privilege of collaborating with a palliative care doctor who is also on the AMA Opioid Task Force, Dr. Chad Kollas. Dr. Kollas along with a few other chronic pain patients and advocates worked together to put out this phenomenal article showing in detail the unacceptable conflicts of interests Roger Chou has, and explains in why we need a congressional investigation into how the guidelines were written. How can you help? Familiarize yourself with the content of this article, and forward it to your local legislators. your local representatives, your senators, etc. The following goals are listed at the end of the article:
