Fighting Addiction or Denying Care?

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An epidemic of opioid abuse in the U.S. killed 93,000 people in 2020 alone. An algorithm intended to help doctors prescribe the drugs responsibly may be barring worthy patients from pain relief.
What’s new: A widely used system assesses whether individual patients are at risk of abusing opioids. In some cases, it has recommended denying painkillers to people who suffer from severe pain and have no history of drug abuse, Wired reported.
How it happened: Most U.S. states have developed databases that track drug prescriptions. NarxCare, a system developed by medical technology company Appriss Health, analyzes such data for at least eight states.

  • Given a patient’s name, NarxCare considers drugs and doses prescribed, numbers of doctors and pharmacies involved, and whether any prescriptions overlap. It produces scores that evaluate the risk that the patient will abuse opioids and other drugs, and a score that evaluates the risk that they will overdose. Appriss says the scores are meant to assist, not to overrule or replace, a doctor’s decision.
  • Several patients interviewed by Wired said they were denied care or were dropped by their doctors after receiving mistakenly elevated scores. In one case, veterinary drugs purchased for pets contributed to a high score.
  • Some behaviors used by such algorithms to generate risk scores — such as visiting multiple doctors or traveling long distances for care — may artificially inflate scores for people who have multiple conditions or live in rural areas, according to a recent study.

Behind the news: Flawed algorithms unexpectedly have cut healthcare benefits to many U.S. citizens, leaving them without care or a way to appeal the decision.
Why it matters: Most people who have opioid prescriptions are not addicts. Cutting them off from painkillers not only leaves them to suffer, it also could drive them to obtain the drugs illegally or harm themselves with illicit substitutes.
We’re thinking: Efforts to limit prescriptions of opioids could save countless people from addiction, and AI can play an important role. Stories of patients who have been denied care highlight the pressing need to improve and audit AI systems, even as they help us avoid fueling the opioid epidemic.

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