The Profiling System in Every State You Never Signed Up For Part ONE

Black Mirror’s “Nosedive” is already happening — the problem lies in murky consent.

Last year, I found out that I had a rare, incurable disorder.

I also found out my government was paying a privately owned company to profile and assign me a “score”.

I don’t know which news was more upsetting.

I wasn’t allowed to know my score or even how it was derived.

What is this “score”?

It is an addiction/overdose risk assessment score, assigned by an algorithm developed by Appriss, Inc., in Louisville, Kentucky.

It assessed a few values entered into data fields, then ran them through its weighted algorithm, and PRESTO!

It spits out a score just for me.

I have a science background.

I am reasonably intelligent.

I didn’t like this.

I began to dig.

Saving Us From Ourselves

Appriss, Inc., began their quest for data mining domination in the middle of the 1990s by the development of the VINE system.

VINE is a victim notification system that alerts the victims of a crime when the perp is released from jail/prison.

Reviews of this system by its users have been mixed at best. The VINE app on iPhone, for example, which is a preferred notification system for most victims, currently sits at a 1.9-star rating on the iTunes Store, with review after review of horrified, scared victim stating they were not informed.

iTunes Store Screencap 1/22/19

A software and data company has 3 apps on iTunes — 1 with no reviews, 2 with 1.9-star reviews and very angry customers because the developers appear to have abandoned any updates for over a year.

Appriss, Inc., has spent the better part of the last twenty years developing and perfecting their algorithms around schedule prescribed medications, PDMPs (prescription drug monitoring programs), and a specialized PDMP in house profiling project they ultimately named NarxCare.

This is far more lucrative to current management than the altruistic vision of the founder.

Appriss has also been responsible for the program that tracks every person who plunks down their driver’s license for Sudafed from behind the counter, the program Methcheck.

A spectacular failed attempt at slowing methamphetamine abuse by the government.

Failed because between the years 2011–2016 methamphetamine overdose deaths in the United States have more than tripled in number, according to the CDC.

A failure doesn’t get illustrated quite so resoundingly very often.

Yet, they still continue their course of stubbornly throttling prescribed opioid medication to the patients who aren’t abusing it in the first place.

Of course, this is all framed “for the best interest of public health”.

Does anyone else cringe when a public official mouths the words “best interest of public health”?

Every time those words exit a politician’s mouth, you can be certain a civil rights violation will be on its heels.

To wit, “the public” is left in the dark regarding these plots, never asked their input, and, most importantly, never asked for informed consent.

Little is known about the data fields Appriss actually inputs.

The algorithms are proprietary.

Furthermore, the state statutes written around PMP/PDMPs have this little nugget hidden inside:

“Program to contract with vendors/3rd parties for the purpose of “obtaining technical assistance in the design, implementation, operation, and maintenance” of the system. “

Questions addressed to the state agencies /reps regarding them are ignored.

What I have been able to ascertain independently is troubling.

Appriss has introduced a number of “add-on” packages to the basic PDMP that each state has in place- thanks to Brandeis University.

The Brandeis proprietary PDMPassist has been the author of the state PDMP metrics and algorithms for each state PDMP program.

Congressman Hal Rogers, of Kentucky, is the PDMP ‘face man’ at a national level.

The ‘Hal Rogers’ PDMP grant program has funded many states’ programs and gotten them up and running.

The Congressman’s moniker is attached to all things PDMP for no obvious reason.

The only thing Rep. Rogers appears known for besides the PDMP programs in his name is being dubbed “the Prince of Pork” by government spending watchdog groups.

He also served as the chairman of the House Appropriations Committee for a short time.

Appriss, Inc., HQ is located in Kentucky as previously mentioned, same as Rep. Rogers.

One thing I have learned in my research throughout the bizarre turns of the opioid crisis is that there are no coincidences.

One of the add-on programs that almost all states have implemented to their PDMPs is called “PDMP AwaRxe”.

This program is nothing more than Appriss, Inc.’s, insidious NarxCare under a different name.

This is also where the “scoring” comes into play.

With NarxCare, a patient gets what is referred to as a NarxScore.

Herein the problem lies.

The PDMP, NarxCare, PDMP AwaRxe, et al., are all rudimentary algorithm programs.

They do not allow for any inputs by a physician into data fields.

This is a problem.


It’s a problem because of many factors, firstly, that patients are not told that they are being high scored or “red flagged” for innocent behavior.

Here is an example of how a patient can be pressured into rehab for a computer algorithm decided diagnosis of addiction when it is, in fact, normal behavior.

Betty is a pastor’s wife who suffers chronic pancreatitis. On Sept 1, she went to an appointment with a new pain management physician.

Her new physician wanted her to be committed for treatment for SUD based on what the computer told him and the flag it gave him regarding Betty.

When she refused to go, he called her husband and enlisted his help to try to convince Betty to go.

photo from Unsplash @cinestock

How did this happen?

The computer algorithm told her new physician that Betty was an extremely high-risk patient.

It said she was a doctor shopper who went to multiple providers and pharmacies over the past 9 months.

It recommended that she seek treatment immediately.

The physician would not listen to Betty when she attempted to explain what happened in the past 9 months.

Addicts are liars.

What did actually happen?

In January, 9 months previously, Betty had her normal pain management appointment.

Three weeks later she was in a terrible car accident (not her fault) and taken by ambulance to a local hospital.

When she was discharged, four days later, it was a Saturday afternoon, around 5 PM.

The orthopedic physician who treated her broken ankle in the hospital wrote her a prescription for pain medication after he spoke to her pain management physician and they came up with a plan.

Her husband filled the prescription at a Walmart pharmacy because their normal pharmacy was closed.

Betty had her normal pain management appointment in March. She was hospitalized at the end of March with appendicitis that had perforated her bowel.

The GI doc discharged her with a few days of pain medication on top of her pain management after consulting her pain management physician.

The prescription was filled at the hospital pharmacy before they left the hospital.

Betty had her normal pain management appointment in May.

She had an infected root canal removed in June and required extensive dental surgery along with a bone graft in her jaw.

Her oral surgeon prescribed pain medicine after consulting with her pain management physician.

Her husband filled the script for her at the Rite Aid near the dentist office because she was in terrible pain and he wanted her to have the medication for the trip home (a 2-hour drive).

Photo from Twenty20 @inamoment rights to use purchased by author

Betty had her normal pain management appointment in July.

Her physician told her he was retiring.

He gave her a few names of physicians in the area.

Betty made an appointment with the new physician for September. She had all her records forwarded there.

Betty had a flare-up of acute pancreatitis at the beginning of August.

She was hospitalized for three days, then discharged with a 4 day prescription of extra pain medicine from the hospitalist.

Her husband filled the script at the Rite Aid by the hospital because it was the only pharmacy open on Sunday.

Because Betty had five different physicians and five different pharmacies recorded within the past 9 months in her records dispensing prescribed opioids, the algorithm automatically flagged her and recommended rehab — all per the NarxCare programming.

The literature says to “have a discussion”.

From Pexels user thatguycraig

No physician in practice utilizing the NarxCare system is following any of the “recommendations” provided in any of these “guides” past the words; “cut off” or “rehab” that I have heard of, anecdotally.

After all, the entire premise of this is based on the CDC guidelines for opioid prescribing for chronic pain, a voluntary guide for new patients, not existing ones, which have never once been utilized in the way they were written — to include the premise of Narxcare in the first place!

2 Responses

  1. The algorithm does not take into consideration factors such as:
    1. Prescriber turn over in a multi prescriber clinic.
    2. Physicians discharging patients from care and forcing the establishment for care at another clinic.
    3. Prescribers taking maternity leave and a rent-a-doc brought in to fill the spot.
    4. In a multi-prescriber clinic, you may have no control over which prescriber sees you on an office visit.
    5. A change in insurance providers may force a patient to use a different prescriber and and pharmacy.
    6. A medical condition or injury, i.e. surgery, will likely force a change in medication, increasing the dose, which naturally raises the score.
    7. By using an algorithm provided by a private entity, it is considered proprietary and therefore is not subject to review as would be if it originated from a government entity. This I believe should be challenged by ACLU.

  2. What a major violation of patient privacy, and the fact it’s used against the patient is criminal.
    The war against opioids is a good way to raise scores.
    The pharmacist refusals are putting patients in a position where they have no choice but to change.
    Change doctor, health crisis, hospital stay, your doctor is unavailable so you see their partner and boom, the person who was stable and on the same dose for years is a victim of the bogus cdc recommendations, and bogus algorithms says they need rehab. How convenient for the bogus doctor bupe.

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