Two equally bad ways of treating acute pain in elderly ED patients?

https://www.pharmacyjoe.com/two-equally-bad-ways-of-treating-acute-pain-in-the-elderly/

In this episode, I’ll discuss an article comparing IV acetaminophen with IV hydromorphone for acute pain in elderly ED patients.

“Episode 740: Two equally bad ways of treating acute pain in elderly ED patients?” The Elective Rotation pharmacyjoe.com | Critical Care | Hospital Pharmacy | PGY-1 Pharmacy Residency

IV acetaminophen has been a tremendous disappointment when compared to opioids in terms of both efficacy and reducing opioid-related side effects. I have not yet seen a study demonstrating a clinically meaningful improvement of IV acetaminophen over an IV opioid for acute pain. However, there continues to be a desire to find a niche for IV acetaminophen, especially in patient populations at risk for opioid related side effects such as the elderly. To this end a Randomized Study of Intravenous Hydromorphone Versus Intravenous Acetaminophen for Older Adult Patients with Acute Severe Pain was recently published in Annals of Emergency Medicine.

The authors sought to compare the efficacy and adverse event profile of 1,000 mg of intravenous acetaminophen to that of 0.5 mg of intravenous hydromorphone among patients aged 65 years or more with acute pain of severity that was sufficient enough to warrant intravenous opioids.

The primary outcome being investigated was an improvement in a 0 to 10 pain score from baseline compared to 60 minutes after study medication was administered. The secondary outcomes included the need for additional analgesic medication and any adverse events that could be related to the study medication. The authors pre-specified a minimum clinically important difference of an improvement of 1.3 or more on the 0 to 10 pain scale.

The patients enrolled definitely represented a cohort with severe acute pain as the median baseline pain score was 10/10.

After 60 minutes, the patients who received 1000 mg IV acetaminophen improved by 3.6 and the patients who received 0.5 mg IV hydromorphone improved by 4.6 out of 10.

Overall pain relief after 1 dose however was not very good for either group. Almost half of the IV acetaminophen patients required additional doses of an analgesic, as did just over one-third of the patients who received IV hydromorphone.

Adverse events were similar between groups and minimal consisting of dizziness, drowsiness, headache, and nausea.

Unfortunately, it seems that efforts to provide analgesia with lower doses of opioids like 0.5 mg IV hydromorphone or alternatives to opioids like IV acetaminophen cannot reliably provide adequate pain relief in a cohort of elderly ED patients with severe acute pain.

To access my free download area with 20 different resources to help you in your practice, go to pharmacyjoe.com/free.

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Healthcare Has Always Been Political

https://www.daily-remedy.com/healthcare-has-always-been-political/

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Over the last year or more, I have been talking and promoting the use of PGx (pharmacogenomics) DNA testing.  We ran a PGx test that our PCP recommended only to discover that it did not cover opiates –  in discussing this test with our PCP – he was under the false impression that it did.  Not only that but I talked to a Pharmacist at this company, he shared with me some other “short comings” of their testing & reports.  So I found another company that did cover opiates and a total of 200 FDA approved meds… so we did that test  https://www.clarityxdna.com/clarityx-comprehensive-test/

It came back and it suggested that Barb may have some metabolism issues with both of her LA & IR opiates and one of her other medications.  I have shared the report – all 70 pages – with our PCP and my observations & opinions of what it revealed.

But on Barb’s report there was something that was very strange that showed up… Barb was diagnosed with Breast Cancer in 1994 – the end of this month she will be a 28 yr survivor – with breast CA, a woman is not considered “cured” until 10 yrs …

Barb was our Master Fitter/Trainer in our Mastectomy prosthetic center…  We knew that the younger a woman was when diagnosed with breast CA… the more likely it would metastasize to brain/bone/lung/liver and that was typically fatal.  Because of what she saw working with women with breast CA she did self breast exam several times a week…  Her lump became palpable between Sunday and Wednesday and she went for a follow up mammogram on Friday.. which confirmed there was a lump… one of the staff walker Barb from the mammogram center to the surgeon’s office she had used before…  he even skipped lunch – because he was scheduled to go out of town for a seminar..  A biopsy was scheduled for Monday and her lump was malignant and growing at TEN TIMES the normal rate.  A modified radical was scheduled for Wednesday.  Back then, a lumpectomy  was not believed to be a good option.  Her lump was already 1.9 Cm and no lymph nodes were involved… made it a STAGE ONE under the classification used at that time… a 2.0 Cm it would have been classified as a stage-2. She finished several doses of chemo on New Years’ eve of 1994.

Barb was prescribed the normal medication post chemo that was suppose to suppress any further metastasize of the cancer.. with breast CA , 60% of the metastasizes happen within the first 3 yrs.  For Barb this medication cause a significant – almost fatal – side effect – temporary  BLINDNESS and the first time she experienced this – SHE WAS DRIVING ALONE…

Of course, this medication was discontinued IMMEDIATELY…  of course back in 1994, the internet was nothing like it is today- as far as depth of research material.  I read all the FDA available literature… nothing showed up… I contacted our PCP … NOTHING… I contacted her Oncologist … NOTHING… I contact the pharma’s research dept that made this brand name drug … NOTHING…

Back then the pharma Glaxo, was providing a internet bulletin board for pharmacists… it was based at the St Louis College of Pharmacy.. somehow.. I was asked to be one of ELEVEN national moderators for this bulletin board.. and because of this, I was fairly active on this bulletin board.  One of the pharmacist at the St Louis College of Pharmacy was a “informational specialist”… so I was at the end of my resources trying to find out about this seemingly unknown reaction to this med that Barb had experienced.   She was able to locate a obscure article in a England Medical Journal from the 70’s that MENTIONED this side effect with this med.

Now back to where this post started, in Barb’s PGx report – which has three columns …. one column listing meds that she should normally metabolize, second column listing meds that she MAY HAVE metabolism problems with and a third column where meds  SHOULD NOT BE USED – based on the pt’s abnormal liver enzyme issues and the ONLY MED on the 70 pages there was ONE MED LISTED IN THE SHOULD NOT USE COLUMN… and it was this med that Barb had this obscure side effects that almost no literature listed it back in 1995.

Of course our DNA was not fully mapped until the early 2000’s and that is what all this pharmacogenomics testing is based on… but it clearly demonstrates how important this testing can be to some/many/all high acuity pts – sickest of the sick and taking a “boat load” of meds. Everyone needs to remember that what medical science knows about the human system is dwarfed by what it doesn’t know.

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When the first COVID-19 vaccines, came to market… two were made with a – what I considered – a process that was too new and too untested… that was the Pfizer & Moderna based on the mRNA process and the third one was being produced by J&J/Jansen using a process that we had used to make our flu vaccines for decades.  Our Congress passed a law that indemnified the pharmas from any law suits/liabilities of producing those vaccines. Over my 52 yr career, I can’t count all the “new meds” that came to market after 10+ yr of clinical trials only to see them pulled from the market from serious adverse events of people taking the meds, either with other meds the pt was taking and/or other comorbidity health issues the pt had.  I don’t ever remember Congress indemnified any pharma- against lawsuits – when they brought out a new med to market. To me, that was a red flag… and millions of doses being administered under a FDA “emergency use authorization”.  This article dated Aug, 2022, does now – does not recommend the J&J even as a booster – but we got both the initial J&J vaccination and as a booster and WE ARE STILL ALIVE…

There seems to be too much “fuzzy data” being published about the adverse events with these vaccines and they seem to LUMP all the vaccines together, when the J&J vaccine is an entirely different animal than the other two.

We always get our annual flu vaccine – during the optimum time frame – of the last of Sept thru the first couple of weeks in Oct.  Unless something that is published about the “new” COVID-19 vaccines and the only ones made available is made using the mRNA process..  I think that we are going to skip any more COVID-19 vaccines… there appears to be some very effective treatments for anyone testing positive for COVID-19. Everyone can make their own choice to take what seems like what is going to be multiple “jabs” per year in perpetuity.  To me that suggests that these mRNA vaccinations may only be providing a passive immunity that will typically last 60-90 days.

Before We Push the New Omicron Vaccine, Let’s See The Data

https://sensiblemed.substack.com/p/before-we-push-the-new-omicron-vaccine

The White House is pushing Americans hard to take a novel Covid vaccine before the studies are complete.

But where’s the data to support such a sweeping recommendation? The new mRNA vaccines expected to be authorized next month have no clinical trial results that are public. In fact, we know nothing about them. Urging the American people to blindly obey to take a novel mRNA vaccine is not only bad medicine, it’s bad policy. And it’s certainly not following the science.

We just saw this data ambush approach two months ago with the Covid vaccines for babies and toddlers. Here’s how the timeline played out. The White House and public health officials promised them and pushed them hard for children between the ages of 6-months and 5 years. Then vaccine manufacturers released data and declared them safe and effective (the media blindly parroted the message). Here’s the catch. The underlying data actually showed the study sample was too small to make safety conclusions, and most of the claimed effectiveness was statistically invalid. The Pfizer vaccine in babies and toddlers had no statistically significant efficacy. Moderna’s vaccine had an efficacy of just 4% in preventing asymptomatic children aged 6 months to 2 years. (Some European countries have restricted the use of Moderna’s vaccine for anyone under the age of 30 due to the risk of myocarditis). One frustrated CDC official told me the vaccines are so ineffective in young children it wouldn’t matter if you, “inject them with it or squirt it in their face.” Maybe that’s why after a month of pushing Covid vaccination for children under five, only 3% of them got the jab.

Supporters of pushing the new omicron vaccine might point to annual influenza vaccines that are blindly offered each year, but:

1) they use a traditional vaccine platform that has withstood the test of time. In contrast, the novel Covid vaccines have been associated with a serious adverse event rate of 1 in 5,000 doses according to a German study published three months ago by the Paul-Ehrilich Institut. While the National Institutes of health has dedicated over a billion dollars to study long-Covid (which has yielded nothing), its spent virtually no money to investigate Covid vaccine complications, like heart injury in young people.

2) There is currently no scientific consensus that a repeated Covid booster strategy is the right approach. Some scientists are concerned about what is called immune imprinting from multiple booster doses that can weaken the immune system. A recent article published in the journal Science noted a reduced immune response against the Omicron strain among people previously infected who then received three Covid vaccine doses compared to a control group that previously had Covid and did not have multiple shots.

3) The new Omicron vaccine, which is based on earlier Omicron strains, has been tested against newer Omicron strains currently in circulation—a distinct research advantage over studying flu shots. But the results have not been made public. Doesn’t the public have a right to know the results?

It may be that an omicron specific vaccine recommendation for the fall is warranted, but pushing it hard before the data is available makes a mockery of the scientific method and our regulatory process.  In fact, why have an FDA, if White house doctors feel that a new medication would likely benefit public health.

Despite the secrecy surrounding data on the new vaccine, Dr. Jha endorsed the new vaccine in his remarks.  “Based on everything we’ve seen so far, all the data suggests it should be highly effective against the new variants,” Jha said.  

Is that aspirational political talk or a scientific conclusion based on sound data? The distinction is critically important because the public has lost trust in health officials after watching them repeatedly make things up as they go and declare them as truths rather than hypotheses. We need public health leaders to show some humility, stick to the science, and be more transparent with data then they ever have been before. If Jha is following the science, we need to see the data.

Marty Makary MD, MPH is a professor at the Johns Hopkins School of Medicine, the Johns Hopkins Carey Business School, and author of the New York Times bestselling book The Price We Pay.

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When stores, like pharmacies, can’t stay open as promised, it’s time to shop elsewhere

https://www.blueridgemuse.com/node/64327

Often, Floyd’s CVS Pharmacy is closed, without notice, for days at a time . They’re not alone.

A lot of Floyd County residents found themselves without access to needed prescription medications because the pharmacy at CVS on Main Street in the town is closed for a third straight day, citing a failure to have a licensed pharmacist on the premises.

To make matters worse, those who need to save money with lower prices at the Dollar General store a few blocks north are closed as well. Unanticipated closures during normal business hours have become the norm at both stores.

An increasing number of county residents have shifted to The Pharm House, which stays open during its posted hours and provides needed prescriptions, often at better prices while honoring insurance discount cards.

Others tell us that they are now driving to Christiansburg at least once a week to obtain prescriptions at Walmart at better prices. The store is open, as is a CVS location and the pharmacy at Kroger.

“CVS is a pathetic, pitiful operation that leaves people in danger when they can’t provide needed prescriptions on time,” says one resident, who asked not to be identified. Calls to CVS’s headquarters for comment were not returned. Emails, too, were not answered.

The problem is not limited to pharmacists. Pharmacy technicians are quitting at CVS, Walgreens, Rite-Aid, and other locations around the nation, citing increased stress and an inability to keep up with an increasing backlog of prescriptions.

“It got to the point that it was just such an unsafe working environment, where you are being pulled a thousand different directions at any given time,” said technician Heidi Strehl, who worked for Rite-Aid in Pittsburgh for 16 years before quitting in disgust. “You’re far more likely to make a mistake and far less likely to catch it.”

Strehl told NBC News that low wages, few raises, and rude customers were just too much.

“I always thought I would retire from that place,” Strehl said. “But all of the parts of my job that I truly enjoyed over the years had slowly just gone away.”

She’s not alone. The more than 400,000 pharmacy technicians in America work in jobs with little training, even though they are working with serious medications where mistakes can threaten and cost lives Most are paid very little, get few if any raises and have meager benefits.

In Floyd, Dollar General is often closed early or sometimes even all day because of employee shortages, COVID-19, and other problems. Those trying to shop at Dollar General on North Main Street just outside the town limits found a hand-written sign on doors that were locked tight.

The retail chain is facing worker revolts throughout the country. One of Dollar General’s managers in Florida posted a series of Tik Toc videos

INC reports:

Employee hours were severely limited by the company, she said, leading to her or another employee often working alone in the store. Shipments arrived unexpectedly, and with no staff to unpack them, she was forced by company policy to leave boxes stacked up in the aisles, blocking the store shelves and leading to customer complaints.

Sound familiar? The aisles are often blocked in the Floyd Dollar General while some shelves are empty. A call to the company was not returned. Neither was an email request for comment.

Need a prescription or a loaf of bread? Best to call and see if the stores or pharmacy or other retail operation is open.

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This farmer uses NO FERTILIZER…. NO PESTICIDES … MAYBE NO DIESEL TRACTORS

Armed Feds Pay a Visit: Amish Farmer Faces Hundreds of Thousands in Fines

https://www.westernjournal.com/armed-feds-pay-visit-amish-farmer-faces-hundreds-thousands-fines/

Amos Miller, an Amish farmer who runs a holistically managed small farm in Bird-In-Hand, Pennsylvania, grows and prepares food in tune with nature, the way he believes God intended. This seems like a sound idea to the approximately 4,000 customers who purchase Miller’s meat, eggs and dairy products from his private, members-only food club.

The federal government, however, appears to disagree. A federal judge recently ordered Miller to cease and desist all meat sales, Our Organic Wellness reported. U.S. marshals were deployed to search Miller’s property. They inventoried his stock to assure he doesn’t sell or slaughter more animals. In other words, the feds shut Amos Miller down.

Miller claims he is being persecuted by the federal government for practicing his religious freedom to grow and prepare food according to his religious beliefs.

“To believe your own thought, to believe that what is true for you in your private heart is true for all men, — that is genius.” So wrote American philosopher Ralph Waldo Emerson in his influential 1841 essay Self-Reliance. Once upon a time, Americans respected the notion of self-reliance. It was at the heart of the American mythos. Not anymore.

In March, George Lapsley, a court-appointed expert, was to receive “unimpeded access” to Miller’s farm to inspect the facilities, according to Food Safety News. On March 11, Lapsley reported that Mr. Miller did not fully cooperate and requested assistance from the U.S. Marshals Service.

Federal Judge Edward G. Smith of the Eastern District of Pennsylvania then ordered that the USMS was authorized to use whatever reasonable force was necessary to gain entry into the facilities it is authorized to inspect.

Furthermore, according to Food Safety News, the court’s order permited Lapsley to make unannounced visits to Miller’s farm. Presumably, this meant anytime, day or night. Never mind God, Big Brother is here.

If this isn’t an escalation, I’m not sure what would qualify as such.

Why is the USMS authorized to use force on an Amish farmer? The USDA contends Miller is slaughtering meat and poultry animals at these locations and distributing them to other states without federal inspection.

To be fair, in 2016 the U.S. Centers for Disease Control and Prevention reported that an outbreak of listeria had been traced to unpasteurized raw milk produced by Miller’s Farm, as reported by CBS News. The incident occurred in 2014. The “outbreak” impacted two people, one in California and one in Florida. One of them died.

At the time, Miller told CBS News that he was not aware of any health problems. “I don’t know that it was proved it’s on the farm here,” he said.  It’s not clear why it took the CDC two years to conclude that it was.

Whatever the case, that was then. This is now.

In the summer of 2021, Miller was ordered to pay $250,000 for “contempt of court.” He was also told to pay the salaries of the USDA investigators assigned to his case. To avoid going to jail, he was ordered to pay $50,000 upfront as a gesture of “good faith,” as reported by Our Organic Wellness.

The notion of self-reliance can be dangerous.  “To believe that what is true for you in your private heart is true for all men,” can be a green light to nightmare land. The 20th century was full of monsters like Mao, Stalin, Hitler and Pol Pot, who believed they were doing the right thing. Villains don’t often see themselves as the bad guy. They think of themselves as heroes.

All the monsters mentioned above, however, have one thing in common — they vied to replace God with government.

Amos Miller isn’t so audacious. He’s simply trying to do what he believes God intends — be a steward of the earth by growing and naturally preparing food. There’s nothing far-fetched or crazy about that. One might go so far as to say it’s good old common sense.

Miller practices rotational grazing. His cattle are raised on organic pastures, with the chickens following behind to eat bugs from the droppings. Whey-fed pigs then trample the fertilizer back into the earth.

Again, there’s nothing sinister going on on Miller’s farm. He just wants to be left alone to go about his business. He just wants to be self-reliant.

Why would the feds resort to force and heavy fines to bring Amos Miller into compliance? Why is his private business any of their business? If Millers’ customers were getting sick from his products, he’d know about it, because they’d either sue him, make a big stink or quietly spread the word. His business would suffer.

It’s fair to ask if the feds are attempting to squeeze religious belief out of the marketplace. They’ve managed to all but banish it from our public schools. During the pandemic, they attempted to selectively clamp down on churches. There’s a pattern here.

One of my readers shared this today

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I have highlighted several sentences in this article that suggest that the people doing the study were making some  GUESSES …like this one…Patients who die of overdose may have more than one prescribing physician and may overdose on illicitly obtained drugs. Just in one sentence they used the WORD MAY… but these medial examiners are sending letters to docs that ONE OF YOUR PTS – OD/DIED FROM A BENZODIAZEPINE in their toxicology. They converted all benzodiazepine to a “diazepam mg equivalent”.  We all know how accurate all those MME comparison work out. What was the toxicology values of these pts… the typical OD… has 4 to 7 different substances in their toxicology, one typically be the drug ALCOHOL. This study reminds me of all the things  I heard during the COVID-19 primary epidemic … when pts were claimed to have died of COVID-19 … when they really died from their existing comorbidity issues BUT… had tested positive for COVID-19.

Letter on Patient’s Fatal Overdose May Curb Benzodiazepine Prescribing

https://www.medpagetoday.com/publichealthpolicy/healthpolicy/100343

Physicians who received a letter from a medical examiner notifying them of a recent patient’s fatal overdose prescribed fewer benzodiazepines, a secondary analysis of clinical trial data showed.

Daily 2-mg diazepam pill equivalents decreased more in an intervention group that received a medical examiner letter and injunction to prescribe safely compared with a control group (-3.7%, 95% CI -6.9% to -0.5%, P<0.05), reported Jason Doctor, PhD, of the University of Southern California in Los Angeles, and co-authors.

On average, 2.9 fewer 2-mg diazepam pills were dispensed per prescriber per month in the intervention group compared with controls, Doctor and colleagues noted in JAMA Internal Medicine.

“The results of this secondary analysis of a randomized clinical trial suggest that having medical examiners send out letters informing clinicians of a fatal scheduled drug overdose in their practice is a low-cost approach to curtailing the overprescribing of benzodiazepines,” they wrote.

“The observed moderate reductions that were associated with the letter seemed to concentrate among continuing prescriptions, which is what was associated with the increase in benzodiazepine prescribing from 2005 to 2012,” they added.

The report extends the trial’s earlier finding that showed physicians in San Diego County who were informed by the medical examiner of a patient’s fatal overdose from July 2015 to June 2016 prescribed 10% fewer opioids.

These notifications may be effective reminders of the potential harm of opioids and benzodiazepines, observed JAMA Internal Medicine deputy editor Mitchell Katz, MD, of NYC Health and Hospitals, in an editor’s note.

“It is important to understand that the prescribed drugs may have been appropriate and that the patients did not necessarily overdose on the drugs that were prescribed by the physician who received the notification,” Katz pointed out. “Patients who die of overdose may have more than one prescribing physician and may overdose on illicitly obtained drugs.”

“Nonetheless, when we prescribe opioids and benzodiazepines, the risks and benefits to patients should always be weighed,” he continued. “Even appropriately prescribed scheduled drugs may be associated with long-term use and abuse, purchase of illicit drugs, and death owing to overdose.”

In their analysis, Doctor and co-authors assessed the change in benzodiazepines dispensed 3 months before (pre-period) and 1 to 4 months after (post-period) the letters and injunctions were sent. The researchers measured benzodiazepine prescriptions in daily 2-mg diazepam pill equivalents.

Overall, patients of 743 prescribers (353 in the intervention group and 390 in the control group) filled a benzodiazepine prescription during the study period. Alprazolam and lorazepam were the most frequently dispensed benzodiazepines.

In the intervention group, an adjusted average of 76.0 pills monthly were dispensed in the pre-period and 72.3 were dispensed in the post-period. In the control group, adjusted mean monthly pills were 82.9 in the pre-period and 82.0 in the post-period.

There was no significant difference by group in new treatment initiations from pre- to post-period.

One limitation to the study was that it did not evaluate the clinical well-being of patients or physicians in the intervention group, Doctor and colleagues acknowledged.

Other localities, like Los Angeles County and Washington State, have adopted the practice of sending letters to prescribing physicians alerting them of patient overdoses, Katz noted.

“As physicians, we do not always know why patients are no longer coming to see us,” he wrote. “Follow-up information can help us to be better physicians.”

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Lauren Deluca

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Executive Director, Chronic Illness Advocacy & Awareness Group a NonProfit Org.

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I just happened to stumbled on to this while looking for something else…  Maybe I am wrong, but to develop a whole system that comes to a conclusion that a particular person’s risk of being or become addicted when they are taking controlled meds, is based on just using the data on 1523 pts.  Back in the last of 2021, the company that owns Narxcare is Bamboo, which was sold to Equifax  https://apprisscorp.com/press-relea…nsights-llc-to-equifax-in-1-825-billion-deal/.  I have read that all the data collected and maintained by Narxcare has been moved and stored outside of the USA… so that our HIPAA law has no authority over the prohibition of sharing/selling our personal health information.

There is some 330-340 million in our country and it is claimed that abt 100 million are dealing with some sort of chronic pain and as a country we purchase about 4 billion prescriptions per year and I have seen statements that abt 20% of those 4 billion prescriptions are for controlled meds…   that is a sampling of 0.001523 % sampling of the estimated number of chronic pain pts. Ohio has been one of the states with a very high substance abuse and OD rates.

According to this https://www.scrapehero.com/kroger-store-locations/ Kroger has 242 stores in Ohio and 160 stores in Indiana. So the sampling was in < 5% of the Kroger stores in those two states.  There are 88 counties in Ohio and 92 in Indiana.

Peer-Reviewed Study Validates Bamboo Health’s NarxCare as Effective Patient Screening Solution for Opioid Risk

https://bamboohealth.com/news-pr/peer-reviewed-study-validates-bamboo-healths-narxcare-as-effective-patient-screening-solution-for-opioid-risk/

Research funded by NIDA and NIH evaluated Narx Score rating system as compared to World Health Organization ‘gold standard’ for substance screening

BOSTON, October 26, 2021 – Bamboo Health, formerly Appriss Health and PatientPing, a healthcare technology solutions company focused on fostering care collaboration and providing information and actionable insights across the entire continuum of care, has announced that a newly published peer-reviewed study concludes the company’s NarxCare solution is effective as an “initial universal prescription opioid-risk screener.”

The peer-reviewed study was conducted through the National Institute on Drug Abuse’s (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) and funded by the National Institutes of Health’s (NIH) HEAL Initiative. The study’s goal was to evaluate the validity of the NarxCare Narcotic Score as a clinical measure of opioid misuse and substance use disorder. Researchers assessed NarxCare risk thresholds relative to the “gold standard” World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (WHO ASSIST).

“Prescription Drug Monitoring Programs (PDMPs) are critical for pharmacists and clinicians to identify risky prescription medication use, but before our study the association between the Narx Score and other indicators of opioid use or risk had not been externally evaluated,” said Dr. Gerald Cochran, associate professor of internal medicine and director of research for the Program on Addiction Research, Clinical Care, Knowledge, and Advocacy in the Division of Epidemiology at the University of Utah School of Medicine, one of the leaders of the study team. “Our research shows that Bamboo Health’s NarxCare metric is a useful initial screening tool for prescribers to determine whether a patient is at risk for opioid misuse.”

Researchers recruited 1,523 participants from 19 Kroger community pharmacies located in both urban and rural Ohio and Indiana who were picking up prescribed opioids. The study was led by Dr. Cochran. The researchers have no relationship with Bamboo Health.

“This independent peer-reviewed study confirms what we at Bamboo Health have known about NarxCare’s ability to provide prescribers with clinical decision support to assess a patient’s vulnerability to opioid use disorder and misuse,” said Rob Cohen, company president and general manager. “We’re proud of the role our technology plays in helping clinicians and pharmacists make more informed prescribing and dispensing decisions to improve patient safety and health outcomes.”

NarxCare is a clinical decision support tool and care management solution that helps prescribers and dispensers analyze controlled substance data from PDMPs and manage substance use disorder. NarxCare automatically analyzes a patient’s PDMP data and provides risk scores along with interactive visualizations of usage patterns of opioids, sedatives, and stimulants to help identify potential risk factors.

The study used narcotic scores to divide participants into three groups representing low-, moderate- and high-risk for misuse; the thresholds proved clinically useful as a universal screen to advise providers on next steps with the patient, such as further review of the data or an additional screening with the patient.

“Pharmacists and physicians can use the thresholds as calls-to-action to further review details in the patient’s prescription history in conjunction with other relevant patient health information as they attend to the patients,” added Cohen. “The analysis, thresholds, and associated scores are not intended to work as sole determinants of a patient’s potential risk. We instruct our customers and clinician users that the purpose of NarxCare and the PDMP is to support their clinical decisions, not displace them.”

A Narx Score is a set of three-digit numbers that correspond to dispensing information for three different types of controlled substances (prescriptions). A separate score exists for narcotics, sedatives, and stimulants. The scores range from 000 to 999. The third number in the score indicates the number of current dispensations. The first two numbers are calculated based on data from the PDMP, including number of prescribers, number of pharmacies where prescriptions were dispensed, strength of the prescriptions, and overlapping prescriptions. More recent prescriptions and changes are weighted more heavily than older prescribing patterns.

Bamboo Health’s PDMP solutions are used in more than 40 states and territories and are leading the nation in prescription data monitoring.

About Bamboo Health

Bamboo Health, formerly Appriss Health and PatientPing, is a healthcare technology solutions company, focused on fostering care collaboration and providing information and actionable insights across the entire continuum of care. As one of the largest, most diverse care collaboration networks in the country, our technology solutions equip healthcare providers and payers with software, information, and insights to facilitate whole person care across the physical and behavioral health spectrums. By serving 2,500 hospitals, 7,800 post-acute facilities, 25,000 pharmacies, 37 health plans, 45 state governments, and over one million acute and ambulatory providers through more than 500 clinical information systems electronically, we impact over 1 billion patient encounters annually in provider workflow. Health systems, payers, providers, pharmacies, governments, individuals, and other organizations rely on Bamboo Health to improve care and reduce cost. Visit www.BambooHealth.com to learn more.

Study published in Drug and Alcohol Dependence journal

https://www.sciencedirect.com/science/article/abs/pii/S0376871621005627

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