So do you know your Narx Score?
First, what is the Narx Score? How did it come about?
In 2011, a company in Louisville, KY—Appriss—had their first meeting to begin the development of the analytics of PDMP data creating the Narx Score. The Narx Score is a numeric reflection of a patient’s controlled drug use. PMP Interconnect was also launched in 2011 with three states sharing data. In 2014, the patent filed in 2011 for the Narx Score algorithm (NARxCHECK) was transferred to the NABP (National Association of Boards of Pharmacies).
NARxCHECK is a patented algorithm that analyzes controlled substance data from PDMPs and provides insight into a patient’s controlled substance use. NARxCHECK quantifies risk with a 3-digit score, termed a “Narx Score”, which ranges from 000-999. Variables used to get this number include
- Drug equivalents
- Number of providers
- Potentiating drugs (benzos and opioids together)
- Number of pharmacies
- Number of overlapping prescription days
The score is intended to create a composite risk index, which increases as the value of one or more of the risk factors above in a PDMP report increases.
Patient characteristics for the last 60 days, 180 days, year, and 2 years are assessed against a given 2009-2010 PDMP population from Ohio. The more recent data is given more weight in the algorithm than the older prescription patterns. Then the assessment of the patient prescription patterns across the different timepoints are then combined to obtain a final composite score (000 to 999).
Narx Scores are computed separately for 3 different drug types: Narcotics, sedatives, and stimulants. However, a prescription for a narcotic does add to the sedative score, and vice versa.
The distribution of the scores are such that in any given population, 75% will fall below 200, 5% will be above 500, and only 1% will be above 650. The last digit in the score represents the number of active prescriptions that a patient will have if medications are taken as directed.
Concerning Narx Scores are intended to trigger a discussion, not a decision. If a Narx Score raises concern, the recommended course of action is for the practitioner to evaluate the PDMP data and discuss any concerns with the patient. There is no Narx Score that is “normal”. It must be applied to the clinical scenario before evaluating appropriateness. However, for protection of the practitioner, this discussion and decision MUST be documented in the patient record. And I would recommend to patients that if any of the items evaluated above change, these changes and the reasons why should be pointed out to the practitioner at the time of the office visit so they can be documented. Especially the fact that today pharmacies run out or deny refills, so patients have to jump to multiple pharmacies. This can increase your Narx Score and put your practitioner in the DOJ crosshairs.
The Narx Score is calculated as a weighted average of the scaled values. 50% of the weighting is applied to the milligram equivalencies of prescribed drugs and the remaining risk factors make up the other 50%.
There are currently three PMP based indicators:
- More than 5 providers in any year.
- More than 4 pharmacies in any 3-month period
- More than 40 MED average and more than 100 MME total at any time in the previous 2 years.
The Narx Scores were designed such that:
- Patients who use small amounts of medication with limited provider and pharmacy usage will have low scores.
- Patients who use large amounts of medications in accordance with recommended guidelines will have mid-range scores.
- Patients who use large amounts of medications while using many providers and pharmacies and with frequently overlapping prescriptions, will have high scores.
The Narx Score was just introduced to me by an investigating doctor. It was developed after my practice was closed. So I have questions for you. Obviously, if all of the states are using a data algorithm to assess controlled drug use, and most states are using the Narx Score, are patients made aware of their score by their practitioner? When you get your records from your physician or they are transferred to another clinic, are Narx Scores included? Do pharmacies share your Narx Score with you?
Then we get to the more occult thinking. Could Narx scores be the reasoning behind pharmacists refusing to fill a patient’s script? If so, that would be against the basic concept of the purpose of the Narx score.
Please share any experience with this score-keeping method or any other your state might be using. If you’ve never heard of it, you can find out what method your state is using through your pharmacist.
Addendum
The research on the Narx Score was provided by Neil Anand, MD. He was interviewed by The Doctor Patient Forum on Sept 26, 2022. You can listen to his interview HERE.
Linda Cheek is a teacher and disenfranchised medical doctor, turned activist, author, and speaker. A victim of prosecutorial misconduct and outright law-breaking of the government agencies DEA, DHHS, and DOJ, she hopes to be a part of exonerating all doctors illegally attacked through the Controlled Substance Act. She holds the key to success, as she can offset the government propaganda that drugs cause addiction with the truth: The REAL Cause of Drug Abuse.
Get a free gift to learn how the government is breaking the law to attack your doctor: Click here to get my free gift
We were just rudely denied our dog’s benzodiazepines by the new Pharmacist at Safeway Pharmacy where we have been getting it filled for 2 years (our Vet doesn’t carry the medication). We weren’t given a reason why, until we pressed her… She straight up called us drug addicts. Long story short, when we went very public about it, Corporate stepped in and she was fired. The nerve she had on her. Now that we switched pharmacies, our NarxScore went up, lol, making the problem even worse. If you have pets and they are on benzodiazepines or pain meds, it is calculated into your NarxScore. This system is messy. On top of that, police officers can look at your NarxScore and even see what medications you are currently prescribed. I think that’s crazy. Your medical stuff should be between you, your doctor, your pharmacist. That’s it. No one else, including police officers, should not be able to see your stuff without a warrant. It’s like anyone being able to see your credit score, how much money you have in the bank, how much debt you have etc. etc. It’s not right.
If I get pulled over, I don’t want to police officer knowing what psychiatric medication I am on, and what cancer medications I am on. It’s not humiliating, it’s PRIVATE.
I understand the underlying premise of this system, but it’s already broken. If our dog can’t get his medication, who’s to say that they are not going to deny me a medication similar, should I need it in the future? And this whole thing about having to go to another pharmacy because your pharmacy doesn’t have your medication or denies you, the fact that using another pharmacy then works against your score is just a horrible snowball effect. This system is already broken.
I am so glad this is being discussed and it needs to be discussed more openly. Pharmacists in the US have become absolutely vile, and it’s been fascinating to learn why. The insanity of this is that it’s driving up deaths – not only suicides from untreated pain and untreated mental health illnesses, but actual overdoses because most people who truly are struggling with the level of “addiction” (I hate that word because it’s so often used as a judgmental insult, rather than a description of someone struggling) are buying them from sources other than doctors. Cruelty and insanity, but what else can we really expect from American health care
I like to use the words “drug dependant” when referring to a chronic pain patient; this gets away from the “addict” narrative.
I would say that to most people, drug dependant would mean addicted. There isn’t any need to use that term anyway. We need to understand that a person’s chronic use of opioids isn’t any different than a diabetic’s use of insulin or a heart patient’s use of a blood pressure medication.
I take every opportunity to educate people on the distinction between dependence and addiction. They are so different.
That’s true. But the government has dictated that anyone on an opioid is an addict. In current bills in Congress they are changing “abuse” to “use”. If you want the propaganda to end and bring pain management and opioids back, you need to learn what I teach and share with others. No drug causes addiction. We need to repeal the Controlled Substance Act. O/W it will be 2050 before opioids return.
The disconnect between the goal of this algorithm and the actual application of the data by certain providers is absolutely horrendous. My experience with Narx scores is a bit unique, but I have no doubt that other situations exist around the country where the use of these scores utterly degrades the quality of patient care. This is an absolute outrage. And the worst part is that it only makes patients feel more powerless in a system that has already given up striving for patient-centered care.
I work in an extremely remote area of Alaska where we don’t have on-site psychiatry staff at our hospital most of the time — almost all the providers treat patients via telehealth from a third party company based in Minnesota, which claims to “specialize” in healthcare solutions for remote and rural practices. Those who understand how this algorithm assesses “risk factors” may see where this is going already. There is no such thing as a patient having “a” provider here who follows them month to month and can actually establish an ongoing therapeutic relationship. In a year of monthly psychiatry appointments a patient could easily see 10 providers. These providers, most of whom seem to be PAs fresh out of school, do an absolute s**t job of virtually everything they lay their hands on. Their caseloads are ridiculously high, they constantly make mistakes, they don’t communicate with one another about patients, and worst of all, they frequently FAIL to communicate critical information to patients themselves (as in forgetting to tell someone that their next prescription won’t be released without a drug screen, which becomes a completely unnecessary high-stress situation when for the patient later on). And since they don’t know one patient from another — you’d need to see someone more than once or twice for that — they make up for it by allowing Narx scores to do their godforsaken jobs for them. The algorithm developers are clear that this is NOT how it is intended to be used, but it’s obvious that no one is making sure that this doesn’t happen. That ship has sailed here and Narx scores are all these prescribers care about if someone is taking a controlled medication.
So everyone here sees a lot of providers. There’s one “risk factor” that will jack up people’s scores. Here is another: we don’t have a retail pharmacy, only a very small one at the local hospital that does not stock certain medications, including Suboxone. They refuse to order it because there is no one with the DEA certification here who can prescribe it. Well…when I moved up here nine months ago, I was a patient who had been on a stable, low dose of Suboxone for pain management for more than four years. A lot of providers (and every single one of them here) are completely unfamiliar with buprenorphine’s role in pain management, they see if and they automatically think someone was abusing opioids at some point in their lives. (So, at least mentally, there’s another huge “risk factor”). And they refuse to hear otherwise. Anyway…I had no idea when I moved up here that it would be completely impossible for me to obtain this medication through the hospital. My previous provider has been kind enough to continue working with me via telehealth, and I get my Suboxone by mail through CVS Caremark. This has been working great for me…EXCEPT…when it comes to my Narx score, I am using an out-of-state pharmacy to obtain a narcotic, which is a giant red flag. Unfortunately for me, I also have ADHD and my previous provider would only cover a couple of prescriptions of my stimulant after I moved so that I could start seeing someone else here. Making this work has been almost impossible and has been one of the most stressful, infuriating, and stigmatizing experiences of my life.
As far as these providers from Minnesota who “serve” our community are concerned, all they see when they look at me is the following: I am still seeing a provider down in the Lower 48 to get my Suboxone, and I get it from a pharmacy that is separate from the one here in town at the hospital. So, multiple pharmacies + multiple providers = a big problem. They finally pored over my records and agreed to treat my ADHD, and they send the stimulant prescriptions to the hospital pharmacy — almost begrudgingly — and EVERY MONTH when I get a new provider on the phone, I get a the same lecture (which comes out more like a threat) about how high my Narx score is. Why? Because I’m using multiple pharmacies for multiple controlled medications, from more than one provider. BECAUSE I HAVE TO. BECAUSE THERE IS LITERALLY NO OTHER CHOICE and they know EXACTLY why. The most outrageous part of their lectures is that they sit there and tell me that my score is so high because I’m getting my stimulants from a different provider every month. I have no words for how absurd this point is. I literally cannot fathom what is going through their mind when they insist on this lecture time and time again. I’m sure that in any one of these discussions, the provider who met with me at my previous appointment is in the office next door to them.
Really.
I cannot imagine how the data from this godforsaken algorithm could be misused to a greater degree. I can’t. In our town there are a lot of dual relationships when it comes to care — providers treat one another under circumstances that would not be ethical most other places, and the worst part about this is that these people are my colleagues. I am a doctoral level psychologist and share a lot of clients with my own providers. So I go from being lectured and stigmatized and being made to undergo drug screen after drug screen because “it’s policy…” and then I have to turn around and work with them in a professional capacity. And I feel VERY unable to make a complaint because of my position. As I said…my situation might be unique, but if this software can create a problem like this ANYWHERE, someone needs to start paying attention to what’s happening. You CANNOT substitute a number for sound medical decision making.
I’m sorry for your predicament, but you are there because people don’t get on the train that can bust through the wall. The answer, as I keep saying, is to teach people the REAL cause of drug abuse, and it isn’t the drugs. This is available right here on Doctorsofcourage. And to get the word out to everyone, we need support. So if you want to see change, you know what to do. http://www.doctorsofcourage.org/membership-levels/ and get me to speak virtually to the group you see through http://www.lindacheekmd.com. Otherwise, you can probably bet that your current regimen will be short-lived as more doctors are attacked for money.
This is SO true! I use a local walk-in clinic as my PCP. I chose this clinic because they have extended hours and they were close to my workplace. The NP that prescribes my medication can change depending on who is on shift the day of your visit. I also have four specialists, and I try to obtain medicine at the most affordable pharmacy. One day a pharmacist rudely commented that I had too many doctors. I thought I was doing the appropriate thing by going to a specialist to get the best medical care for my conditions. Apparently, I was killing my PMP score. I wondered why people treated me as if I was “seeking”. I HATE taking medication, so it does seem condescending and judgmental when a provider treats you like you’re a manipulative person. I wish providers would have an honest discussion with patients so a patient can explain WHY things look like they do. Instead, they use a number without regard for clinical information. They’re not even interested in having an accurate medication list! Perhaps something is prescribed but I’m not taking it because of an adverse reaction? It’s crazy, and it leaves someone with true pain undertreated with no options to give a true reflection of the situation. If you go get a second opinion, you look even worse! I was an x-ray/lab tech for almost 20 years. Now I’m talked to as if I need psychological treatment. Recent receipt of my medical records is the only way I knew how bad this looked. Ugh.
So what are you doing to change that? The answer is here on Doctorsofcourage. Learn it, pass it on. No drug causes addiction and we need to repeal the Controlled Substance Act. People need to earn the REAL cause and address that!
How is this legal, don’t Hippa laws come into play? If a patient hasn’t authorized sharing personal information the company should not have it.
Also why can’t a patient access the data base and find out their individual score?
Sounds like someone came up with a cheap money making scheme!
That’s a very good question. And I don’t know the answer. But it isn’t a “cheap” money making scheme. Appriss just sold their business for 1.8 billion.
So I went through the calculation tool, and it seems if you have 1 doctor, 1 pharmacy and take 90mme, the lowest you can get your score is 700.
Also, how is this supposed to be helpful when a patient is punished, for 2 years, if a pharmacy happens to be out of drug? That’s nonsensical.
Since when did a piece of paper and some idiots IDEAS cancel the HUMAN SUFFERINGS PAIN!. THIS NEEDS TO BE OUTLAWED.
I agree!!
Wouldn’t you need to consent to this company/algorithm to gain access to your medical records or history?
The algorithm is being used behind your back. You have access to the data that compiles your “record” and this is one. You don’t have to consent to them using it to find out yours.
Not to mention, I forgot to say, that anybody who’s unlucky enough to have gotten into several car accidents or needed surgeries one after the other is also screwed. Unlucky people are screwed. I mean 100 mme over a period of 2 years is insane. There goes anybody who’s ever needed a rotator cuff surgery. Or anyone who’s ever had major surgery like an open heart or removal of cancer. You are literally denying care by using this score and patience are never told about it. we’re never told about something that directly affects our medical care and we are never given the score even though that should be considered our medical records as well.
If I were you I would do the following:
1. Find out what data algorithm is used in your state.
2. Find out, as the patient involved, how you would go about getting your Narx score (or its equivalent) and find out if you can get a list of anyone who has queried the system for your score.
3. If any (or all) of the providers and pharmacies you’ve tried to use have queried the system, and didn’t discuss it with you, I would try to find a lawyer to sue them all individually.
4. Check with ACLU, as this is a constitutional question that affects many people, and they might find it suits their requirements.
5. Try to find others who have been treated the same way, and try to get a class action going against the company profitting off of the algorithm, or the Nat’l Assoc. of Boards of Pharmacy.
BTW, lyme disease is a function of dysbiosis and can be cured through the Seven Steps to Healing.
I just moved to Texas. Because I had to spend time giving the fact that I have Lyme disease and most doctors don’t even believe that’s real, looking for doctors. Conveniently enough even though I have never been spoken to about a narx score, I have been dropped by my pain care and now literally every kind of doctor refuses to see me. Not just pain doctors. I believe that the reason behind this is because my doctor uncomfortable with the fact that I was taking short-term medication, decided he wanted to try other things. Never mind that I was perfectly comfortable where I was at. He kept putting me on medications and dosages that did not work. And then I would call and tell him they’re not working and he would put me on something else. This happened over a period of 6 months, so many different drugs. All because I was willing to try other things. But because of the overlapping drugs, never mind that I gave them all of the ones that I had not used anytime medication was changed, because of the fact that I have been searching for doctors and pharmacies that I liked and that were helpful for a hard to treat disease, because my pharmacy refused filling medications and I had to switch pharmacies. Because of all of these things that had nothing to do with me at all, I now can’t get care. Of any kind. Mark my words that this is genocide. What they’re doing will result in genocide and it already has. What they don’t tell you is that since the narx score has been put into effect, suicides have gone up by 20% and illicit drug use by 40%. not to mention that literally anybody with a chronic pain issue Or for that matter of chronic health issue will eventually have a high score because you are marked negatively for having an illness that they don’t know how to treat. Anybody who Is in the military or who is married to somebody who’s in the military will be screwed because they move so often. And if you have ever been depressed, even if it wasn’t an actual diagnosable depression, if you feel sad sometimes and you feel anxiety sometimes which, you do, no matter who you are and especially if you’ve been sick for 15 years getting consistently worse and getting no help from doctors, then you are penalized. There are so many things about this that fly in the face of our supposedly free country and completely negate the Constitution. The people who should be going to jail are the ones who created this and the ones who are implementing it.
I heard about this from a chronic pain blog, and later overheard my sister (who is an ANP) mention a score in a conversation with a coworker. So, apparently providers take them seriously. I have never been told of their existence by any of my healthcare providers or pharmacists- this makes me even more angry- like it is some super stealth spyware they keep amongst theirselves…
Thanks for the input. Hopefully more will respond to see just how transparent this oversight is. When I practiced, the PDMP was new in my state, but I used it. And I went over it with my patients on their initial visit and rechecked it quarterly.