Elizabeth Amirault had never heard of a Narx Score. But she said she learned last year the tool had been used to track her medication use.
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During an August 2022 visit to a hospital in Fort Wayne, Indiana, Amirault told a nurse practitioner she was in severe pain, she said. She received a puzzling response.
Your Narx Score is so high, I cant give you any narcotics, she recalled the man saying, as she waited for an MRI before a hip replacement.
Tools like Narx Scores are used to help medical providers review controlled substance prescriptions. They influence, and can limit, the prescribing of painkillers, similar to a credit score influencing the terms of a loan. Narx Scores and an algorithm-generated overdose risk rating are produced by health care technology company Bamboo Health (formerly Appriss Health) in its NarxCare platform.
Such systems are designed to fight the nations opioid epidemic, which has led to an alarming number of overdose deaths. The platforms draw on data about prescriptions for controlled substances that states collect to identify patterns of potential problems involving patients and physicians. State and federal health agencies, law enforcement officials, and health care providers have enlisted these tools, but the mechanics behind the formulas used are generally not shared with the public.
Artificial intelligence is working its way into more parts of American life. As AI spreads within the health care landscape, it brings familiar concerns of bias and accuracy and whether government regulation can keep up with rapidly advancing technology.
The use of systems to analyze opioid-prescribing data has sparked questions over whether they have undergone enough independent testing outside of the companies that developed them, making it hard to know how they work.
Lacking the ability to see inside these systems leaves only clues to their potential impact. Some patients say they have been cut off from needed care. Some doctors say their ability to practice medicine has been unfairly threatened. Researchers warn that such technology despite its benefits can have unforeseen consequences if it improperly flags patients or doctors.
We need to see what’s going on to make sure we’re not doing more harm than good, said Jason Gibbons, a health economist at the Colorado School of Public Health at the University of Colorados Anschutz Medical Campus. We’re concerned that it’s not working as intended, and it’s harming patients.
Amirault, 34, said she has dealt for years with chronic pain from health conditions such as sciatica, degenerative disc disease, and avascular necrosis, which results from restricted blood supply to the bones. Email Sign-Up
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The opioid Percocet offers her some relief. Shed been denied the medication before, but never had been told anything about a Narx Score, she said.
In a chronic pain support group on Facebook, she found others posting about NarxCare, which scores patients based on their supposed risk of prescription drug misuse. Shes convinced her ratings negatively influenced her care.
Apparently being sick and having a bunch of surgeries and different doctors, all of that goes against me, Amirault said.
Database-driven tracking has been linked to a decline in opioid prescriptions, but evidence is mixed on its impact on curbing the epidemic. Overdose deaths continue to plague the country, and patients like Amirault have said the monitoring systems leave them feeling stigmatized as well as cut off from pain relief.
The Centers for Disease Control and Prevention estimated that in 2021 about 52 million American adults suffered from chronic pain, and about 17 million people lived with pain so severe it limited their daily activities. To manage the pain, many use prescription opioids, which are tracked in nearly every state through electronic databases known as prescription drug monitoring programs (PDMPs).
The last state to adopt a program, Missouri, is still getting it up and running.
More than 40 states and territories use the technology from Bamboo Health to run PDMPs. That data can be fed into NarxCare, a separate suite of tools to help medical professionals make decisions. Hundreds of health care facilities and five of the top six major pharmacy retailers also use NarxCare, the company said.
The platform generates three Narx Scores based on a patients prescription activity involving narcotics, sedatives, and stimulants. A peer-reviewed study showed the Narx Score metric could serve as a useful initial universal prescription opioid-risk screener.
NarxCares algorithm-generated Overdose Risk Score draws on a patients medication information from PDMPs such as the number of doctors writing prescriptions, the number of pharmacies used, and drug dosage to help medical providers assess a patients risk of opioid overdose.
Bamboo Health did not share the specific formula behind the algorithm or address questions about the accuracy of its Overdose Risk Score but said it continues to review and validate the algorithm behind it, based on current overdose trends.
Guidance from the CDC advised clinicians to consult PDMP data before prescribing pain medications. But the agency warned that special attention should be paid to ensure that PDMP information is not used in a way that is harmful to patients.
This prescription-drug data has led patients to be dismissed from clinician practices, the CDC said, which could leave patients at risk of being untreated or undertreated for pain. The agency further warned that risk scores may be generated by proprietary algorithms that are not publicly available and could lead to biased results.
Bamboo Health said that NarxCare can show providers all of a patients scores on one screen, but that these tools should never replace decisions made by physicians.
Some patients say the tools have had an outsize impact on their treatment.
Bev Schechtman, 47, who lives in North Carolina, said she has occasionally used opioids to manage pain flare-ups from Crohns disease. As vice president of the Doctor Patient Forum, a chronic pain patient advocacy group, she said she has heard from others reporting medication access problems, many of which she worries are caused by red flags from databases.
Theres a lot of patients cut off without medication, according to Schechtman, who said some have turned to illicit sources when they cant get their prescriptions. Some patients say to us, Its either suicide or the streets. Elizabeth Amirault of Indiana has dealt with chronic pain for years. She believes a tool that tracks her prescription drug use negatively influenced her ability to get the medication she needs. (Nicholas Amirault)
The stakes are high for pain patients. Research shows rapid dose changes can increase the risk of withdrawal, depression, anxiety, and even suicide.
Some doctors who treat chronic pain patients say they, too, have been flagged by data systems and then lost their license to practice and were prosecuted.
Lesly Pompy, a pain medicine and addiction specialist in Monroe, Michigan, believes such systems were involved in a legal case against him.
His medical office was raided by a mix of local and federal law enforcement agencies in 2016 because of his patterns in prescribing pain medicine. A year after the raid, Pompys medical license was suspended. In 2018, he was indicted on charges of illegally distributing opioid pain medication and health care fraud.
I knew I was taking care of patients in good faith, he said. A federal jury in January acquitted him of all charges. He said hes working to have his license restored.
One firm, Qlarant, a Maryland-based technology company, said it has developed algorithms to identify questionable behavior patterns and interactions for controlled substances, and for opioids in particular, involving medical providers.
Thecompany, in an online brochure, said its extensive government work includes partnerships with state and federal enforcement entities such as the Department of Health and Human Services Office of Inspector General, the FBI, and the Drug Enforcement Administration.
In a promotional video, the company said its algorithms can analyze a wide variety of data sources, including court records, insurance claims, drug monitoring data, property records, and incarceration data to flag providers.
William Mapp, the companys chief technology officer, stressed the final decision about what to do with that information is left up to people not the algorithms.
Mapp said that Qlarants algorithms are considered proprietary and our intellectual property and that they have not been independently peer-reviewed.
We do know that there’s going to be some percentage of error, and we try to let our customers know, Mapp said. It sucks when we get it wrong. But we’re constantly trying to get to that point where there are fewer things that are wrong.
Prosecutions against doctors through the use of prescribing data have attracted the attention of the American Medical Association.
These unknown and unreviewed algorithms have resulted in physicians having their prescribing privileges immediately suspended without due process or review by a state licensing board often harming patients in pain because of delays and denials of care, said Bobby Mukkamala, chair of the AMAs Substance Use and Pain Care Task Force.
Even critics of drug-tracking systems and algorithms say there is a place for data and artificial intelligence systems in reducing the harms of the opioid crisis.
It’s just a matter of making sure that the technology is working as intended, said health economist Gibbons. Andy Miller: amiller@kff.org, @gahealthnews
Sam Whitehead: swhitehead@kff.org, @sclaudwhitehead Related Topics Pharmaceuticals Health IT Indiana Michigan North Carolina Opioids Contact Us Submit a Story Tip
Lisa Nandy, the culture secretary, is to sign off the appointment of a chair of English football’s new referee within days.
Sky News has learnt that David Kogan, a media industry veteran who has helped negotiate a string of television rights deals across the sport in recent decades, is to be formally approved as chair of the Independent Football Regulator (IFR).
Whitehall sources said an announcement could be made by the Department for Culture, Media and Sport (DCMS) as soon as this week, although they added that the timetable could slip by a few days.
Once approved, Mr Kogan is expected to face a committee of MPs for a confirmation hearing early next month, the sources added.
Sky News revealed last weekend that Mr Kogan had emerged as the frontrunner for the post after an earlier shortlist of three candidates was passed over.
The new regulator has the firm backing of Sir Keir Starmer, and is a key element of legislation currently passing through Parliament.
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Mr Kogan, whose boardroom roles have included a directorship at state-owned Channel 4, was initially approached during a previous recruitment process launched under the last Conservative administration.
He has some links to Labour, having in the past donated money to a number of individual parliamentary candidates, chairing LabourList, the independent news site, and writing two books about the party.
Mr Kogan has had extensive experience at the top of English football, having advised clients including the Premier League, English Football League, Scottish Premier League and UEFA on television rights contracts.
Last year, he acted as the lead negotiator for the Women’s Super League and Championship on their latest five-year broadcasting deals with Sky – the immediate parent company of Sky News – and the BBC.
His current roles include advising the chief executives of CNN, the American broadcast news network, and The New York Times Company on talks with digital platforms about the growing influence of artificial intelligence on their industries.
In recent months, Sky News has disclosed the identities of the shortlisted candidates for the role, with former Aston Villa FC and Liverpool FC chief executive Christian Purslow one of three candidates who made it to a supposedly final group of contenders.
Image: Secretary of State for Culture, Media and Sport Lisa Nandy. File pic: Reuters
The others were Sanjay Bhandari, who chairs the anti-racism football charity Kick It Out, and Professor Sir Ian Kennedy, who chaired the new parliamentary watchdog established after the MPs expenses scandal.
The apparent hiatus in the appointment of the IFR’s £130,000-a-year chair threatened to reignite speculation that Sir Keir was seeking to diminish its powers amid a broader clampdown on Britain’s economic watchdogs.
Both 10 Downing Street and the Department for Culture, Media and Sport (DCMS) have sought to dismiss those suggestions, with insiders insisting that the IFR will be established largely as originally envisaged.
The creation of the IFR, which will be based in Manchester, is among the principal elements of legislation now progressing through parliament, with Royal Assent expected before the summer recess.
The Football Governance Bill has completed its journey through the House of Lords and will be introduced in the Commons shortly, according to the DCMS.
The regulator was conceived by the Tories in the wake of the furore over the failed European Super League project, but has triggered deep unrest in parts of English football.
Its creation forms part of a process that represents the most fundamental shake-up in the oversight of English football in the game’s history.
The establishment of the body comes with the top tier of the professional game gripped by civil war, with Abu Dhabi-owned Manchester City at the centre of a number of legal cases with the Premier League over its financial dealings.
The Premier League is also keen to agree a long-delayed financial redistribution deal with the EFL before the regulator is formally launched, although there has been little progress towards that in the last year.
“We do not comment on speculation,” a DCMS spokesperson said when asked about the impending announcement of Mr Kogan as the IFR chair.
“No appointment has been made and the recruitment process for [IFR] chair is ongoing.”
In the sportscar world, there is much discussion about retaining the “purity” of the sputtering, underperforming gas-guzzling engines of yesteryear. After a drive in Everrati’s Porsche 911 restomod, you’ll be ready to embrace the present and see just how much the drive experience can improve with modern technology.
There has been a lot of discussion about “purity” of the driving experience related to EVs. Some decry the “numb” feeling of the consumer-focused EVs they’ve driven, and think that this is indicative of some wider impossibility to provide an engaging drive experience in an electric vehicle.
But of course, when you compare a modern jellybean SUV, regardless of powertrain, with a purpose-built sportscar, there are going to be some differences in drive dynamics that aren’t flattering to the SUVs.
So lets make that comparison a little more fair. Let’s take an actual sportscar, a Porsche 911 (964) RSR, updated to the present day with an electric powertrain, and see just how much that “purity” in drive experience can be carried over with intentional effort, rather than kowtowing to perceptions of current market trends.
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For some background on myself, I started driving EVs with the original Mini E, which was merely a retrofit vehicle with the back seats replaced by a giant stack of batteries. It was a bit of a kludge, but I still fell in love with it largely due to the strengths of electric propulsion.
I then went on to buy an original Tesla Roadster, one of the few true sportscars out there that runs on electricity, so I’ve got more experience than most in small electric two-seaters.
There are certainly a lot of high-performance EVs these days, but most of them are hefty (4,000-5,000 lbs or more), 4-5 seaters with all-wheel drive (my toxic trait is that as far as I’m concerned, if it isn’t rear wheel drive, it isn’t really a sportscar).
So imagine my enthusiasm when I was offered a drive in a custom-built electric Porsche 911 (as long as Porsche refuses to make one itself…).
So, I headed down to Crystal Cove in Newport Beach, California, to meet Everrati CEO Justin Lunny and take this thing for a spin, to see what this real electric sportscar can do – and lets just say there might be a new entry on my lottery ticket shopping list.
Everrati is a UK-based company that does electric restomods of several vehicles, including the Porsche 911, Mercedes-Benz W113 Pagoda, Land Rover Series IIA and Ford GT40.
The company has completed 20 cars so far, with Porsche 911s being the most popular vehicle to convert.
I caught Lunny charging the Porsche as I pulled up, at a 50kW charging station. It has two charging inlets – one in the rear, under the trunk, which does DC or AC charging, and one in the front, using the 911’s original fuel door, which only does AC charging. The car is capable of 70kW charge rates, and while we don’t know what its charge curve looks like, that should mean 30-45 mins for a 10-80% charge.
The vehicle I drove is a 911 (964) RSR, created by Everrati as a commission, as many of its vehicles are. The vehicle still has a few finishing touches that need to be put on it, but otherwise was mostly complete. As a commission, the buyer was able to customize various aspects of the vehicle (including, for example, charge port location).
The interior of the vehicle is nicely finished, with everything redone from the original, but still in retro style. Gauges, knobs and switches are all in a similar style to the original, though a small single-DIN CarPlay headunit betrays the modernization under the hood.
It’s a two-seater, with some room behind the seats for some bags, but no seatbelts or room for people due to the rollbar. And the seats are heavily bolstered, locking you into position for when you whip it through corners. This is a real sportscar, it’s not just masquerading as one.
On a weekday on public roads, there wasn’t much opportunity to really open up the car or get in too much trouble, but the California weather and scenery were exactly what you’d expect. Our drive went up and down PCH and through some canyons, with a quick dip onto the freeway.
The amount of trouble we could get into was also limited by the car’s excellent handling. With a light weight and wide tires (295s on the rear, 30mm wider than the originals), the car felt extremely planted wherever we took it.
Now that’s a wide stance
Everrati says that it’s important to maintain the weight of every vehicle it releases, and that it tries to ensure that its restomods don’t come out heavier than the original vehicle. It says this restomod is about 40lbs lighter than a 964 turbo (though that would make it heavier than the original RSR, which had significant weight-savings applied).
Despite the addition of a chunky 62kWh battery pack (range ~200 miles), Everrati says it was able to keep weight down by replacing several body panels with carbon fiber, in cooperation with Aria group, a contract manufacturer in Irvine, CA. Aria group works with Singer, the highly regarded Porsche restomodder – and is also helping TELO produce its tiny electric truck.
There’s no room in the trunk full of batteries… but that’s normal for a 911. A “frunk” exists, but is tiny.
Everrati even went to the effort of ensuring weight distribution is similar to the original 911.
Famously, 911s are one of few cars designed with a rear-mounted engine, whose weight hangs behind the rear axle. From an engineering perspective, this is simply the wrong way to design a car – you want to reduce the car’s moment of inertia, which means bringing any heavy components as far inboard as possible.
Everrati did bring the motor slightly inboard of where the 911’s engine is, but it’s still placed behind the rear axle, maintaining the 911’s historically weird handling. And 70% of the car’s batteries are in the rear, to keep it rear-heavy.
In our drive test, the handling certainly didn’t feel heavy and felt extremely well-balanced, so we think Everrati did a good job here.
Steering is something else that Porsche has always been praised for. Everrati tried to maintain the steering feel of the original, with only light power assist leading to a heavy steering feel.
This was welcome to me, as my Roadster has manual steering, with no power assist at all. So I’m used to having to crank a small wheel around. The steering had a little bit of “play” in the wheel, which I imagine owes to its early 90s heritage (though still much tighter than the classic Bronco restomod I just drove prior), but otherwise felt exactly how I wanted it to – a relatively quick steering ratio with plenty of feeling transmitted to the driver.
But it has also managed to roughly double the horsepower from the original Porsche it was based on. Everrati says its restomod can produce about 500 horsepower, compared to the ~300 horsepower of even the racing version of the 964 911.
How it looks from underneath – a Tesla drive unit mounted just behind the axle
As is the case with Everrati’s vehicles, its drive software was customized for the customer in question. The customer asked for a drive experience that closely mirrored the original Porsche it was based on, so it wasn’t as “punchy” as some of today’s most powerful EVs, like Tesla’s Plaid Model S or the Turbo edition of Porsche’s Taycan and Macan EVs.
I liked this, myself, as I do think that we’ve gotten a little too punchy these days and lost the linearity I appreciate out of the throttle pedals in the Roadster and original RWD Model 3.
It also had virtually no off-throttle regen, instead placing the regenerative braking on the pedal. This is a sticking point for me, as I prefer one-pedal driving with strong off-throttle regen like many longtime EV drivers who have experienced it, so I’m glad that Everrati said it could offer something like that for customers who request it.
Speaking of brakes, the brake pedal, to me, felt a little soft. This could have been due to the tuning of the regenerative braking system, and also could surely be modified to an owner’s desires. I never did any particularly hard braking events that would have needed to engage the car’s friction brakes, but I just would have liked a little touchier brake pedal.
We also had a quick stop for a shake at the nearby Crystal Cove Shake Shack, and impressed some onlookers from the surrounding all-too-wealthy area. We caught several passers-by checking the car out, and they were quite surprised to learn that the classic Porsche they were looking at (otherwise not too rare of a sight in “New Porsche Beach”…) was electric.
Overall, this restomod is better put together than any I’ve seen or felt, and drove fantastically well.
I am often disappointed in some way by the EVs that I test drive, because they’re just not as fun to drive as the EVs that I’ve spent all my time in (Mini E, Tesla Roadster and Model 3). There’s often something missing, or something different, which may or may not have a good reason for being how it is, but at the end of the day it just makes the car less appealing to me than the EVs that I really love.
Not so with the Everrati. While I’d tune a couple things differently myself, this thing felt great. Just absolutely top tier. I just had to keep interrupting myself while talking to Lunny during my test drive, telling him how great this car felt. Just fantastic.
And that leads us back to the beginning – whether an EV can offer a “pure” driving experience. While taking this thing up and down PCH, through canyons, on a perfect Southern California day, without any of the rumbling, noise, or delayed shifting of gears needed from a traditional ICE engine.
There’s nothing to get between you and driving, and all the sensory experiences that motion entails. The car did what I wanted, when I wanted, and felt and looked great doing it. That sounds like as pure a driving experience as one can find.
As for the price? Well… “if you have to ask, you can’t afford it.” Everrati’s website doesn’t list prices, rather listing it as “POA” (price on application) and having a “let’s talk” button to reach out. The car we drove cost around $450k – on top of the donor car, which can’t have been cheap to begin with.
So, if you happen to have recently found that bitcoin drive you misplaced in 2011, now you know what to do with it.
If you’d like to read more (and see more photos) head on over and take a look at Everrati’s brand book, with lots of pretty pictures of the company’s vehicle projects.
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U.S. Department Secretary of the Interior Doug Burgum looks on during CERAWeek in Houston, Texas, U.S., March 12, 2025.
Kaylee Greenlee | Reuters
OKLAHOMA CITY — The Trump administration is considering investing in companies that mine and process critical minerals in an effort to end U.S. dependence on imports from countries including China, Interior Secretary Doug Burgum said this week.
“We should be taking some of our balance sheet and making investments,” Burgum said late Wednesday at a conference organized by the Hamm Institute for American Energy. “The U.S. may need to make an “equity investment in each of these companies that’s taking on China in critical minerals,” he said.
China dumps minerals on international markets, collapsing prices and making it difficult for U.S. companies to compete, Burgum said. “You’re competing against state capital because China is picking these strategically as areas that they want to invest in,” Burgum said.
The U.S. could use a vehicle like a sovereign wealth fund to invest in domestic miners focused on extracting and processing critical minerals, he said. “Why wouldn’t the wealthiest country in the world have the biggest sovereign wealth fund,” the Interior Secretary said.
Retaliatory export controls
Beijing earlier this month imposed export controls on rare earth elements — a subset of critical minerals —in retaliation for President Donald Trump’s decision to hike tariffs on goods made in China. Rare earth elements are used in key industries including defense, energy and automobiles. The U.S. imported 80% of the rare earths it used in 2024, according to the U.S. Geological Survey. About 70% of U.S. rare earth imports came from China in 2023.
“We have to get back in the game,” Burgum said, referring to mining. “It’s not just drill, baby, drill. It’s mine, baby, mine. If we don’t do that as a country, we will not be successful. We will literally be at the mercy of others that are controlling our supply chains.”
The Trump administration is also considering a sovereign risk insurance fund to guard companies that invest in approved projects against changing political winds in Washington, he said. If a future president cancels a project through executive fiat, companies would be paid back from the fund, Burgum said.
“Think of it like an insurance market that would be backed by the federal government,” Burgum said. “You got to write a check. There’s got to be a financial cost if you’re going to do these decisions where you’re destroying our balance sheet or destroying a company’s opportunity,” he said.
The U.S. needs to stockpile key critical minerals through a mechanism similar to the strategic petroleum reserve, Burgum said. When China dumps minerals on global markets and prices plummet, the U.S. should buy those minerals and stockpile them, he said.
“Those three things would put us in the game around critical minerals — the stockpiling, the sovereign risk insurance and the ability to take an equity position. We’re working on all three of those,” he said.