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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

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Landeskog: 1st game in 3 years ‘a memory for life’

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Landeskog: 1st game in 3 years 'a memory for life'

DENVER — Colorado Avalanche captain Gabriel Landeskog took the ice in his first NHL game in nearly three years Wednesday night in a 2-1 overtime loss to the Dallas Stars in Game 3 of their first-round series.

It marked his first NHL appearance since June 26, 2022, when he and the Avalanche beat Tampa Bay to win the Stanley Cup. He had been sidelined because of a chronically injured right knee.

Landeskog started alongside Nathan MacKinnon and Martin Necas. He played just over four minutes in the first period, making an immediate impression in Game 3 by hitting Stars forward Mikko Rantanen, who used to be Landeskog’s teammate. He had no shots on goal but finished with a team-leading six hits in 13:16 of ice time.

The Stars took a 2-1 series lead.

“Felt great in all areas tonight in terms of being back,” Landeskog said. “Very special night regardless of the outcome.”

It was an emotional lead-up to the game for Landeskog. There were the ovations from the crowd, and chants of “Landy, Landy, Landy.” There were signs all over the arena, including one held up by his kids that read, “So proud of you Daddy!” The team also played a video tribute, with Landeskog tapping his heart in appreciation.

Landeskog said he felt “blessed and very fortunate” to be embraced by the crowd.

“I don’t know exactly what was going through my mind and body at that time, but it was pretty special, and that’s a memory for life. Simple as that,” Landeskog said. “Avs faithful, they make it special, you know? It’s a special place to play, it’s a special place to live and raise a family. And obviously the last three years have been difficult at times. And to come back and feel that love, I mean, incredible. So it means a lot.”

Landeskog said Rantanen welcomed him back when the two lined up for the opening faceoff Wednesday night.

“Regardless of what jersey he wears I love him. He’s a good friend of mine,” Landeskog said of Rantanen after the game. “But in this series, we’re obviously not friends when we’re playing. But obviously very special to be out there for that.”

It was Landeskog’s first game with the Avalanche in 1,032 days. He became the fifth player in NHL history — among those with a minimum of 700 games played — to return to his team after 1,000 or more days without a game, according to NHL Stats. The last one to do so was longtime Avalanche forward and Hall of Famer Peter Forsberg.

“I feel surprisingly calm and in control right now. I know the butterflies and the nerves will come, I’m sure,” Landeskog said during a pregame interview. “I found myself thinking about this moment a lot over the last three years. And now that it’s here, it’s the reverse — I’m thinking a lot about the hard work that’s gone into it, some of the ups, a lot of the downs, sacrifices and support I’ve had along the way.

“Thankful for everybody and all their support, but now it’s go time so I’m excited to get out there.”

Landeskog’s presence on the ice figured to provide a big boost not only for his teammates but the capacity crowd. His No. 92 sweater is a frequent sight around the arena.

The noise in the building was loud, the energy was electric.

“Everyone is rooting for him. It’s a great comeback story,” Avs coach Jared Bednar said after morning skate. “I trust in Gabe’s preparation, and what I’m seeing with my own eyes that he’s getting close and ready to play. I think he feels really good about where he’s at.

“Adding him back into our locker room, he’s almost an extension of the coaching staff, but he’s still one of the guys and the guy that everyone looks up to. You can’t get enough of that this time of the year.”

Landeskog’s injury dates to the 2019-20 season when he was accidentally sliced above the knee by the skate of teammate Cale Makar in a playoff game against Dallas. Landeskog eventually underwent a cartilage transplant procedure on May 10, 2023, and has been on long-term injured reserve.

He was activated Monday before Game 2 in Dallas and skated in pregame warmups but didn’t play.

Stars forward Matt Duchene was teammates with Landeskog, and they remain good friends.

“We’ve been rooting for him to come back,” said Duchene, who was the No. 3 pick by Colorado in 2009. “Obviously, it makes our job harder having a guy like that out there, but on the friends side, the human side and the fellow athlete side, I think everyone’s happy to see the progress he’s made. … I’m just really happy that he’s gotten to this point.”

It doesn’t mean the Stars will take it easy on Landeskog — or him on them.

“It’s remarkable he’s coming back, if he’s coming back, as a friend,” said Rantanen, a 2015 first-round pick by Colorado before being traded in January to Carolina and on to Dallas in March. “As an opponent, obviously, no mercy.”

The 32-year-old Landeskog recently went through a two-game conditioning stint with the American Hockey League’s Colorado Eagles. He practiced with the Avalanche leading up to their playoff opener.

The Associated Press contributed to this report.

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Coach: Oilers ‘gift-wrapping opportunities’ for L.A.

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Coach: Oilers 'gift-wrapping opportunities' for L.A.

It’s not just the Los Angeles Kings who are beating the Edmonton Oilers. The Oilers are also beating themselves.

That was the response Wednesday from Oilers coach Kris Knoblauch after he watched his team allow six goals for the second straight game in a 6-2 loss to the Kings in Game 2 of the Western Conference quarterfinals.

“The last two games, [the Oilers have allowed] five on the special teams, so that’s a problem,” Knoblauch said. “The other one is just mistakes. I don’t necessarily see us — I don’t see L.A. making plays to beat us. Mistakes, gift-wrapping opportunities. That’s different. If they make a heck of a play and [are] able to score goals, you just tip your hat and say, ‘There’s not much we’re able to do.’ But I don’t think I’ve seen very much of that. I think it’s been mostly gaffes that have cost us.”

Entering the postseason, the defending Western Conference champions were already facing questions about how their defensive structure would perform against the Kings. Most of those concerns were centered around their goaltending, which finished the regular season in the bottom 10 in team save percentage, according to Natural Stat Trick. The concerns were further amplified by the fact that one of their best players, defenseman Mattias Ekholm, would miss the first round with an undisclosed injury.

Game 1 against the Kings saw the Oilers fall into a 4-0 deficit before a late second-period goal from Leon Draisaitl sparked a comeback that saw them tie game with 88 seconds left in the third before Phillip Danault scored the game winner with 42 seconds remaining in L.A.’s 6-5 victory.

In Game 2, the Kings jumped out to a 3-0 lead before goals from Draisaitl in the second and former Kings winger Viktor Arvidsson in the third cut the lead to 3-2 before the Kings scored three unanswered goals in less than five minutes.

Knoblauch pulled goaltender Stuart Skinner after the fifth goal before his replacement, Calvin Pickard, allowed a goal on three shots in a little more than a minute worth of work.

“We’re down 5-2, give him a break, but also sometimes when the goalies change, there’s a little boost to our team, an immediate spark,” Knoblauch said. “That’s a stretch, it’s a long shot after the TV timeout, give it a try.”

Knoblauch was asked by reporters how he’ll assess who will start in Game 3 between Skinner, who has allowed 11 goals on 58 shots through two games, or Pickard.

The second-year Oilers coach said he’ll get together with his coaching staff and decide.

But Knoblauch added that he believed Skinner was not at fault for the team’s defensive troubles.

“I don’t think there’s been any bad goals. There’s been a lot of goals but the chances that we’re giving up are Grade A’s,” Knoblauch said. “I’m not sure that are many, ‘Geez, where’s the save there?’ It’s been very difficult for a goaltender playing. More structure and the less we’re giving up those opportunities, it’s a lot easier for Stuart Skinner or Calvin Pickard playing.”

Brandt Clarke scored the Kings’ first goal on the power play as he was able to get open in the slot for a tip-in on an odd-skater rush. Quinton Byfield pushed it to 2-0 when he walked in on net and fired a point-blank attempt that beat Skinner while Andrei Kuzmenko‘s goal saw him get behind the Oilers on the power play.

“When you’re making that gaffe and a guy is all by himself in the slot and we’ve seen probably three of those in the last two games, that’s not giving your goaltender much help,” Knoblauch said.

With Clarke, Kuzmenko and Anze Kopitar all scoring power-play goals, it led to Knoblauch addressing why the Oilers have struggled whenever the Kings have been on the extra-skater advantage.

Edmonton’s penalty kill was among the factors in its run to the Stanley Cup finals last season. The Oilers were an NHL-best 94.3% in short-handed situations.

Through two games this postseason, they’ve already allowed five goals on 10 power-play opportunities.

“They made a change at the end of the season, and it’s a good power play,” Knoblauch said. “There’s a lot of good moving parts there and it’s difficult to check all five of those guys. They bring a different element. It’s exactly what we expected from them. We saw a lot of penalty kills in our last regular-season game against them, and obviously, we’ve looked at the other games they’ve played against other teams. I don’t think there’s anything that’s unexpected.”

Knoblauch’s recollection of what the Oilers saw from the Kings toward the end of the regular season plays into what could become part of a larger narrative throughout the series.

In their last four combined regular-season and playoff games against the Kings, the Oilers have allowed 20 goals. That includes a 3-0 loss on April 5 followed by a 5-0 loss on April 14.

With the series set to resume Friday in Edmonton, the Oilers will try to find the cohesion that has eluded them against a team they’ve faced in the first round for what is now a fourth consecutive season.

Over their previous three encounters, they’ve split the first two games with the Oilers going on to win the series. But with the Kings leaving L.A. with a pair of victories, they now stand two wins shy of advancing to the second round for the first time since the 2013-14 season, when they won their most recent Stanley Cup.

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Thompson ‘the difference’ in 3rd as Caps go up 2-0

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Thompson 'the difference' in 3rd as Caps go up 2-0

WASHINGTON — The highlight-reel, diving save that it looked like Logan Thompson made to rob Jake Evans was not actually a save at all, and he wants to make sure everyone knows that.

“I didn’t save it,” Thompson said. “It went off the post. I think I almost knocked it in.”

Sure, Thompson and the Washington Capitals got a little lucky on that one. But his goaltending in the third period, when he made some spectacular stops, is the biggest reason they lead the Montreal Canadiens two games to none in their first-round playoff series.

“He was the difference tonight in the third: He wins us that game in the third period,” coach Spencer Carbery said after a 3-1 victory in Game 2, after which Thompson was selected the first star. “You could feel the building with the energy with each save. It felt like he just got bigger and bigger and bigger. He was tested. He made some huge saves in that third period to keep us in front.”

The Canadiens had multiple opportunities to tie the score, trailing 2-1 and pressing Thompson.

They got a 2-on-0 rush with 11 minutes left, but Thompson stopped Josh Anderson. With 4:22 on the clock, he got his stick in front of a textbook deflection by Christian Dvorak, who beat him earlier for a goal. And on the next shift, he denied Juraj Slafkovsky.

Fans rose to their feet to give Thompson a standing ovation and chanted “LT! LT!” after each of the saves.

“Extraordinary,” rookie Ryan Leonard said. “A lot of trust back there with that guy. He’s a gamer.”

Making it an even better tale is this was just Thompson’s second game back after getting injured when a shot dislodged his mask April 2 at Carolina.

“I knew I wasn’t going to get a game before playoffs,” Thompson said. “Just staying ready in practice, working as hard as I can and just waiting to see if I get my name called. It did. It’s playoffs. It’s not the start of the year: You can’t take your time to get into it. You just have to hit it sprinting. That’s kind of what I’ve done, and it’s worked out.”

Thompson and Charlie Lindgren alternated starts for the first half of the season. Then it became evident Thompson was Washington’s No. 1 netminder, something solidified when he got a six-year, $35.1 million extension in late January and Lindgren signed for three years and $9 million in early March.

Lindgren shouldered the load down the stretch, a year after carrying the Capitals into the playoffs, but there was no doubt about Carbery and goaltending coach Scott Murray going to Thompson to start the series as long as the 28-year-old was healthy.

“These games, this is where he wants to play,” Carbery said. “He wanted to play in the playoffs. He said: ‘I’m ready to go. I want to be in the net in Game 1.’ No disrespect to Charlie Lindgren. He wants these moments, and that’s an important part of it.”

Thompson made an important save early in the second period to keep his team’s deficit at one goal. He was at his best in the third, making 14 of his 25 saves to keep Montreal from evening things up.

“We knew they were going to come out in the third just like they did last game, Thompson said. “It’s easy to get into it when you make those saves. You’re definitely right back in the game. It could easily swing the other way if a couple of those go in and you’re fighting it, right? Luckily things went my way.”

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