Scarlet letters for pain patients

4/6/2015, Media Advisory: What If We Knew The Future? RxAnte Unveils A Prevention Approach To Safer Opioid Use At National Rx Drug Abuse Summit

WHAT:  Dr. McKethan will describe a novel, prevention-focused program to help health care payers and providers prevent potentially unsafe opioid use at the fourth annual National Rx Drug Abuse Summit in Atlanta.  The program takes a proactive, preventive approach that uses “big data” and predictive analytics, alert systems and different intervention measures to address the growing opioid abuse problem in the U.S.

WHY:  Prescription drug abuse has reached epidemic proportions nationwide. Opioid misuse is estimated to cost $70 billion annually and leads to nearly 100,000 avoidable emergency room visits each year.

WHERE:  National Rx Drug Abuse Summit, Westin Peachtree Plaza Hotel, 210 Peachtree St. N.W., Atlanta, GA 30303

Also published was, “FDA/DEA/PDMP/UDT: Alphabet soup or sensible and integrated risk management?” an editorial, written by Steven Passik, PhD, and Kenneth Kirsh, PhD, of the Millennium Research Institute, and Robert Twillman, PhD, of the American Academy of Pain Management, that examined both UDT and prescription drug monitoring programs (PDMP) as complementary tactics in managing the risks of prescribing controlled substances, such as opioids. It concludes that, while PDMPs are important, PDMPs alone will not help clinicians manage aberrant drug behavior without the additional insights provided with UDT…

RxAnte, which applies predictive analytics to medication adherence, became part of Millennium Laboratories in December…  The start-up has “millions of dollars” in revenue coming from large payers and pharmacies, such as CVS Caremark, Aetna, and WellCare Health Plans. It now monitors medication compliance for more than 8 million patients, since introducing its product in 2011…

Based on several studies which establish a clear link between compliance and lower costs, the government now rewards health plans for boosting adherence of Medicare patients on blood pressure, cholesterol, and diabetes drugs.

RxAnte has set out to prove its technology improves outcomes. Mining its customers’ claims data, it applies variables, ranging from past refills to the number of drugs a patient takes, to predict on a scale of 0 to 100% who is most likely to be non-compliant…

Imagine that a doctor can predict very early in the pain management process if a patient is at risk for opioid abuse…  Aaron McKethan Ph.D, president of RxAnte, told the National Pain Report that pilot programs will be launched later this year by his company working with some major insurers using what is called “predictive analysis” that can identify highest risk patients in the first 90 days of treatment…

McKethan said he has a cousin who is a chronic pain sufferer (failed back surgery) who “needs high powered medication in order to live his life”.  In the RxAnte model, which already has over two dozen predictors, his cousin would be at low risk. That’s because, among other reasons, he gets his medication from the same physician and the same pharmacy, he picks it up regularly and there’s no evidence of abuse…

McKethan’s cousin and millions of chronic pain patients like him who are at low risk won’t be lumped in with those from those who either are at risk for abuse or might be selling or other nefarious pursuits ascribed to pain medication.  As he told McKethan, “Hallelujah, treat me like a normal person. I deserve that!”

Sure, Mr. McKethan’s cousin is excited because he’s been classified as “low risk.”  I wonder if he would feel the same excitement if he had been classified as “high risk.”

Many pain patients believe that the PDMPs, urine tests, pain contracts, and pill counts they have to suffer through will prove that they’re not drug addicts; will prove that their pain deserves to be adequately treated with prescription medications, including opioids; will keep the DEA off their backs and the backs of their doctors and pharmacists.  Turns out, that’s not true.  From long-term pain patients to terminal cancer patients, few have been spared the consequences of the drug war. Many patients have been abandoned by their doctors and are unable to access health care, let alone treatment for pain, because of these “predictive” tests and monitoring.

See, many pain patients who follow all the rules have learned that all this monitoring will not keep them from being treated as drug addicts and criminals; may restrict or even cut off their access to pain management treatments.  (I wonder, can RxAnte predict which patients will turn to criminal behavior?  And what would they do with that information, sell it to the DEA?)

Do not be fooled that you will be one of the pain patients who are determined to be at “low risk” for drug abuse and addiction.  If analyses done with big data actually worked, then economists would be right once in awhile, instead of hardly ever.  No one can predict the future, including big data.

And once you have a “high risk” label, it will be impossible to get rid of, whether it turns out to be true or not.  If a chronic pain patient who’s been given this label gets cancer or needs surgery, they will not have access to the pain medications which are strong enough to manage the increased pain.

Just like the inaccuracies of drug tests which can falsely label you as an addict and a criminal, tests based on big data will slap a label on you which most of us will not be happy with.

What do you think will happen to the pain patients who are given this “high risk” label?  Even more discrimination, if that’s at all possible.  Doctors will refuse to treat them (which is already happening, without the additional label).  Insurance companies will refuse to cover certain medications for them or even cover “high risk” pain patients at all.  And low-risk patients will point and say, well, as long I’m not part of the high-risk group, I’m safe.  You know, until the next inaccurate test shows something different.

Might as well make pain patients wear a scarlet letter “A” for addict, even though millions and millions of pain patients don’t fit that description.  And keep in mind that this “high risk” group includes those who suffer from mental illnesses.

As a pain patient, who’s side are you on?  As long as everything is currently working out for you, and you’re able to obtain the treatments you need, don’t you care what happens to the rest of us?

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