Kathryn, a young woman from Kentucky, went to the hospital one evening in July 2020 in pain.Kathryn, a 32-year old psychology graduate student in Michigan, suffered from endometriosis. This is a painful condition in which uterine-like cells are abnormally developed in the wrong locations. These growths can be shed and sometimes painfully cramped and scarred, which may cause internal organs to stick together before the cycle begins again.Kathryn used Percocet to manage her pain for years. Endometriosis can be progressive. Kathryn was once rushed to emergency surgery to remove an ovarian cancerous growth. Kathryn now fears that something equally dangerous is happening.Doctors performed an ultrasound in the hospital to rule out any worst-case scenarios. Kathryn was then admitted for observation to check if her ovary was developing another cyst. They said that they would continue to provide intravenous opioid medication for Kathryn until the crisis passes.However, things changed on Kathryn's fourth day at the hospital. Kathryn was abruptly told by a staffer that she would not be receiving opioids. The woman stated that she didn't think you were aware of the high scores in your chart. It is obvious from your prescriptions that you require help that isn't pain-related.Kathryn spoke with WIRED under the condition that we only use her middle name for privacy. What kind of assistance was she referring to? What prescriptions exactly? She was still in severe pain and was quickly discharged from the hospital.Kathryn was home two weeks later when she received a letter from the gynecologists stating that her doctor had ended their relationship. She was still confused. This message offered at least some explanation. It stated that she was being cut off due to a NarxCare report.Kathryn, like most people, had never heard about NarxCare. She looked it up and discovered a number of databases and algorithms that play an increasingly important role in the United States' response to the overdose crisis.The US Department of Justice has spent hundreds of millions of dollars over the past 20 years in developing and maintaining state-level prescription drugs databaseselectronic registers that allow authorities to track scripts for controlled substances in real-time. PDMPs are now available in every US state except one. Missouri is the last remaining state to be excluded.Appriss, a single company, has dominated the management of state prescription databases over the last few years through a series acquisitions and government contracts. The registries are somewhat fragmented, each one with its own requirements and quirks. Appriss helped make them interoperable by combining them into a seamless national prescription drug registry. It also goes beyond just collecting and retrieving records. It develops machine-learning algorithms that generate data insights. This indicates that it can tap into vast data reservoirs outside of state drug registries.NarxCarethe system that inspired Kathryn's gynecologist and heris Appriss' flagship product for pharmacies and hospitals, was an analytics tool and care management platform which claims to instantly and automatically identify patients at risk of misusing opioids.At the most fundamental level, a doctor can query NarxCare about Kathryn. The software searches state registries looking for red flags that indicate she is drug shopping. It records the number of pharmacies visited by a patient, the distance she traveled to get health care and the prescriptions she received.
