Narx Scores Overview

CAUTION / IMPORTANT REMINDER: NarxCare is an application that provides a set of data, visualizations, and resources to support prescribers' and dispensers’ review of controlled substance data from government managed and regulated Prescription Drug Monitoring Programs (PDMPs). NarxCare is intended to aid, not replace, medical decision making. None of the information presented in NarxCare should be used as sole justification for providing or not providing medications.

NarxCare provides three substance-specific (i.e, narcotics, sedatives, and stimulants) analytic exposure summary scores that may be automatically returned to the requesting system as it relates to a patient, collectively called Narx Scores. Narx Scores derive from a percentile-ranked descriptive statistics approach for controlled substance use (i.e., narcotics, sedatives, stimulants) comparing single patients to their home state’s PDMP population.

Requesting systems receiving such data can choose to display Narx Scores within their native electronic health record (EHR) or pharmacy management system. However, many systems choose to display the Narx Scores on the Patient Report. 

Narx Score Calculations and Metrics

Each Narx Score has a numerical value based on a synthesis of key patient metrics derived from the PDMP. 

Narx Scores are calculated for narcotics, sedatives, and stimulants and have the following characteristics:

1. Each score consists of there digits ranging from 000-999.

2. The first two digits represent a relative scoring system for a given patient's exposure to a controlled substance compared to the rest of the patient's home state PDMP population (described in detail below).

3. The last digit of each score for a patient represents the number of active prescriptions of that type. For example, a Narcotic Narx Score of 504 indicates the patient has four active narcotic prescriptions according to information obtained from the PDMP on dispensations. In the standard user interface tile, the number of active prescriptions is also shown, in written form, directly below the score for ease of reference.

4. The scores correspond to the prevalence and timing of literature-based exposures that exist within the PDMP data for that specific patient.

• There are four metrics used in Narx Score calculations. They are as follows:

         1. The number of controlled substance prescribers.

         2. The number of pharmacies visited where controlled substance prescriptions were filled.

         3a. The total dosage of dispensations (opiates and sedatives only).

         3b. The number of days supply for a dispensations (stimulants only).

         4. The number of overlapping days for each drug type.

• Each metric is tallied across 4 time frames of reference:

         1. Most recent 2 months

         2. Most recent 6 months

         3. Most recent 1 year

         4. Most recent 2 years

5. The time elapsed for any literature-based exposures serves to decrease its contribution to the score. For example, 1,000 MME dispensed within the last month will elevate the score more than 1,000 MME dispensed one year ago.

6. The distribution of Narx Scores for patients found in a PDMP will vary by state. Generally speaking, less than 1% of scores will be greater than 650 and over 78% of scores will be lower than 200.

If one or more of these elements are not available for a patient, the Narx Scores are not calculated. Instead, "000" will be presented to prescribers and dispensers. This is not an indicator of the absence of exposure, but rather the absence of data necessary to deliver a score.

Narx Scores were designed such that:

1. Patients who are exposed to small amounts of controlled substances with limited provider and pharmacy usage will have lower scores (e.g., scores below 199).
2. Patients who are exposed to large amounts of controlled substances in accordance with recommended guidelines (single provider, single pharmacy, etc.) will have mid-range scores (e.g., scores between 200 and 500).
3. Patients who are exposed to large amounts of controlled substances while using many providers and pharmacies, and with frequently overlapping dispensations, will have higher scores (e.g., scores above 500).

It is important to understand that there are several different patterns that can result in the same score. Only by reviewing the actual PDMP data can the patterns that contributed to a specific patient’s Narx Score be determined.

CAUTION / IMPORTANT REMINDER: Narx Scores can be used by prescribers and dispensers as indicators to guide further review of details in the patient’s dispensation history while attending to their patients. Narx Scores are intended to inform medical decision-making and should not be used to replace prescribers’ and dispensers’ independent clinical judgment. None of the information presented should be used as sole justification for providing or not providing medications.