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.
For additional information on Rx Graph, please refer to Rx Graph Overview.
How Rx Graph, used in concert with additional information, can help to support discussions with patients:
Case A - A 53-year-old patient with diabetes, hypertension, and chronic leg pain has been receiving 30-day opioid prescriptions averaging 60 MME daily from 5 different providers on a recurring basis.
Important Consideration: Many patients are seen in multi-provider practices and often see partners or associates of their primary provider. In addition to considering the number of providers the patient is seeing, a typical inquiry would be to determine whether those providers are providing coordinated care, as represented by consistent and non-overlapping prescriptions.
Case B - A 37-year-old patient with chronic headaches and pseudo-seizures has received 20 opioid prescriptions ranging from 2-5 days in duration from 10 different providers over the last 3 months. Most recently, the patient also received a 30-day benzodiazepine prescription from a new provider.
Important Consideration: This patient appears to lack a primary provider who is overseeing her care as it relates to her chronic headaches. She is receiving numerous overlapping prescriptions that could potentially indicate unmanaged chronic pain, a substance use disorder, or an undiagnosed condition. Her recent benzodiazepine prescription may increase her risk of unintentional overdose. Prescribers and dispensers would typically conduct a thorough review of the risks and benefits of prescribing or dispensing a controlled substance with the patient. This may include an in-depth history and physical exam, appropriate testing, and a direct query about her patterns of use.
Case C - A 25-year-old patient with sick cell anemia and a history of chronic opioid prescriptions equating to an average of 90 MME daily from two different providers in a coordinated manner has numerous month-long gaps in prescription fills over the last 2 years.
Important Consideration: Typically, patients with a history of chronic opioid use at elevated dosing levels who demonstrate gaps in prescription fills are asked by their prescriber or dispenser how they managed their pain (and/or potential withdrawal symptoms) during the times of no prescription fill. The patient may have been admitted to the hospital during these times, traveled out of state, or potentially turned to illicit sources. An appropriate history to delineate what was happening in the patient’s life during these times may be important to proper care.