Can We Predict Who Is At Risk For Opioid Dependency?

Can We Predict Who Is At Risk For Opioid Dependency?

RxAnte_Aaron McKethan 4x6

Aaron McKethan Ph.D, president of RxAnte

Imagine that a doctor can predict very early in the pain management process if a patient is at risk for opioid abuse.

That day may not be far off. In fact, it may be here.

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.

So how does it work?

The premise is that not all pain patients are alike.

McKethan said that most analysis of pain medication use is driven by Medicare and Medicaid and health insurers who are mostly looking for patients who are already being harmed by drug use and tend to emphasize  whether there is fraud, waste and abuse.

Not enough attention has been given to what he calls, “patient safety”.

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.

The model that has been developed includes data on the patients themselves (gender, geography, age), the attributes of the medication on the patient (using claim information can see if dosing is change, other medications that are being taken) and the attributes of the medication themselves (how strong are they, are patients stopping and starting).

McKethan is certain that the predictive analysis works. They’ve been working a year and a half using claims data of large insurance companies to develop the model.

What the pilot projects are designed to find is whether it matters.

Will it change how doctors and others use the information in how they treat their patients?

McKethan thinks it will.

Each patient will have a score - (his cousin’s score would indicate a low risk) and the doctor will see that.

What RxAnte wants to ask the doctors is “If we could tell you accurately whether the patient is at higher or lower risk for unsafe use of these medicines, would that change how you treat him or her?”

So it’s not pain specialists who will be part of the pilot - it’ll be family doctors. Primary care physicians write 80% of the initial opioid prescriptions and also refill 80% of those prescriptions.

Another target audience is what he calls the “care management programs” which are mostly run by health plans and the questions are the same. “Would knowing a patient at risk earlier result in you engaging that person earlier, and presumably getting him or her help, earlier?”

While pharmacists won’t be part of the first pilot, McKethan said he has already had some initial conversations with large pharmacy chains about his model and there appears to be some interest.

So what will this year’s pilot programs show?

Realistically, it will show whether having predictive analysis can “move the needle” in terms of reducing the  estimated $70 billion in extra costs, 100,000 emergency room visits and 120 deaths per day that are tied to prescription drug abuse in the United States that RxAnte cites.

It will have another impact.

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!”


For the record: RxAnte is a Millennium Health company. Millennium is a powerful bioinformatics and analytics company. Doctors send urine samples to Millennium, whose system can detect 130 drugs and return results to doctors within 24 hours.

McKethan also said that the insurance companies and health plans that will participate in the pilot have not yet been publicly disclosed. We will follow up with him and RxAnte in the future as more details are released.

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Authored by: Ed Coghlan

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deb moore, any PCP can write rxs for pain meds for their chronic pain patients. But, it is their decision if they want to. A lot depends on the diagnosis, how well the PCP knows the patient and the meds that are needed. Many PCP’s don’t want to incur the cost of treating their patients with chronic pain and it is easy to undertand why. Pain management drs charge much more for a office visit for the same amount of time for doing the same thing than PCP’s do. The drs have to protect themselves and other patients from those who want to abuse pain meds and that costs money.


Anyone who treats a chronic pain patient should know they are not the ones selling their meds. That is if they are aware and care about their patients. Bone on bone joints in hips and knees, OA so bad in backs that standing is impossible. Fibro can be just as devastating but alot can be done with diet and exercise and supplements I feel.

Pharmacist Steve

Since the DEA , licensing boards and judicial system is behind the “fear of prescribing”.. IMO.. anything that could interfere with those entity’s reason to exist.. will be resisted as an accepted methodology to increase or properly prescribe opiate therapy to chronic pain pts.It is more about job protection than appropriate pt medical care

Kurt W.G. Matthies

This is all well and good.

We’ve seen studies that list the amount of ‘abuse’ among pain patients from a few percent to up above 50%.

We’re told that this concern over pain patients, opioid abuse, opioid diversion, etc. is for “our own good.” In all frankness, for the millions of pain patients who have been maintained on large doses of opioid analgesics and are opioid tolerant, this concern is a red herring. Pain patients do not abuse their meds — they are looking for pain relief and not getting it.

In my long experience as a pain patient maintained on COT, I’ve come to realize that the risk when treating people like myself has more to do with the prescriber’s fear of being prosecuted for writing what some consider to be too many opioids rather than a patient’s need for more analgesia.

The risk of opioid poisoning in an opioid tolerant person is very low. The “chilling effect” is the major factor in the under medication of people with long-term chronic pain.

State health department rulings on maximum daily doses of opioids are at the crux of denying an individual the pain medications they require to adequately reduce pain. Long term pain patients live minimal reduction in pain from opioids because of prescriber’s discomfort in writing an adequate doses, and their medical boards back perpetuate this painful malpractice. And don’t forget the DEA, justifying its huge budget, claiming credit at every step in this war on pain patients.

Until we, as a nation, can remove police from the middle of the doctor/patient relationship, especially in the treatment of long-time opioid tolerant patients, people living with severe intractable pain will remain in pain — under treated, depressed, and feeling like hopeless in a political struggle that has very little to do with the positive medical outcomes for this particular group of patients.


deb moore, a lot depends on the patient, the diagnosis, medical evidence to support the diagnosis and the meds that are being prescribed. Not all chronic pain patients have problems finding a dr to manage their pain and/or having their pain med rxs filled.

deb moore

I’m confused. I haven’t seen a primary care doctor in over 10 years that would write my pain meds. Circumstances made no difference to these doctors. I’ve lived in Ohio , Kentucky, Georgia. And west Virginia and none of them cared why I couldn’t find a pain doctor. I have been on narcotics since 1998 for fibromyalgia and since about 2004 have been treated like a criminal. Hope this program works


It may be a start. The big question is how much faith will the non pain managements dr put in it because the drs will still be responsible.

We mitigate risk in order to impact health:
Diet, exercise, lifestyle, statins for hypertension and coronary artery disease.
The rules of pain management changing so quickly: every patient I’ve ever seen would be high risk in this model. Pharmacies are refusing to fill prescriptions so everyone of my patients is pharmacy shopping. Doctors are dropping patients out of fear which is much more about the doctor than it does about the patient.A Patient that has been dropped however is very high risk.
Question: do you refuse to treat the high risk patient in pain?
That would be insane.
Pain management requires relationship.
We have enough nutty protocols already.
Life itself is risky.
Let’s engage, consider risk, and do the right thing.


Mr. McKethan should know that medicine and science is not advanced enough to assert that Franklins law doesnt apply to anyone taking an opioid. Research has shown that someone who has no prior drug history and no experience with opioids may become addicted. Lynne Greenburg in her book- The Body Broken- is an example of such.
In addition, Mr. McKethan doesn’t address the issue of stigma or burden attached to undergoing his “predictive analysis”. And from my point of view its long overdue for ‘experts” to acknowledge the considerable treatment burden associated with pain care.
Mr. McKethans predictive analysis has not met evidence pyramid guidelines- there are over 300 pain conditions and where are the systematic studies or meta-analysis for the 300 pain conditions showing his predictive analysis works?
The danger of his method is that some who may not have a problem with opioids will be predicted to have a problem and be denied needed medication- where is Mr. McKethans failure mode and error analysis or continuous improvement plan to address such- i didnt see it mentioned in the article.


This sounds like a great start!