"Despite reassurances brought by the 2022 Supreme Court ruling in Ruan v. US,13 many clinicians have abruptly reduced or discontinued prescription opioids,14 restricting access to primary care for patients15, 16 and potentially facilitating a transition to the illicit market where overdose and death are frighteningly common.17, 18 It is at this unique and dynamic intersection between the domains of public health and public safety that proprietary technologies marketed as clinical decision support (CDS) tools have entered clinical care without rigorous external validation, public data sharing, or regulatory approval.

"Bamboo Health’s NarxCare is one such technology: a PDMP-based analytics platform marketed as a CDS tool for physicians, pharmacists, and policymakers.19 Its patented algorithm, embedded into clinic workflows, generates multiple “Narx Scores” purporting to represent a patient’s risk of non-medical use of prescription “narcotics” (opioids), sedatives, and stimulants, and a composite score quantifying the overall risk of overdose death.20 Clinicians view Narx Scores prominently displayed—such as next to a patient’s height, weight, and allergies21—in electronic medical record (EMR) systems across over 45 states, and in national pharmacies such as Sam’s Club and Walmart. Although it is unclear exactly how Narx Scores are used clinically, Bamboo Health’s promotional materials suggest NarxCare’s rapid implementation—amplified by near-universal state PDMP mandates—has positioned it to impact over one billion patient encounters annually across the US.21"


Buonora, M.J., Axson, S.A., Cohen, S.M. et al. Paths Forward for Clinicians Amidst the Rise of Unregulated Clinical Decision Support Software: Our Perspective on NarxCare. J GEN INTERN MED (2023). doi.org/10.1007/s11606-023-08528-2