Predicting Our Way Out Of A Crisis

The belief that we can “Minority Report” our way out of a crisis of overdose deaths is not only wrong, it’s deeply dystopian.

Taylor Nichols, MD

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FDA approves first test to help screen for risk of opioid use disorder | CNN

A new product called AvertD has recently been approved by the FDA.

As an emergency and addiction medicine physician, this worries me a lot, actually.

These developments can have disastrous unintended downstream consequences and can very easily lead to increasing stigma and under-treating pain. We cannot adequately predict future outcomes, even with genetic testing, and I don’t believe tools like this have significant validity. As noted on MedPage Today, the company which created the test, SOLVD, presented results of a single observational study that utilized machine learning as a predictive algorithm to the FDA which demonstrated a sensitivity of 82.76% and a specificity of 79.23% for detecting opioid use disorder. This level of specificity for what should be considered a critical clinical decision instrument would be considered unacceptable by most standards for predicting bad outcomes.

For example, we use risk stratification clinical decision instruments all the time in emergency medicine to aid our decision making. Do you think discharging someone having chest pain with less than 80% certainty that they were not having a heart attack would be acceptable? No, absolutely not.

Then why would we be willing to accept less than 80% certainty in an observational study to appropriately predict if someone might develop opioid use disorder? How will that solve for anything other than stigmatize patients, lead to misdiagnoses and under-treatment?

Regardless, even with 100% accuracy, this would not and will never “solve” the crisis of overdose deaths.

The reason is because we do not have an “opioid crisis” we have a crisis of failed policies.

In the end, the fact remains that the use of psychoactive substances or means to alter our perception of reality is a natural response to existing, and substance use disorders always have and always will be a potential future consequence of the complex web of genetic plus environment plus exposure. We cannot control our own genetics, and while we can…

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Taylor Nichols, MD

Humanist. Emergency Medicine and AddictiEmergency + Addiction Medicine | Health policy and advocacy | Health tech and innovation