Researchers in Alberta are experimenting with artificial intelligence to measure the risks of prescription opioids amid the ongoing drug overdose crisis across Canada.
While doctors have a set protocol to identify patients at risk of opioid addiction, Dr. Dean Eurich said machine learning “could do a better job” of pinning down who is most susceptible.
The AI-assisted system could provide an additional “level of comfort to clinicians … (knowing) there are also other supports they can use to help (in) making sure the patient is getting the right drug at the right time,” said Eurich, program director for the clinical epidemiology program at the University of Alberta.
With this tool, physicians could predict the impacts of a prescription opioid on patients and save them from unnecessary emergency department visits or even death within 30 days of starting the medication.
Eurich was lead investigator on research published in December with JAMA Network, which analyzed medical data of more than 850,000 Albertans anonymously and predicted the best outcomes for the patients.
The data sets were mainly provided by Alberta Health.
Dr. Fizza Gilani of the College of Physicians and Surgeons of Alberta said machine learning could be an effective way to reduce hospitalizations and morbidity for patients once integrated in the health system.
“The model (could) predict risks of hospitalization,” said Gilani, who is the program manager of prescribing, analytics and the tracked prescription program at the college.
At times, she added, current methods don’t predict the origins of risk and the medical solutions could be more complicated than reducing a patient’s opioid dose.
The AI system was fed with various health factors to determine risks to a patient, including the history of injury, obesity, depression, diabetes, fluid disorder and psychosis. These were combined with diagnoses from doctors, health-care visits and information including where the patient lives.
“The idea is not to make physicians stop prescribing opioids, (but) to minimize the risk after the opioid exposure,” said Gilani.
The researchers looked at about three million opioid prescriptions a year from various medical professionals — doctors, nurse practitioners, dentists — to more than 600,000 patients in Alberta. Those who had cancer or were receiving palliative care were excluded.
Eurich said 20 per cent of patients were using opioids with other high-risk drugs, “increasing the risk of adverse outcome.”
Over the years, people’s interaction with the health system has become more complex, demanding an efficient approach to moving through the health-care system, Eurich said.
“As a human, I can look at a couple of dozen variables and predict outcomes, but we’re finding that’s just not enough.”
He said the machine learning takes a different approach, building systematic models with a nuanced set of data, including various key factors, and finding the combinations predicting the best outcomes for a patient.
Eurich, who has been working on AI predictions for more than three years, said the system can “predict correctly (for) four out of every five patients.” A patient identified as high-risk would have a higher chance of being hospitalized within the first 30 days of prescribing the drug, according to the machine.
He added that AI-powered systems could also rapidly adapt to the changing environment — for instance, a sudden spike in opioid-related death during the pandemic.
The goal, Eurich said, is to “reduce the risk of patients who are using high-risk medications that we know can result in poor outcomes.”
Researchers will soon be testing the AI system with real-time data, Eurich said. They will also look into whether the system could limit long-term use of high-dose opioids among patients.
One advocacy group thinks the machine won’t help with the opioid crisis in Alberta.
Moms Stop the Harm co-founder Petra Schulz said most of opioid-related deaths in the province are fuelled by street drugs and not prescription opioids.
“This kind of AI could make the safer alternatives even less available,” she said. “It’s like you’re doing detective work and wanting to figure out what is not going right for the patient instead of developing a trusting doctor-patient relationship, which allows the patient to (speak) openly.”
Gilani agreed with Schulz’s observation on the opioid crisis but said there is an “indirect linkage” between a host of factors fed into the AI system and that the tool could help in reducing those deaths based on the data.
Eurich said a “good portion” of poor outcomes related to opioids is not fuelled by street drugs, but by prescription use — particularly in the beginning.
He said patients continue to get exposed to opioids for pain medication and eventually start using the health system to “doctor shop (and) obtain massive quantities of opioids… also end(ing) up being cut with other substances.”
Eurich said the machine would provide “good continuity of care” even when patients change doctors, reducing their chances of harm from prescription drugs.
This report by The Canadian Press was first published Feb. 18, 2023
This story was produced with the financial assistance of the Meta and Canadian Press News Fellowship
Some Ontario doctors have started offering a free shot that can protect babies from respiratory syncytial virus while Quebec will begin its immunization program next month.
The new shot called Nirsevimab gives babies antibodies that provide passive immunity to RSV, a major cause of serious lower respiratory tract infections for infants and seniors, which can cause bronchiolitis or pneumonia.
Ontario’s ministry of health says the shot is already available at some doctor’s offices in Ontario with the province’s remaining supply set to arrive by the end of the month.
Quebec will begin administering the shots on Nov. 4 to babies born in hospitals and delivery centers.
Parents in Quebec with babies under six months or those who are older but more vulnerable to infection can also book immunization appointments online.
The injection will be available in Nunavut and Yukon this fall and winter, though administration start dates have not yet been announced.
This report by The Canadian Press was first published Oct. 21, 2024.
-With files from Nicole Ireland
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
ISLAMABAD (AP) — Polio cases are rising ahead of a new vaccination campaign in Pakistan, where violence targeting health workers and the police protecting them has hampered years of efforts toward making the country polio-free.
Since January, health officials have confirmed 39 new polio cases in Pakistan, compared to only six last year, said Anwarul Haq of the National Emergency Operation Center for Polio Eradication.
The new nationwide drive starts Oct. 28 with the aim to vaccinate at least 32 million children. “The whole purpose of these campaigns is to achieve the target of making Pakistan a polio-free state,” he said.
Pakistan regularly launches campaigns against polio despite attacks on the workers and police assigned to the inoculation drives. Militants falsely claim the vaccination campaigns are a Western conspiracy to sterilize children.
Most of the new polio cases were reported in the southwestern Balochistan and southern Sindh province, following by Khyber Pakhtunkhwa province and eastern Punjab province.
The locations are worrying authorities since previous cases were from the restive northwest bordering Afghanistan, where the Taliban government in September suddenly stopped a door-to-door vaccination campaign.
Afghanistan and Pakistan are the two countries in which the spread of the potentially fatal, paralyzing disease has never been stopped. Authorities in Pakistan have said that the Taliban’s decision will have major repercussions beyond the Afghan border, as people from both sides frequently travel to each other’s country.
The World Health Organization has confirmed 18 polio cases in Afghanistan this year, all but two in the south of the country. That’s up from six cases in 2023. Afghanistan used a house-to-house vaccination strategy this June for the first time in five years, a tactic that helped to reach the majority of children targeted, according to WHO.
Health officials in Pakistan say they want the both sides to conduct anti-polio drives simultaneously.
WASHINGTON (AP) — Millions of people with private health insurance would be able to pick up over-the-counter methods like condoms, the “morning after” pill and birth control pills for free under a new rule the White House proposed on Monday.
Right now, health insurers must cover the cost of prescribed contraception, including prescription birth control or even condoms that doctors have issued a prescription for. But the new rule would expand that coverage, allowing millions of people on private health insurance to pick up free condoms, birth control pills, or “morning after” pills from local storefronts without a prescription.
The proposal comes days before Election Day, as Vice President Kamala Harris affixes her presidential campaign to a promise of expanding women’s health care access in the wake of the U.S. Supreme Court’s decision to undo nationwide abortion rights two years ago. Harris has sought to craft a distinct contrast from her Republican challenger, Donald Trump, who appointed some of the judges who issued that ruling.
“The proposed rule we announce today would expand access to birth control at no additional cost for millions of consumers,” Health and Human Services Secretary Xavier Becerra said in a statement. “Bottom line: women should have control over their personal health care decisions. And issuers and providers have an obligation to comply with the law.”
The emergency contraceptives that people on private insurance would be able to access without costs include levonorgestrel, a pill that needs to be taken immediately after sex to prevent pregnancy and is more commonly known by the brand name “Plan B.”
Without a doctor’s prescription, women may pay as much as $50 for a pack of the pills. And women who delay buying the medication in order to get a doctor’s prescription could jeopardize the pill’s effectiveness, since it is most likely to prevent a pregnancy within 72 hours after sex.
If implemented, the new rule would also require insurers to fully bear the cost of the once-a-day Opill, a new over-the-counter birth control pill that the U.S. Food and Drug Administration approved last year. A one-month supply of the pills costs $20.
Federal mandates for private health insurance to cover contraceptive care were first introduced with the Affordable Care Act, which required plans to pick up the cost of FDA-approved birth control that had been prescribed by a doctor as a preventative service.
The proposed rule would not impact those on Medicaid, the insurance program for the poorest Americans. States are largely left to design their own rules around Medicaid coverage for contraception, and few cover over-the-counter methods like Plan B or condoms.
