Software aids in battle against substance abuse

Simon Budman, founder and CEO of Inflexxion, is about to get a quick education on drug addiction in New Mexico. The state is using software developed by his Newton, Mass.-based company to provide a more accurate picture of substance-abuse issues. The data will be used to help the state determine how it can best direct its resources to fight substance abuse. "For New Mexico, we'll have a very comprehensive picture of how people get into substance-abuse care and how they encounter substance-abuse problems," Budman said.

Sixty-nine New Mexico substance-abuse clinics are using Inflexxion's Addiction Severity Index Multi-Media Version (ASI-MV) to collect data. The interactive software program updates a paper-based substance-abuse evaluation form that has been used since 1980.

The ASI-MV is one of several tools that Inflexxion uses to provide real-time, product-specific data to substance-abuse facilities nationwide. The tools are part of the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO), a system designed to shed more light on substance-abuse issues and prescription painkiller addictions.

"NAVIPPRO will enable pharmaceutical companies to focus on emergent trends in the abuse of their products and help them adjust their responses accordingly," said Budman. "In the future, we expect that NAVIPPRO will become the standard monitoring tool in prescription opioid risk management."

While it is far too early for NAVIPPRO to become a standard operating tool, Inflexxion's ASI-MV software has built up quite a client base. The program has been used for more than six years in more than 700 substance-abuse treatment settings, prisons, drug courts, probation departments, and welfare offices throughout the nation.

Like its paper-based predecessor, the ASI-MV questionnaire asks suspected drug abusers about past substance abuse, mental or physical illness, and employment. According to the company, questions and answer choices are presented verbally and written on-screen. Clients do not have to be literate to self-administer the interview. Rather than provide the answers to a trained clinician, however, those who use the computerized version of the questionnaire are taken through a virtual tour, stopping at a doctor's office to answer medical questions, and dropping by an attorney's office to answer legal questions.

Patients who admit to abusing prescription painkillers are taken to a different part of the survey and asked more specific questions, such as the kinds of painkillers they are abusing and the source of the painkillers. "We will have brand-specific information on what [painkillers] people are using and how they are using them," explained Budman.

Because the ASI-MV questionnaire is computerized, Budman said the company can change or modify questions as it sees fit. "If we see there's an outbreak or misuse of Vicodin or some [other drug] in a given area of the country, we can push down more specific questions," Budman explained. "We can make any kinds of changes we need to on the fly."

Inflexxion launched a Web-enabled version of the survey in April that can be downloaded to a desktop PC so that patients can upload substance-abuse data to the site. Budman said this feature is designed to help provide pharmaceutical companies with more detailed data on ways their drugs are being abused.

Alpharma Pharmaceuticals is hoping to use the data garnered from NAVIPPRO to develop abuse-resistant painkillers. "This collaboration will help us identify risk areas so that we can develop solutions to maximize drug safety and minimize misuse of prescription pain medications," Alpharma Pharmaceuticals president Ronald Warner said in a statement.

Budman hopes NAVIPPRO will help provide better "postmarketing surveillance" of drugs, particularly prescription painkillers. "I think there's an awareness that there has not been sufficiently good work done in the postmarketing area. For the most part, drugs get approved, and that's the last they have to do with the Food & Drug Administration," Budman said. "That's not satisfactory from anybody's perspective. There's a very strong feeling on the part of the FDA that you need to be watching your drug after it's launched."

But better monitoring is not the answer, argues Kevin Nestrick, a pharmacist and founder of Option Care of Arizona, a home-infusion healthcare program based in Prescott, Ariz. Nestrick said there are mechanisms already in place to monitor the distribution of prescription medications.

"The DEA, state boards of pharmacy, pharmacy records, and many other systems monitor where the drug goes," Nestrick said. "It just needs to be used properly."

National statistics, however, indicate that prescription painkillers are increasingly used improperly. About 48 million people age 12 and older have used prescription drugs for nonmedical reasons, according to the National Institute on Drug Abuse (NIDA), which provided $7 million to Inflexxion for NAVIPPRO. Other figures from NIDA show 12- to 17-year-olds abuse painkillers more than any other drug.

"The source of the drug or alcohol is not the problem," Nestrick said. "The problem is the end user."

And the solution, at least for Nestrick, begins with pharmacists. "The pharmacist is a professional resource that the patient can reach out to for support," he said. "We are there for the patient 24/7. Pharmacists have a more hands-on relationship with patients."

Budman agrees. "Pharmacists are at the leading edge to organize risk-management programs," he explained. "They are central in these kinds of programs. People see pharmacists as people who understand the drug and understand the research that goes into it."