{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:26:21Z","timestamp":1785774381383,"version":"3.56.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Risk &amp; Safety in Medicine"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite the investment of significant effort and resources, our country remains exposed to an alarming risk of opioid overdoses due to opioid addiction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study demonstrates the impact of misguided medical insurance and government policies on the opioid epidemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective chart review study of 142 patients who were denied access to care by insurance companies (CareSource, Molina, Aetna, government regulators, and contractors). The study provides a systematic analysis of the risk stratification of these patients based on the NARX score, prescribed medications, and OARRS report analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients who were denied access to care by the major insurance carriers in Ohio, CareSource, Aetna, and Molina had an average high NARX score of 309.8\u2013310.5 range. The review of the prescribing provider lists on Ohio Automated RX Reporting System reports showed that, in most occasions, patients had significant difficulty in finding a qualified pain provider for 3\u00a0months or more.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Review of denied-care patient NARX scores shows, conclusively, that very high-risk patients were affected the most. These misguided medical insurance and government policies have exposed the most vulnerable and high-risk patients to significant risk of mortality and morbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09246479251360693","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T10:57:15Z","timestamp":1760007435000},"page":"31-39","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Misguided medical insurance and government policies in the opioid epidemic: A chart review and NARX score analysis"],"prefix":"10.1177","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0642-300X","authenticated-orcid":false,"given":"Leon","family":"Margolin","sequence":"first","affiliation":[{"name":"Comprehensive Pain Management Institute, LLC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juscelino F","family":"Colares","sequence":"additional","affiliation":[{"name":"Case Western Reserve University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanford","family":"Lefkowitz","sequence":"additional","affiliation":[{"name":"Comprehensive Pain Management Institute, LLC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Ancowitz","sequence":"additional","affiliation":[{"name":"New York State Assembly Ways and Means Committee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanford","family":"Rosenblum","sequence":"additional","affiliation":[{"name":"Rosenblum Law"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"Centers for Disease Control and Prevention (CDC). Drug overdose deaths in the United States 1999\u20132022. 2022. https:\/\/www.cdc.gov\/nchs\/products\/databriefs\/db491.htm"},{"key":"e_1_3_4_3_2","unstructured":"Ohio Administrative Code (OAC) \u00a7 4731-29-01. https:\/\/codes.ohio.gov\/ohio-administrative-code\/rule-4731-29-01"},{"issue":"3","key":"e_1_3_4_4_2","first-page":"307","article-title":"Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice","volume":"54","author":"Agerwala SM","year":"2022","unstructured":"Agerwala SM, McCance-Katz EF. Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice. J Psychoact Drugs 2022; 54(3): 307\u2013317.","journal-title":"J Psychoact Drugs"},{"key":"e_1_3_4_5_2","unstructured":"New York State Office of Alcoholism and Substance Abuse Services. SBIRT standard practice and cost savings data. https:\/\/oasas.ny.gov\/system\/files\/documents\/2019\/08\/OASAS-1_NY_SBIRT_Flyer.pdf"},{"key":"e_1_3_4_6_2","unstructured":"Ohio automated Rx reporting system (OARRS) manual. https:\/\/www.ohiopmp.gov\/Documents\/OARRS_User_Manual.pdf"},{"key":"e_1_3_4_7_2","first-page":"1080","article-title":"SBIRT and NCS for high-risk chronic pain patients: a peer-reviewed study","volume":"5","author":"Margolin L","year":"2020","unstructured":"Margolin L, Streem D. SBIRT and NCS for high-risk chronic pain patients: a peer-reviewed study. J Diabetes Treat 2020; 5: 1080.","journal-title":"J Diabetes Treat"},{"key":"e_1_3_4_8_2","unstructured":"The White Paper. SBIRT and pain management in Ohio. Comprehensive Pain Management Institute (CPMI). 2024. https:\/\/cpmiohio.com\/wp-content\/uploads\/2024\/03\/White-Paper-SBIRT.x46178.pdf"},{"key":"e_1_3_4_9_2","unstructured":"ASAM Consensus Statement. Appropriate use of drug testing in clinical addiction medicine. 2017. https:\/\/downloads.asam.org\/sitefinity-production-blobs\/docs\/default-source\/guidelines\/the-asam-appropriate-use-of-drug-testing-in-clinical-addiction-medicine-full-document.pdf?sfvrsn=700a7bc2_0"},{"issue":"2","key":"e_1_3_4_10_2","first-page":"123","article-title":"Universal precautions for people at risk of opioid overdose","volume":"44","author":"Wakeman SE","year":"2023","unstructured":"Wakeman SE, Green TC, Rich JD. Universal precautions for people at risk of opioid overdose. Subst Abuse 2023; 44(2): 123\u2013129.","journal-title":"Subst Abuse"},{"issue":"1","key":"e_1_3_4_11_2","first-page":"S1","article-title":"Comprehensive, evidence-based, consensus guidelines for prescription of opioids for chronic non-cancer pain from the American Society of Interventional Pain Physicians (ASIPP)","volume":"26","author":"Manchikanti L","year":"2023","unstructured":"Manchikanti L, Kaye AD, Knezevic NN, et al. Comprehensive, evidence-based, consensus guidelines for prescription of opioids for chronic non-cancer pain from the American Society of Interventional Pain Physicians (ASIPP). Pain Physician 2023; 26(S1): S1\u2013S101.","journal-title":"Pain Physician"},{"key":"e_1_3_4_12_2","unstructured":"Ohio Department of Mental Health and Addiction Services (MHAS). Integrated crisis and addiction response. 2023. https:\/\/mha.ohio.gov\/about-us\/media-center\/news\/pr-05-07-2023#:\u223c:text=In_2020%2C_Ohio_had_45.6 by_the_disease_of_addiction"},{"key":"e_1_3_4_13_2","unstructured":"Martino S. SBIRT implementation and outcomes in healthcare settings. 2020."},{"key":"e_1_3_4_14_2","unstructured":"Ohio NGO petition to DOJ on SBIRT and pain management services. 2025. https:\/\/cpmiohio.com\/wp-content\/uploads\/2025\/04\/Ohio-NGO-DOJ-petition.pdf"},{"key":"e_1_3_4_15_2","unstructured":"Centers for Medicare & Medicaid Services (CMS). SBIRT coverage guidelines. 2022. https:\/\/www.cms.gov\/Outreach-and-Education\/Medicare-Learning-Network-MLN\/MLNProducts\/downloads\/SBIRT_Factsheet_ICN904084.pdf"},{"key":"e_1_3_4_16_2","unstructured":"Case western reserve university conference presentations on opioid crisis. https:\/\/www.csuohio.edu\/sites\/default\/files\/Racial_Disparity_and_Opioid_Crisis_Flyer.pdf. https:\/\/www.youtube.com\/watch?v=Tqlp_N_z-Xw&t=2945s"},{"key":"e_1_3_4_17_2","unstructured":"Franklin County Forensic Science Center. Overdose deaths data. 2021. https:\/\/coroner.franklincountyohio.gov\/getattachment\/81c81378-bd61-49aa-bd88-22355ddf9907\/Overdose_2017-2021_Report.pdf.aspx?lang=en-US"},{"key":"e_1_3_4_18_2","unstructured":"Ohio Revised Code (ORC) \u00a7\u00a7 4729.51 4729.54 4729.552."},{"key":"e_1_3_4_19_2","unstructured":"American Board of Physical Medicine and Rehabilitation (ABPMR) External Review: https:\/\/cpmiohio.com\/wp-content\/uploads\/2020\/12\/Dr-Margolin-ABPMR-SBIRT-PIP-project-pdf. https:\/\/cpmiohio.com\/wp-content\/uploads\/2021\/12\/ABPMR-PIP-NCV-EMG-Autonomic-Studies_approval.pdf"},{"key":"e_1_3_4_20_2","unstructured":"Kimura J. External review of CPMI protocols. \u201cLetter validating ABPMR study re CPMI protocols.\u201d attached as exhibit BB to whitepaper: overview of CPMI\u2019s provision of pain management services to chronic pain patients and the DOJ\u2019s wrongful investigation and settlement. https:\/\/cpmiohio.com\/wp-content\/uploads\/2024\/03\/White-Paper-SBIRT.x46178.pdf"},{"key":"e_1_3_4_21_2","unstructured":"Wainapel S. External review of CPMI protocols. \u201cLetter validating ABPMR study re CPMI protocols.\u201d attached as exhibit CC to whitepaper: overview of CPMI\u2019s provision of pain management services to chronic pain patients and the DOJ\u2019s wrongful investigation and settlement. https:\/\/cpmiohio.com\/wp-content\/uploads\/2024\/03\/White-Paper-SBIRT.x46178.pdf"},{"key":"e_1_3_4_22_2","unstructured":"Vasilakis W. External review of CPMI protocols. \u201cLetter validating ABPMR study re CPMI protocols.\u201d attached as exhibit DD to whitepaper: overview of CPMI\u2019s provision of pain management services to chronic pain patients and the DOJ\u2019s wrongful investigation and settlement. https:\/\/cpmiohio.com\/wp-content\/uploads\/2024\/03\/White-Paper-SBIRT.x46178.pdf"},{"key":"e_1_3_4_23_2","unstructured":"Oac \u00a7 4731-11-11(C) OAC \u00a7 4731-11-14(B)(1) OAC \u00a7 4731-11-14(F) OAC \u00a7 4731-11-14(G). https:\/\/codes.ohio.gov\/ohio-administrative-code\/rule-4731-11-11. https:\/\/codes.ohio.gov\/ohio-administrative-code\/rule-4731-11-14"},{"key":"e_1_3_4_24_2","unstructured":"Ohio 129th General Assembly. House bill 93. 2011. https:\/\/legiscan.com\/OH\/text\/HB93\/2011"},{"key":"e_1_3_4_25_2","unstructured":"Centers for Medicare & Medicaid Services (CMS). NCS local coverage determination. 2019. https:\/\/localcoverage.cms.gov\/mcd_archive\/view\/lcd.aspx?lcdInfo=35897:24"},{"key":"e_1_3_4_26_2","unstructured":"Berna C. Mayo clinic proceedings: documentation of organic pathology in pain management. 2015."},{"key":"e_1_3_4_27_2","unstructured":"Drug Enforcement Administration (DEA). Chronic pain management guidelines. 2020. https:\/\/www.youtube.com\/watch?v=RvNQwQrqRBQ"},{"key":"e_1_3_4_28_2","unstructured":"Center to Advance Palliative Care (CAPC). Pain Assessment and Documentation Tool (PADT). 2019 Available from: https:\/\/www.capc.org\/documents\/38\/"},{"issue":"6","key":"e_1_3_4_29_2","first-page":"5417","article-title":"Chronic pain-associated cardiovascular disease: the role of autonomic dysfunction","volume":"24","author":"Bruehl S","year":"2023","unstructured":"Bruehl S. Chronic pain-associated cardiovascular disease: the role of autonomic dysfunction. Int J Mol Sci 2023; 24(6): 5417.","journal-title":"Int J Mol Sci"},{"issue":"3","key":"e_1_3_4_30_2","first-page":"686","article-title":"Heart rate variability and pain: a systematic review","volume":"11","author":"Koenig J","year":"2022","unstructured":"Koenig J. Heart rate variability and pain: a systematic review. J Clin Med 2022; 11(3): 686.","journal-title":"J Clin Med"},{"key":"e_1_3_4_31_2","first-page":"123","article-title":"Effect of neuromodulation for chronic pain on the autonomic nervous system: a systematic review","volume":"17","author":"Tracy LM","year":"2024","unstructured":"Tracy LM, Ioannou L, Baker KS, et al. Effect of neuromodulation for chronic pain on the autonomic nervous system: a systematic review. J Pain Res 2024; 17: 123\u2013137.","journal-title":"J Pain Res"},{"key":"e_1_3_4_32_2","unstructured":"American academy of neuromuscular & electrodiagnostic medicine (AANEM) guidelines. https:\/\/www.aanem.org\/docs\/default-source\/documents\/aanem\/advocacy\/model-policy-for-nerve-conduction-studies-and-needle-electromyography.pdf?sfvrsn=fba901ae_3"},{"key":"e_1_3_4_33_2","unstructured":"U.S. Department of Health and Human Services (HHS). Five-point opioid strategy. 2017. https:\/\/www.hhs.gov\/overdose-prevention\/"},{"key":"e_1_3_4_34_2","unstructured":"PBS. Racial disparities in the opioid crisis. 2023. https:\/\/www.pbs.org\/newshour\/show\/racial-disparity-in-addiction-treatment-access-highlights-inequities-of-opioid-epidemic"},{"key":"e_1_3_4_35_2","unstructured":"Harrow RS. Letter of support from the former NY State. DOJ Medicare and Medicaid Division Chair. 2025. https:\/\/cpmiohio.com\/wp-content\/uploads\/2025\/04\/Letter-to-OVV-O1636592xD07F1.pdf"},{"key":"e_1_3_4_36_2","unstructured":"Covent Bridge Group. (2021\u20132024). Medicare contractor denial data. https:\/\/cpmiohio.com\/wp-content\/uploads\/2024\/05\/Letter-to-CoventBridge-2021.x68908.pdf. https:\/\/cpmiohio.com\/wp-content\/uploads\/2024\/05\/Letter-to-CoventBridge-Feb-24.x68908.pdf"}],"container-title":["International Journal of Risk &amp; Safety in Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09246479251360693","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09246479251360693","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09246479251360693","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:45:48Z","timestamp":1777509948000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09246479251360693"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1177\/09246479251360693"],"URL":"https:\/\/doi.org\/10.1177\/09246479251360693","relation":{},"ISSN":["0924-6479","1878-6847"],"issn-type":[{"value":"0924-6479","type":"print"},{"value":"1878-6847","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,9]]}}}