77. Epic’s Opioid Risk Score77. Epic’s Opioid Risk Score
Addiction Medicine Journal Club
External Validation of Epic’s Risk of Opioid Abuse and Overdose Model Among Primary Care Patients in Three Health Systems.
37:13•1 Jun 2026
Epic’s Opioid Risk Score, Online Gambling Fallout, and Psychedelic Hype Under the Microscope
Episode Overview
- Epic’s opioid risk score showed very low sensitivity and poor positive predictive value, missing most patients who later developed opioid use disorder or overdosed.
- Because the model is a proprietary “black box” using potentially stigmatising variables, the hosts worry it may be used to deny opioids rather than guide supportive care.
- States that legalised online sports betting saw noticeable increases in bankruptcies, delinquencies, and lower credit scores, highlighting population-level financial harm.
- Practical support for gambling problems can include state self-exclusion programmes and calling gambling helplines together with patients during appointments.
- Fast-tracking ibogaine and other psychedelics raises concerns that commercial and cultural enthusiasm may be leaping ahead of solid evidence and established treatments.
“It feels like if we rolled out alcohol first as an anxiety medication and then later on as a recreational product.”
Understand the complexities of addiction with insights from two front-line clinicians who spend their days in Epic and their evenings pulling apart the data behind it. Aimed squarely at addiction specialists, GPs, and anyone working in substance use care, this episode takes a hard look at Epic’s opioid risk score and asks a simple question: does it actually help patients? You’ll hear Dr. John Keenan and Dr.
Sonya Del Tredici joke about “hour 15 of epicism” before getting serious about what the software’s opioid risk model does. They explain how Epic’s score tries to predict a patient’s 12‑month risk of opioid use disorder or overdose, then walk through a large external validation study of over 700,000 primary care patients. The punchline?
The tool hardly ever flags patients, misses most who go on to have problems, and mainly works as a reassurance that someone is low risk — which isn’t especially useful when the outcome is already rare. The pair don’t shy away from the ethical knots either. They worry that a low‑performing “black box” score, built on factors like demographics and prior justice involvement, risks deepening stigma and becoming a quiet excuse to withhold pain treatment from marginalised groups.
They also react to Donald Trump’s executive order to fast‑track psychedelic drug treatments such as ibogaine, questioning whether hype and marketing are racing ahead of evidence: “It feels like if we rolled out alcohol first as an anxiety medication and then later on as a recreational product.” If you’re juggling EMR alerts, patient stigma, and a wave of new “miracle” treatments, this episode offers plenty to chew on — how might you balance technology, caution, and patient trust in your own practice?
Along the way, the conversation widens out. They review data on online sports betting showing population‑level jumps in bankruptcies, debt, and credit problems after states legalise phone-based betting, while sharing practical tips like state self‑exclusion schemes and calling gambling helplines with patients right in the consultation.
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