Speaker: Cynthia Femano, Sr Systems Engineer, Neo4j

1. Neo4j Connections
Graphs in Life Sciences and Healthcare
Reveal Hidden Patterns in Healthcare
Data: Graph Analytics and the Opioid
Crisis
Cynthia Femano – Sr. Systems Engineer, Neo4j

3. 3
~70,000 US deaths/year from drug overdoses
~70% of those deaths from Opioid drugs

4. Fentanyl – A highly potent synthetic opioid intended to treat severe pain
associated with terminal cancer

5. September 29, 2008
Cephalon, Inc. – ACTIQ® (Fentanyl
Citrate) “Off Label” Marketing

6. https://oig.hhs.gov/oei/reports/oei-02-17-
00250.pdf

7. ü How can we track down the source & causes of
the opioid epidemic?
ü Who is doing the over-prescribing and why?
ü Are some parts of the country more susceptible
than others?
This brings to light several questions

8. ü Use public domain datasets that are openly available
ü Connect these datasets in a graph using common
attributes (NPI, NDC, Geolocation)
ü Use a combination of Cypher queries and a graph
visualization tool (Neo4j Bloom) to derive insights from
the data
Our analysis method

9. Labeled Property Graph

10. Combine data from Medicaid Part D and CMS Open
Payments to determine if there is a connection between
Payments made by pharma companies to physicians and
the Part D Prescriptions these same physicians wrote for
opioid class drugs.
Use DEA ARCOS data to examine the Opioid Supply Chain.

11. CMS Open Payments Data
CMS Open Payments Data from the Years 2013-2015. (27M records)
This includes information about payments made by drug manufacturers and specialty pharmacies to doctors and teaching hospitals. The payments are
for things like meals, entertainment, consulting or speaking fees, etc. Each payment is associated with a particular drug or medical device that they are
trying to market.
https://openpaymentsdata.cms.gov/

12. Medicare Part D Prescriber Data
Medicaid Part D Prescriber Data from the Years 2013-2015 (72.3M aggregate records)
This includes aggregated data for drugs and devices, showing number of doses prescribed by a certain provider over the course of a
year.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Part-D-Prescriber.html

13. DEA ARCOS – Pill Distribution of Controlled Substances
ARCOS FOIA Data (178.6M transactions)
Released by the Washington Post, This data tracks the distribution of oxycodone and hydrocodone pills from manufacturer to
pharmacies and physicians in the United States from 2006 through 2012.
https://www.washingtonpost.com/graphics/2019/investigations/dea-pain-pill-database/#download-resources

14. • The NPPES NPI Provider Registry
The NPI Registry Public Search is a free directory of all active National Provider Identifier (NPI) records.
• The FDA NDC National Drug Code Directory
Drug products are identified and reported using a unique, three-segment number, called the National Drug
Code (NDC), which serves as a universal product identifier for drugs.
14
Other Data

15. CMS Open Payments / Medicare Part D / DEA ARCOS Schema

16. Highest Value Opioid Drugs 2013-2015

17. Top Opioid Payees 2013-2015

21. Using Neo4j Bloom to explore the graph

22. Graph Feature Categories and Algorithms
Pathfinding
and Search
Finds the optimal paths or evaluates
route availability and quality
Centrality /
Importance
Determines the importance of
distinct nodes in the network
Community
Detection
Detects group clustering
or partition options
Heuristic
Link Prediction
Estimates the likelihood of
nodes forming a relationship
Evaluates how alike nodes
are
Similarity
22

24. INSYS Thereputics: Prioritizing profits over
patient’s lives

25. https://www.justice.gov/usao-ma/pr/founder-and-former-chairman-board-insys-
therapeutics-sentenced-66-months-prison

26. Alec Burlakoff:
A 60 Minutes investigation into the causes of the American opioid epidemic includes an
examination of the tactics of one former top sales executive.

27. ü While voluminous, detailed data exists to track
payments, prescriptions and the distribution of opioids.
ü There is a network of influence between doctors,
teaching hospitals and pharma companies. Graph
algorithms can reveal this network by finding patterns in
the data.
ü Graph analytics can help to identify the opioid supply
chain and find geographic areas most at risk.
In summary…

29. Thank you!
Cynthia Femano – Sr. Systems Engineer, Neo4j
cynthia.femano@neo4j.com