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Intel aims to tackle the opioid epidemic with blockchain technology

Andrew Munro 1 May 2018 NEWS

The blockchain cannot solve the opiate epidemic, mostly because of the situational factors involved.

It's a relatively straightforward plan. Intel is working alongside health practitioners to use the blockchain to more closely track opiate-based medications from factory to patient, with the goal of spotting the leaks in the supply chain. These leaks are where opiates jump the rails from prescribed use to drug dealers and abusers.

These leaks might look like one patient picking up prescriptions from multiple doctors, "pill mill" doctors that over-prescribe or pills going missing somewhere between the factory and the end user.

Drug overdoses killed 64,000 Americans in 2016, up from about 50,000 the year before, the vast majority of which were caused by opiates. The number of opiate-related deaths in those years was enough to decrease life expectancy in the USA two years in a row. As it stands, predictions see it claiming half a million lives in the USA alone in the next 10 years. So a solution would be nice.



The good news

A single immutable ledger system would be extremely useful and well-suited to tackling pill mills, double-doctoring and other systemic abuse. DHL and Accenture are working on a similar blockchain-based system to track medicines in developing countries, where counterfeit medication is estimated to kill about a million people per year.

Supply chain solutions are a relatively straightforward application of distributed ledger technology. It can be used to track goods from end to end on an immutable ledger. The idea is essentially to give each shipment or container its own unique identity. These can then be traced with RFID tags or similar devices along the entire supply chain, all the way to distribution centres, prescribing doctors and end users, which each have their own unique identifiers. The nature of distributed ledger technologies means that this can all be done without unduly compromising privacy.

It would be especially useful in the USA, which is made up of dozens of different states, each with its own separate medical boards and other authorities, and which is pursuing top-down efforts to tackle the opioid epidemic state by state. Currently, the job of tracking prescriptions is mostly handled by state-level drug monitoring programs, which aim to identify doctors that run pill mills or overprescribe patients, or patients that double (or triple, quadruple, etc) dip by getting the same prescription, or a different prescription for the same ailment, filled by multiple doctors.

The downside of this system is that patients can simply cross the state border to get prescriptions filled multiple times. This can be solved by compiling all available state prescription information into one accessible database.

However, that doesn't solve the problem of doctors knowingly or unknowingly prescribing excess dosages, malingerers picking up fake prescriptions with the intention of selling them, someone simply changing the database or not entering information into it and similar issues. This is where the distributed ledger comes in.

It's immutable, tamper-proof and can be used to track the medications themselves across the entire supply chain to identify these kinds of leaks.

The bad news

The success of the system is dependent on getting as many people on board with it as possible, and many stakeholders will need to be dragged into it kicking and screaming. Many of the leaks that the system aims to track have been obvious for a long time. The problematic part might be plugging them.

Consider the town of Kermit in West Virginia, population 392. Over the course of two years, it received 9 million hydrocodone pills from out-of-state drug companies. This is much like nearby Williamson, population 2,900, whose two pharmacies received nearly 21 million opiate painkillers between 2006 and 2016. All of these pills were legally shipped and tracked as they should have been.

The state of West Virginia, as well as Ohio (which was legally prescribed the equivalent of 68 pills per resident in 2012) and Mississippi, has since sued drug companies for their role in the opioid epidemic, accusing them of conducting misleading marketing campaigns that underplayed the risk of opiate addiction. In the case of Ohio, a settlement for a few tens of millions of dollars was reached. In some ways, one might argue that pharmaceutical companies knowingly leveraged the addictive properties of opiate medications to make sure business kept booming in the future. In 2007, several Purdue executives pleaded guilty to falsely marketing OxyContin in a way that played down the drug's risk of addiction and potential for abuse.

However, none of this seems to have had any impact. Despite decade-long efforts to crack down on these problems, the number of opiate deaths has just kept rising. The latest complete annual CDC figures for overdose deaths are from 2016, and they showed a 21.5% increase over 2015. And so far, the available numbers from 2017 indicate that it will be another record-breaking year for overdose deaths.

Blockchain can't solve the opiate epidemic

The system is focused on tracking pills, in order to knock down the occasional pill mill and double dipper. This has been going on for years and is clearly not making much of a dent.

Part of the problem might be that it's too little too late. The pills laid a groundwork of addiction for the USA's opiate crisis to take on a life of its own. People left with opiate addiction following prescribed or recreational pill usage are now driven towards alternatives like heroin and fentanyl. And there's no shortage of illicit suppliers ready to fill the hole in the market left by the eventual withdrawal of brand-name opiate pills from the market.

As of 2016, after the crackdown on pills started yielding results, the number of fentanyl overdoses had increased by 540% in three years.

The cheap yet hyper-potent substance is often used either as a filler, to cut other drugs or as the key ingredient in home-made opiate pills distributed around much of the USA. There are domestic operations around the USA that make their own pills from fentanyl bought overseas. In many cases it's simply bought online (often with cryptocurrency) from sellers in China and then sent by mail.

One of the things making it so easy is the US postal service's failure to widely deploy a package tracking system, which would help intercept these shipments. An investigation into the postal service revealed that the drug suppliers are well aware of the chances of seizure with different delivery services, and simply price it into their shipments accordingly. Customers who want private express services like FedEx or DHL need to pay a premium to offset the increased chances of seizure.

The bulk of the problem, in the USA at least, no longer lies with brand name opiate pills. It's since moved onto more classic drug deals and international imports. Not only are these beyond the reach of Intel's blockchain solution, but even if it wasn't, there would still be problems with the actual implementation. Just look at the US postal service's struggles to implement a more straightforward technology solution, or the extensive uphill battle and many lawsuits that were needed before pharmaceutical companies started reining in their opiate promotion.

It's not clear what the solution is, only that it will need to be international.

But the world is off to a good start. The USA and China are already engaging in a close cultural exchange program over opiates. Specifically, pharmaceutical companies are starting to push legal opiates hard around China, while Chinese drug labs are starting to push illegal opiates hard around the USA. And both sides are increasingly facilitating their supply lines through distributed ledger technology.

"Can blockchain fix the opioid epidemic?" No, but it's mostly due to situational factors that limit its usefulness here, rather than problems with the technology itself. It can help a lot, but it certainly can't solve it entirely.

Is cryptocurrency making the opiate epidemic worse by facilitating drug purchases? No, it's just making it slightly more efficient by reducing the risks and improving the drug dealer's margins. The number of yachts owned by drug kingpins has little to do with the number of overdoses caused by their products.

In the end, distributed ledger technology might help the most by bringing the world slightly closer together in some ephemeral way. If there is a real solution to the increasingly global opiate problem, it might be in that direction.


Disclosure: At the time of writing the author holds ETH, IOTA, ICX, VEN, XLM, BTC, XRB

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