Drug overdose is "a leading cause of injury and death" in the United States – the Centers for Disease Control and Prevention estimates that 174 people died from an overdose every day in 2016.
One major facet of this problem is opioid addiction. In 2016, over 65 percent of overdose-related deaths involved opioids. Nonfatal opioid overdoses have increased as well, as has the spread of infectious diseases tied to intravenous opioid use.
The US is clearly embroiled in an opioid epidemic.
However, overdose is only one aspect of the opioid crisis and is ultimately informed by three other key components: overproduction, overdistribution, and overprescription.
Initially, pharmaceutical companies may produce more opioids than the market demands. Angel Versetti, CEO of supply chain-focused blockchain and IoT network Ambrosus, boils this overproduction down to a lack of data coordination. Most companies in the industry store their data within private databases, meaning each organization's information is sequestered from other institutions. These separate companies, therefore, "are the only stakeholders who actually know how many opioids" they manufacture.
Overproduction leads to overdistribution because these same companies are only tracking where they distribute their drugs. Not only will there be a surfeit of opioids floating around the pharmaceutical market; there will also be certain areas that have more of the drugs to go around simply because there is no data coordination.
Moving away from the supply chain, perhaps the largest component of the opioid issue is overprescription by doctors. The US' history of overprescribing opioids is no secret – in the 1990s, pharmaceutical companies misled doctors about the safety and effectiveness of the drugs, leading medical professionals to prescribe them for various types of pain. Patients then became reliant on their daily doses because the drugs are addictive. Decades later, and the country is still combating opioid addiction.
With its transparent and traceable nature, blockchain technology has emerged as a potential solution to address this crisis. Although a blockchain would not necessarily be able to stop individuals from abusing the drugs after obtaining them, it might be able to counteract the opioid issue at the supply chain level. Similar proofs of concept already exist to track products within the food and beverage, diamond, and equipment supply chains.
Versetti said that a blockchain-based system could usher in "a new standard" for information sharing within the pharmaceutical industry:
"Blockchain provides a precedent from which a pharmaceutical company – or many – could transparently demonstrate the amount of opioids they have manufactured, where they have been distributed, and whether there was actually sufficient demand for them. In the future, as the full scope of blockchain becomes more understood, governments could then require pharmaceutical companies to share all of that information with the legal authorities and the general public."
An expanded information standard such as this would, by its nature, help prevent the overproduction of opioids, as there would be no need to coordinate different sets of information when all that data is transparent and shared across multiple stakeholders from the get-go.
Versetti also noted that a foundational issue with the pharmaceutical industry is "a lack of trust"; this is especially true of opioids, since there "is a lack of oversight" regarding the industry's distribution of the drugs. Therefore, he believes "a trustless technology" like blockchain "must be the primary solution" that is explored.
He went on to explain how a blockchain network like Ambrosus might be integrated into a pharmaceutical company's information systems. In his example, Versetti said that a drug could be fitted with a sensor, such as a chemical tracer or a radio-frequency identification (RFID) chip, that would log information about the product onto a blockchain. Each drug would then have a separate digital identity immutably stored on the network.
Besides tracking opioid production and, therefore, helping to mitigate overdistribution, blockchain technology could address any potential tampering with the drugs (like through counterfeiting). In this way, blockchain-connected sensors such as RFID chips would not only aid in monitoring the opioid supply chain but also provide "a new layer of accountability and ownership" for each drug.
Although Versetti did not mention using a blockchain network like Ambrosus in the healthcare industry, this application could help tackle the opioid issue at the prescription level. Instead of tracking production and distribution in a supply chain, a healthcare-oriented blockchain would allow medical professionals to see how many opioids are being prescribed.
This information would enable doctors to better regulate how much of these drugs are getting into the hands of patients and, depending on the network's implementation and security protocols, what conditions are being treated with opioid painkillers. (This second part is important because opioids have historically been prescribed for some pain that does not necessitate their use.)
Despite the benefits of blockchain and its successful integration into various supply chains, some critics do not see the technology as a panacea for the opioid crisis. Economist Max Gulker noted that the US' recent efforts to crack down on drug abuse, though not utilizing or based on blockchain technology, have exacerbated the problem in some regions, leading individuals to turn to heroin if they cannot easily obtain opioids.
For example, the Carolinas Medical Center in Charlotte, North Carolina, found that its heroin detox patients were largely police officers, lawyers, and nurses – folks from "some of the best neighborhoods in the area" who did not fit the typical modus operandi of a heroin addict, according to CNN. These individuals used to take pills for pain but ultimately transitioned to heroin.
Gulker said a negative effect like this has been "one of the more tragic examples of the law of unintended consequences." Better methods to track drugs like opioids have their benefits, but he believes that the system in general "pushes those [most] likely to abuse drugs to more dangerous substances, while perhaps making it harder for those who actually need the medication for pain."
Of course, any blockchain solution is not without its disadvantages – blockchain's role in the opioid epidemic is not unique in that regard. It is important to note, however, that the potential consequences tied to this specific use case are arguably greater than just, for example, crates of food not being tracked. Actual human lives would be affected.
But even with the potential drawbacks of a blockchain-based solution to the opioid crisis, the benefits may outweigh the risks. A public ledger might not comprehensively solve the problem, but it would at least slow the issue down, helping to reduce the number of individuals who will become addicted to these drugs. It is certainly worth acknowledging that those who are already addicted may be led to more hardcore drugs like heroin, but doing something to prevent future addiction may be better than doing nothing at all.
That said, a solution, whether blockchain-based or not, should holistically consider the state of the opioid epidemic so that it mitigates the occurrence of unintended consequences.