Accidental overdose of opiates has taken over 37,000 lives in 2016, easily surpassing deaths due to HIV/AIDS epidemic at its peak. The opioid epidemic in America is getting increasingly worse every year as nearly 170 Americans die daily as a consequence of opioid overdoses (1).
Efforts to use Blockchain to solve the opioid crisis often hinge on the accountability step for the release of the medication. Concerned parties suggesting Blockchain as a single solution for the opioid epidemic often attribute the liability for abuse to the physician who prescribes the opioid or to the pharmacist at the point of fulfillment. In this model, the responsible parties are deemed as those who issue the opiates. While pragmatic from the supply chain management perspective, a more robust understanding of the epidemic suggests that culpability for addiction entails more than supply chain dynamics.
The problem is in the mishandling and misuse of opiates, not the way in which they are prescribed. Studies show that opiates are extremely addictive (2). We must begin to treat opiates as addictive substances.
The purpose of this article is neither to disparage the past efforts to end the national opioid epidemic, nor to discredit past discussion proposing Blockchain as the crucial component to end such an epidemic. From the supply chain management perspective, Blockchain plays a critical role in ending physician and pharmacist fraudulent practices and clerical errors. However, this article serves to suggest that maybe we have to approach the problem in a different manner given the tools we have at our disposal.
Many forget America has gone through this same epidemic before, during the Civil War in the mid to late 19th century. Granted, it was a completely different time with less ease and accessibility to opiates. Even so, the epidemic subsided through education and awareness rather than a dearth of drug supply. This first epidemic was successfully contained through a collaborative effort by physicians, pharmacists, and lawmakers who provided medical education and federal regulations to help with restraint from taking opiates.
The opioid epidemic is, above all else, a problem in America’s struggle with substance abuse and addiction. To that end, the issue is not merely as simple as supply chain clerical errors, but it is a psychological disorder in struggling with addiction. Given the use of opioids as a gateway or transition drug to heroin abuse, the key to solving this problem is recognizing the prevalence of addiction in US society. To resolve such a massive medical issue requires not just a change in the method of delivery, but a fundamental change in the ecosystem of opiate prescription.
We must hold all parties accountable for the prescription of opiates for pain management rather than traditional analgesia. Alternatives exist to current management of pain with opiates. Analgesia has proven, in some cases, to be even more effective than opiates for managing pain. “In patients undergoing cardiac surgery, a multimodal regimen offered significantly better analgesia than a traditional opiate regimen. Nausea and vomiting complaints were significantly reduced.” (3) Federal legislation must also be able to come down and ensure proper medical education for high risk patients if they must be on opiate-derived analgesia. Current efforts to prevent relapse show marked improvement in recovery rates with increased family and social support, whereas a lack of a familiar support system correlates with persistent opioid use.
Blockchain can play a pivotal role in the research and development of opiate alternatives. Providing a decentralized database of test results with free access to this data prevents the possibility of duplicated efforts globally as well as enhanced coordination across projects. Even with the prominence of opiate deaths, this epidemic is not officially considered a “National Health Emergency” in that Congress has not allocated specific funds for research as took place during the HIV/AIDS epidemic. Unlike the HIV/AIDS epidemic, there is no medicinal cocktail that inhibits the retroviral pathway as researchers have since discovered for HIV therapy. Only methadone helps treat opioid addiction in preventing withdrawal symptoms. However, by leveraging blockchain, we can tackle the larger issue of addiction stigma.
Instead of “tagging” and restraining patients, as some projects suggest, as high risk for substance abuse, we should provide these patients in at-risk communities with educational resources to understand addiction and mental health disorders. Interestingly enough, despite backlash against the DARE program of the 90’s because of the inefficacy in its approach of drug abstinence instead of drug awareness, efforts exist to recreate the DARE program for the opioid epidemic.
The solution is far more complex than one person or technological solution. It requires a greater effort than just research or prescription tracking. Blockchain may not be the answer to all of the moving pieces that allowed for the epidemic to get this bad, but it can provide steps towards the solution. We should support the efforts put forth by projects like MedCredits, BlockMedX, JustUs amongst others, and continue to implore others to push forth and think of alternative methods to stop the epidemic in its current severity (4). At the end of the day, no one solution will eradicate the epidemic, it will be an entire ecosystem of applications.