Blockchain expert Victoria Adams is no stranger to the devastation of the opioid epidemic. She watched in dismay as her daughter became addicted to prescription opioids, cycling in and out of rehab centers only to relapse days, months, or years later.
Now, Adams is one of the most outspoken voices in a growing movement to enlist blockchain—the new, secure, record-keeping technology—into the battle against the opioid crisis. She travels to conferences across the country, where she argues passionately for radical new approaches to fighting the epidemic in front of audiences of staid healthcare IT executives.
“We need a new Manhattan Project in this country to solve this problem!” she half-shouted to attendees gathered at meetup hosted in July by a Washington, DC-based networking group for blockchain enthusiasts. For Adams, who leads U.S. government practice at the blockchain company ConsenSys, the opioid crisis is her World War II, and blockchain is the atomic bomb.
Blockchain has become a new buzzword across many industries, and healthcare is no exception. According to a 2018 survey by Deloitte, 30% of life science companies have already invested in blockchain, with 60% of healthcare executives stating that blockchain will be important to maintain a competitive edge. They see a huge potential for blockchain technology in an industry where patient privacy regulations have created deeply entrenched data silos.
Because of the hype, the mere mention of the term can now trigger skepticism—some warranted, some not. Its potential roles in the opioid crisis generally fall into two main categories. First, there are a set of applications, relating to objectives like disease-mapping and drug-tracking, where it could improve and expand existing data-analysis tools. It can give us more and better information about the epidemic by linking disparate data sets across government agencies, healthcare facilities, and drug manufacturers. These goals seem quite achievable, and efforts to realize them are already under way.
Danielle Tarino, a health information technology specialist for the Addiction Policy Forum, sees blockchain as facilitating this first category of use.
“Blockchain itself isn’t going to cut straight to the jugular of the opioid epidemic,” she says in an interview. Instead, she continues, it will be used to “improve upon [infrastructure] systems that already exist.”
Evangelists envision using the technology to spur better treatment by caregivers, and even to incentivize patients to adhere to treatment regimens.
However, there are also blockchain enthusiasts who contend that the technology can eventually yield a second category of applications that are far more novel—qualitatively different from the tools that are available today. These evangelists envision exploiting the technology to spur better treatment by caregivers, and even to incentivize patients to adhere more rigorously to their treatment regimens. But these uses are also more speculative, at least for the time being.
Blockchain first made its debut as the backbone of the cryptocurrency Bitcoin. But it has since been applied across many industries as a better way to document and manage transactions among parties who normally wouldn’t trust one another.
Blockchain networks can be designed to share information between groups while preserving special protections for sensitive data. In the healthcare context, this feature could enable the sharing of data while keeping patient names anonymous, for instance.
Another key, alluring feature of blockchain networks is that they are said to be tamperproof. If one member of a network tries to delete, fiddle with, or backdate data, the whole network will know immediately of the alteration.
As an example of a tangible, first-category application, Fast Company reported earlier this month that IBM and the Centers for Disease Control and Prevention (CDC) are exploring how blockchain might be used to glean new and deeper insights from the agency’s existing disease surveillance activities.
Right now, the CDC’s National Center for Health Statistics works with physicians and hospitals to collect a wide range of data, such as death rates, prescribing patterns, and family dynamics. It is hoped that blockchain could make it easier for the CDC to collect this information, keep it safe from hackers, and manage which of its employees can access it.
IBM already built a “proof-of-concept” model demonstrating this is possible as part of its two-year collaboration with CDC, says David Mcelroy, blockchain technical lead for IBM’s federal government unit.
Blockchain could also be used to improve the way we trace the movement of prescription opioids through the market, to detect diversion and suspicious sales. Though there are already several government programs that monitor the drug supply in this fashion, including systems used by the FDA and DEA, it’s currently difficult to see where products are in real time.
“I think blockchain can definitely help in terms of the transparency of the flow of information,” says Jim Nasr, vice president for technology and innovation at the contract research organization Synchrogenix, a unit of Certara, which is a life science consultancy firm.
The pharmaceutical industry is also eager to use blockchain and internet-connected gizmos, akin to FitBits for shipping crates, to trace the movement of drug products from manufacturing facilities abroad to medicine cabinets in the U.S. A range of companies—from chipmaker Intel to a startup called iSolve (a company building blockchain technology specifically for the drug supply chain)—are involved in these efforts.
Because blockchain networks are tamperproof, a blockchain-enabled, global supply chain network could identify the precise moment drugs are siphoned out of the legitimate supply and into the black market. Similarly, it could zero in on pill mills that are churning out implausible numbers of opioid prescriptions.
The states’ prescription drug monitoring programs (PDMPs) might also be able to use blockchain to improve the accuracy and impact of their efforts to monitor patients’ use of opioids and other medications. It could also help them “talk” to one another across state lines.
“We need to break out of the paradigm we’re in, because it’s not working.”
The more avid blockchain enthusiasts, those envisioning the second category of application, have more dazzling ambitions. They contend that blockchain will eventually permit us not just to improve upon current systems, but to revolutionize the healthcare market.
In Adams’ view, for instance, blockchain could be used to create a marketplace where addiction treatment centers would be rewarded for positive outcomes. This notion springs from the technology’s power—employed with Bitcoin and other digital currencies—to let users accrue value as “tokens” and trade them.
Adams also foresees a marketplace in which addiction treatment metrics could be verified and audited by a network comprised of Medicaid programs, insurance providers, and clinics. Treatment centers would be rewarded for achieving long-term sobriety among their patients. The program would create financial incentives to deliver effective rehabilitation care.
George T. Mathew, MD, believes that blockchain can be used to re-align incentives in the addiction treatment industry, where there is “huge opportunity for fraud, waste and abuse.”
“In some ways, [patients with addiction] are the most preyed upon people in the country.”
“In some ways, [patients with addiction] are the most preyed upon people in the country,” he says. “When it comes to being able to verify that these are good sites, [Medicaid programs] don’t have any criterion, and that’s a problem.” Mathew is the chief medical officer of healthcare payer services at DXC Technology, a multinational IT company.
Adams and Matthew are currently petitioning state Medicaid programs and treatment centers to buy into their vision, but agree that it may take years for such a healthcare marketplace built on blockchain to become a reality.
Meanwhile, other blockchain enthusiasts have proposed harnessing the ability of recently-approved “smart pills”—ingestible medical devices loaded with sensors—to build a blockchain-fueled marketplace in which patients in recovery are themselves rewarded for sticking to their treatments.
Eventually, patients could opt into “token incentivization programs for good behavior,” says Mike McCoy, the blockchain implementation manager at Accenture. Of course, this approach would require patients to have access to a computer, or at least a smartphone—a tall order for some people struggling with addiction, McCoy acknowledges.
“When you have a crisis like [the opioid epidemic], it’s important to remember that every dollar you spend doing something that doesn’t work comes at a huge cost.”
Though intriguing, avant-garde blockchain proposals are sometimes just used as marketing ploys, cautions Tarino, of the Addiction Policy Forum. “I think a lot of companies—especially in major consulting firms—are using the lingo to get the government to buy product,” she says.
“When you have a crisis like [the opioid epidemic], it’s important to remember that every dollar you spend doing something that doesn’t work comes at a huge cost,” warns Philip Clothiaux, director of membership and projects at Hashed Health, an organization that helps nurture and support startup blockchain companies. “Often times the best use cases are ones that are not glamorous.”
Still, it’s tempting to push the boundaries of what blockchain might do to fight the opioid crisis.
Says Adams: “We need to break out of the paradigm we’re in, because it’s not working.”