Abstract Background The intersection of cryptocurrency, especially Bitcoin, with public health issues, particularly synthetic opioid-related deaths, presents an emerging field of study. This research explores the statistical relationship between Bitcoin market fluctuations and synthetic opioid mortalities, against the backdrop of Drug Enforcement Administration (DEA) enforcement actions. Methods Utilizing data from 2009 to 2022, this study employs Pearson correlation and linear regression models to investigate the relationship between annual Bitcoin price fluctuations and synthetic opioid-related death rates, alongside DEA domestic arrest trends. Results A pronounced positive correlation (r = 0.92) was found between Bitcoin price changes and synthetic opioid mortality rates, with the Bitcoin price accounting for approximately 84.78% of the variance in opioid-related deaths (R² = 0.8478). The analysis also notes a disparity between increasing synthetic opioid fatalities and decreasing DEA domestic arrests. Conclusions The findings reveal significant correlations between Bitcoin price fluctuations and synthetic opioid-related fatalities, highlighting potential gaps in current drug enforcement strategies. This study underscores the need for an interdisciplinary approach to address the complexities introduced by cryptocurrency in the opioid crisis and suggests the necessity of integrating financial and public health strategies to combat emerging drug abuse trends.
Ryan W. Seaberg, Tyler R. Seaberg, David C. Seaberg
Objective: Distributed ledger technology can be used as a transparent, shareable ledger, that can record transactions between two parties efficiently and in a more secure, verifiable, and permanent way than the current electronic prescribing systems. We studied the use of a distributed ledger electronic prescribing programme, Prescription Abuse Greatly Reduced (PAGR) Prescriptions, to examine the effect of blockchain on provider prescribing efficiency at three family medicine clinics. Design: The PAGR was installed side-by-side to the electronic health record at three family medicine practice clinics in middle Tennessee. A prospective, convenience sample of patients at all three clinics was used for analysis. Trained observers were used in each clinic to document the side-by-side use of current prescribing practice versus the use of the PAGR electronic prescribing system by the individual providers.The primary outcome was total time to write the prescription. Secondary metrics included compliance with checking the state's Physician Drug Monitoring Program (PDMP.) , accuracy of medicine reconciliation, use of patient's eligibility on insurance, prescription benefits, and change in prescription caused by benefits analysis or drug-interactions. Provider satisfaction was measure on a 4-point Likert scale.Data were analysed using two-tailed, paired Student T-tests with alpha set at 0.05. A sample size of 107 patients was calculated to have a power of 80% to detect a 50% change in the prescription writing time. Results: The primary outcome of total prescription writing time was 171 ± 41 sec for current prescribing practice versus 63 ± 15 sec for the PAGR system (p = 0.0006). All providers were extremely satisfied with the use of the PAGR programme. Conclusion: Use of the PAGR electronic prescription programme significantly saved a mean of 1 min 48 sec per written prescription at the three Family Medicine Clinics. The PAGR also provided accurate medicine reconciliation and complete PDMP checks for controlled substance prescriptions. The patient real-time benefits check and drug-drug and allergy-drug reviews resulted in the provider changing the prescription 28% of the time, enhancing safety and out-of-pocket patient expenses. Future enhancements include expanding the insurance benefits analysis and developing provider notifications when patients are non-compliant with filling their prescriptions.
Aldren Gonzales, Scott R. Smith, Prashila Dullabh, Lauren Hovey · 7 authors
The scale and severity of the opioid epidemic call for innovative, multipronged solutions. Research and development is key to accelerate the discovery and evaluation of interventions that support pain and substance use disorder management. In parallel, the use and integration of blockchain technology within research networks holds the potential to address some of the unique challenges facing opioid research. This paper discusses the applications of blockchain technology and illustrates potential ways in which it could be applied to strengthen the validity of outcomes research on the opioid epidemic. We reviewed published and gray literature to identify useful applications of blockchain, specifically those that address the challenges faced by opioid research networks and programs. We then convened a panel of experts to discuss the strengths, limitations, and feasibility of each application. Blockchain has the potential to address some of the issues surrounding health data management, including data availability, data sharing and interoperability, and privacy and security. We identified five primary applications of blockchain to opioids: clinical trials and pharmaceutical research, incentivizing data donation and behavior change, secure exchange and management of e-prescriptions, supply chain management, and secondary use of clinical data for research and public health surveillance. The published literature was limited, leading us to rely on gray literature, which was also limited in its discussion of the technical aspects of implementation. The technical expert panel provided additional context and an assessment of feasibility that was lacking in the literature. Research on opioid use and misuse is challenging because of disparate data stored across different systems, data and system interoperability issues, and legal requirements. These areas must be navigated to make data accessible, timely, and useful to researchers. Blockchain technologies have the potential to act as a facilitator in this process, offering a more efficient, secure, and privacy-preserving solution for data exchange. Among the 5 primary applications, we found that clinical trial research, supply chain management, and secondary use of data had the most examples in practice and the potential effectiveness of blockchain. More discussions and studies should focus on addressing technical questions concerning scalability and tackling practical concerns such as cost, standards, and governance around the implementation of blockchain in health care. Policy concerns related to balancing the need for data accessibility that also protects patient privacy and autonomy in revoking consent should also be examined.
This article describes the structure and functionality of OpTrak, a decentralized app implemented using the Ethereum blockchain that targets the opioid epidemic currently plaguing the United States. Over-prescription and distribution of opioids cost the national healthcare system over $78 billion every year. Problems persist in every stage of the process, from doctors prescribing the medication to the pharmacists fulfilling prescriptions. These problems arise from a combination of factors, including lack of accountability, transparency, and reliability in the current prescription drug monitoring programs. This work provides three key contributions to research on a technical approach to mitigate the opioid epidemic. First, the authors pinpoint key problems in the current opioid prescription system. Second, they propose an integrated approach for addressing the problems by leveraging distributed ledgers, focusing on blockchain technology. Third, the authors describe the structure and functionality of OpTrak that allows a consortium of care providers to exchange patient prescription data securely.
OBJECTIVE: To introduce the basic concepts of blockchain technologies in tackling the opioid epidemic. DESIGN: A narrative review. SETTING/BACKGROUND: The opioid epidemic is taking a big toll in terms of lives and livelihood in America. Various public and private sector agencies are actively implementing different strategies to contain the epidemic. Development of robust real-time databases that are secure and easily accessible to the stakeholders in the opioid/paincare ecosystem is essential. Blockchain technologies, with their inherent features of decentralization, immutability, and easy access are well suited to achieving these goals. Some practical applications of blockchain technologies include data collection/aggregation/analysis, patient/provider identification, traceability/monitoring of opioids, supply chain provenance, prescription monitoring, licensure and credentialing, interoperability, seamless integration/communication, development of opioid alternatives, and research incentivization. CONCLUSIONS: Blockchain technologies may help support the efforts of different agencies in curtailing the opioid epidemic.
Patrick Li, Scott D. Nelson, Bradley Malin, You Chen
Background: Access to accurate and complete medication histories across healthcare institutions enables effective patient care. Histories across healthcare institutions currently rely on centralized systems for sharing medication data. However, there is a lack of efficient mechanisms to ensure that medication histories transferred from one institution to another are accurate, secure, and trustworthy. Methods: In this article, we introduce a decentralized medication management system (DMMS) that leverages the advantages of blockchain to manage medication histories. DMMS is realized as a decentralized network under the hyperledger fabric framework. Based on the network, we designed an architecture, within which each prescriber can create prescriptions for each patient and perform queries about historical prescriptions accordingly. Finally, we analyzed the advantages of DMMS over centralized systems in terms of accuracy, security, trustworthiness, and privacy. Results: We developed a proof of concept to showcase DMMS. In this system, a prescriber prescribes medications for a patient and then encrypts the prescriptions via the patient’s public keys. Patients can query their own prescriptions from different histories across healthcare institutions and then decrypt the prescriptions via their private keys. At the same time, a prescriber can query a patient’s prescription records across healthcare institutions after approval from the patient. Analytic results show that DMMS can improve security, trustworthiness, and privacy in medication history sharing and exchanging across healthcare institutions. In addition, we discuss the potential for DMMS in e-prescribing markets. Conclusions: This study shows that a distributed secure ledger can enable reliable, interoperable, and accurate medication history sharing. Keywords: Blockchain Ledger, Decentralized, Hyperledger Fabric Framework, Medication Histories Please see a related Letter to the Editor (https://doi.org/10.30953/bhty.v2.98), and its response (https://doi.org/10.30953/bhty.v2.108)
The USA is entering an era of major change in the financing and delivery of health-care services, including a greater emphasis on evidence-based treatment. Mainstream US alcohol treatment is an amalgam of experience- and evidence-based approaches; the National Institute for Health and Clinical Excellence (NICE) alcohol guideline could provide a model for reform in the USA. The NICE guideline 1 on the diagnosis, assessment and management of harmful drinking and alcohol dependence should be required reading for anyone concerned about evidence-based approaches to alcohol treatment. The guideline was developed to ‘improve standards of care, diminish unacceptable variations in the provision and quality of care … and ensure that the health service is patient centred’ (p. 13). Under the UK single-payer model, once a NICE guideline is published and disseminated, local health-care groups are expected to develop a plan to implement the guideline. The guideline covers five major domains, offering a comprehensive set of recommendations that carefully distinguishes the needs of persons with harmful drinking/mild alcohol dependence from the needs of those with more severe dependence. Key recommendations focus on the therapeutic relationship; family involvement; use of standardized assessment tools; development of agreed-upon drinking goals; use of care coordination and case management; use of evidence-based treatments, such as motivational interviewing, Twelve-step facilitation, behavioral couple therapy, and pharmacotherapies; mutual help groups; treatment of comorbid psychological problems; and outcomes monitoring. This is an excellent guideline, but could it be applied in the USA? The delivery of alcohol treatment is quite different in the USA than in the UK; these differences might limit the applicability of the guideline. In the USA, alcohol and drug problems are typically treated in the same programs, and the administration of policy and services occurs through a single state authority over both alcohol and other drug issues. There are approximately 13 000 substance abuse treatment programs in the country. Treatment is provided through private programs, funded through health-care insurance, self-payment, or endowments; and public programs, funded through sources including Medicaid (for low income individuals and those with disabilities), Medicare (for older adults) and block grants from the Federal government to each state. Each of the 50 states independently governs the system of care within that state; sometimes authority is assigned at the county level (with 3033 counties or county-equivalents in the USA). The large number of programs and decentralization of authority challenge the application of any uniform standard across the country. The vast majority of US programs view alcohol problems from a disease perspective and incorporate Twelve-step principles into the treatment, but more than half also say they have adopted motivational interviewing, motivational enhancement therapy, and cognitive-behavioral approaches 2. The primary goal of treatment is typically abstinence from all psychoactive drugs. In contrast to the UK, the USA has no systematic approach to incorporating research findings into alcohol treatment, nor are there US-wide mandated standards of care. The US Preventive Task Force (USPSTF) is tasked with making evidence-based recommendations about preventive and treatment health services, leading to guidelines for clinical care that are adopted by Medicaid and Medicare. The only alcohol-related USPSTF guideline is for alcohol screening and counseling in primary care settings 3. Various other groups have developed and promulgated practice guidelines 4; some private insurance companies use such guidelines for the purposes of reimbursement. The structure and delivery of health-care services in the USA is likely to change considerably with the 2008 passage of mental health/substance abuse parity legislation, and full implementation of the 2010 Patient Protection and Affordable Care Act (ACA) (upheld by the US Supreme Court in June 2012). The ACA requires that alcohol and other substance use disorders (SUD) be part of the ‘essential health benefit’ package and prohibits insurers from denying coverage for pre-existing conditions. The ACA mandates SUD/mental health screening and referral in primary care settings. It is anticipated that expanded health-care coverage will lead to a greater number of individuals with SUDs who have insurance, resulting in a greater demand for SUD services. The guideline represents a different philosophical approach to alcohol problems than that of the current US system and there are significant differences in the systems of care, but many of the assessment and treatment recommendations are highly pertinent to the USA. Philosophically, the mainstream US treatment system takes a medical approach. A formal Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis is required, and individuals are referred to as ‘patients’ or ‘clients’ (versus ‘service users’ in the guideline) who receive ‘treatment’ (versus ‘care’). Although programs and providers aligned with the guideline perspective exist in the USA, they do not represent a majority. Views of the family also differ. The guideline recognizes family engagement and support as a central component of treatment; mainstream US programs rarely, or only superficially, include a family component in treatment. The guideline is supposed to lead directly to changes in the delivery of services; currently the USA has no similar system to enforce change. With the full implementation of the ACA, the USA will have to develop better ways to deliver evidence-based treatments and monitor/enforce their use; the UK system could provide a model. The US integration of alcohol and other substance use services within the same programs could make it more difficult to apply the guideline in the USA. However, there are sufficient similarities in the service delivery systems in terms of levels of care and differentiation of service needs based on problem severity that many of the guideline recommendations could be adopted. The guideline recommends the use of standardized measures to assess individuals seeking services. The US system also is moving to a standardized intake assessment model, with many states requiring the use of the Addiction Severity Index 5. The US system would do well to consider the more alcohol-specific measures recommended in the guideline. The selection of drinking goals continues to be more controversial in the USA than elsewhere. The guideline provides a sensible, evidence-based model for working collaboratively with clients to select treatment goals; the USA should more fully embrace that model. Finally, the guideline provides an excellent blueprint for selection of treatments based on presenting concerns and the severity of the drinking problem. The research literature that underpins the recommendations represents work of US, UK and other European scientists, suggesting a knowledge base that is generalizable across cultures. More fully adopting the assessment, goal-setting and treatments recommended by the guideline could improve outcomes and efficiency in the US system. In conclusion, the Guideline Development Group (GDG) has performed an incredible service for those affected by problematic drinking. The US system of care is in a state of change as the ACA and the attendant changes in health-care delivery are enacted across the country. Philosophical perspectives on drinking problems and approaches to treatment are evolving slowly in the USA; the perspective and recommendations of the GDG should form a blueprint for advancing efficacious treatments on both sides of the Atlantic. None.