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Unmet Medical Need
Narcotic drugs are double-edged swords. On the one hand, they have the potential to improve quality of life, e.g. for cancer patients with severe pain. On the other hand, narcotics carry the potential to destroy lives, as they are highly addictive. A current study estimates the number of opioid addicts to about 166 000 people in Germany (Drogenbeauftragte der Bundesregierung, 2018). The non-medical usage of these drugs is identified as a major threat to global public health (UN Office on Drugs and Crime, 2018).
Therefore, the prescription of narcotic drugs in Germany is strongly regulated. The Betäubungsmittelgesetz (BtMG) and the Betäubungsmittelverschreibungs-verordnung (BtMVV) provide the legal foundations for narcotic drugs in Germany and define clear requirements for their prescription. The current process is manual and paper-based, hence it creates an enormous burden for all those involved and results in high personnel, print and administrative costs. Even more alarming is that these processes are still unsafe. Paper prescriptions can be easily stolen or manipulated. Despite rising numbers of drug crimes, the Federal Opium Agency lacks comprehensive and up-to-date information on prescribed and issued narcotic drugs. Furthermore, the physical storage of paper prescriptions in pharmacies and doctor's offices causes data protection issues. Also, the manual documentation and issuing process is prone to human error, as highlighted by the discussion on retaxation. Already in 2003, the Federal Opium Agency has highlighted security loopholes and inefficiencies of the current narcotic drugs circulation and demanded a digital process.
eBtM is a blockchain-based solution for the narcotic drugs circulation in Germany, where a prescription is handled digitally as a smart contract. It creates a decentralized network, which is administered by doctor's offices, pharmacies and regulatory authorities. The blockchain model allows for the safe, immutable and comprehensive storage of narcotic drug transactions in a decentralized register.
Let us have a look at an example. Bob is a cancer patient and needs analgesics for pain relief. His doctor Alice prescribes narcotic drugs: She logs onto her computer's eBtM wallet and enters the required medication. The prescription is digitally signed by Alice and handled as a smart contract. This contract allows Bob to pick up his medication within the validity period. Alice transmits the transaction to the eBtM network. This network is private and permissioned. When Bob picks up his medication at the pharmacy, he triggers the smart contract through his electronic health card or by scanning a QR code. The handover is mapped on the chain: while the pharmacist is identified by his public key, the drug is identified by a scan of the securPharm code. An automatic notification is sent to the insurer.
With this lighthouse project, eBtM marks the first step towards implementation of e‑prescriptions in Germany.
The team combines a clinical and a technical perspective. Dr. Christian Sigler is a resident physician at Charité Berlin where he works at the hematology ward at the Campus Benjamin Franklin. Irina Hardt is a PhD candidate in Information Technology at the University of Ulm, focusing on Explainable Artificial Intelligence and eGovernment. As winners of the Federal Ministry of Health's blockchain challenge, the team has already established a dialogue with both key political actors and pilot organizations.
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