# eBtM - Electronic Narcotic Prescription with Blockchain

> The eBtM system is a blockchain-based solution for creating tamper-proof electronic narcotic prescriptions, developed by Charité Berlin and the University of Ulm. The system uses blockchain technology as a tamper-proof backbone to store all transactions redundantly, preventing and detecting fraud. The project won an innovation competition by the German Federal Ministry of Health in early 2019 and is still in the concept phase.

**Sector:** Tertiary sector · **Industry:** Health technology · **Organisation:** Charité Berlin & Universität Ulm (unterstützt vom BMG) · **Maturity level:** Concept

Canonical URL: https://www.sapientblock.com/en/use-cases/charite-berlin-btm-rezepte-faelschungssicher-ausstellen

## Documentation status

- **Project status:** Concept
- **Evidence:** Evidence medium
- **Editorial review:** Ufuk Avci, 15 April 2026

## Description

Controlled substance prescriptions (BTM prescriptions) in Germany are issued on paper using three-colour forms with watermarks. The system is prone to errors: forgeries allow unlawful access to strong painkillers and opiates. In 2019, the federal government highlighted blockchain-based prescription issuance as a promising use case in its national blockchain strategy.

The German BTM prescription system is based on tripartite paper forms (yellow controlled substance prescription) with watermarks and doctor’s signature. Pharmacies must manually verify authenticity and can only detect forgeries to a limited extent. The federal government identified in the 2019 blockchain strategy the possibility of issuing BTM prescriptions based on blockchain: the doctor digitally signs with their cryptographic key; the prescription is anchored as an immutable record on the blockchain; pharmacies check authenticity and redemption status immediately via blockchain query. Double redemption (redeeming the same prescription multiple times) would be structurally excluded. With the introduction of the e-prescription (mandatory in Germany from 2024, FHIR standard), the first step towards digitalisation has been taken. Blockchain integration would significantly enhance the security of the e-prescription: cryptographic signatures instead of a central database, tamper-proof redemption history.

## Benefits

- Medical practices and pharmacies can avoid re-billing cases and associated costs.
- Patients receive increased security when controlled substances are prescribed.
- Blockchain technology makes controlled substance prescriptions tamper-proof and effectively prevents forgeries.
- Administrative processes are automated, saving time and costs.
- Electronic billing with health insurance funds is fully digitalised and made more efficient.
- Medical staff benefit from less manual work and reduced form errors.

## Challenges

- Companies must invest in new software and train their employees accordingly.
- The system is still in the concept phase with no known pilot projects or live implementations.
- Integration into existing IT infrastructure of medical practices and pharmacies requires technical adjustments.
- Medical staff must adapt to new digital processes and receive appropriate training.

## Technology foundation

The eBtM system is based on blockchain technology, which stores all prescription transactions tamper-proof and redundantly. The blockchain acts as a decentralised backbone that enables an immutable record of all controlled substance prescriptions, thereby preventing forgeries and uncovering fraud attempts.

## Sources

- [Kabinett beschließt Blockchain-Strategie](https://www.pharmazeutische-zeitung.de/kabinett-beschliesst-blockchain-strategie/)