Money is flowing into addiction technology, but will it curb the spike in opioid overdose deaths?

David Sarabia had already sold two startups at age 26 and had enough money to never have to work another day in his life. He moved from Southern California to New York and began to indulge in all the luxuries his new status as a millionaire handed down. Then everything changed and his life quickly unfolded.

“I became a massive cocaine addict,” Sarabia said. “It started out as a casual party, but it escalated into just about anything I could get my hands on.”

At a particularly low point, Sarabia was homeless for three months, sleeping on public transport to stay warm. Even with a lot of money in the bank, Sarabia says, he had lost the will to live. “I had given up,” he said.

He kind of got back on his feet, and for the next three years he lived as a “functional cocaine addict” until his best friend, Jay Greenwald, who died after a night of partying. Eventually, Sarabia settled into a rehab in Southern California — apparently luxurious, though Sarabia didn’t find that to be the case.

Yet the place saved his life. Clinicians genuinely cared, he recalls, though their efforts were hampered by clumsy technology and poor management. He felt the owners were more interested in making a profit than helping people recover.

Just days away from cocaine, the tech entrepreneur was scribbling drawings for his next startup idea: a digital platform that would make paperwork easier for clinicians, combined with a mobile app to guide patients through recovery. After leaving treatment in 2017, Sarabia tapped into his remaining wealth — around $400,000 — to fund an addiction tech company he named inRecovery.

As the nation’s opioid overdose epidemic hits an all-time high of more than 100,000 deaths in 2021, effective ways to combat drug addiction and expand access to treatment are desperately needed. Sarabia and other entrepreneurs in the field they call addiction technology see a $42 billion US market for their products and an area of ​​addiction treatment that, in technical terms, is ripe for disruption.

It has long been torn between opposing ideologies and approaches: drug treatment versus brutal detoxification; residential versus outpatient treatment; abstinence versus harm reduction; peer support versus professional help. And most people who report having substance abuse problems never manage to access treatment.

Technology already offers help to some. Those who can pay out of pocket or have treatment covered by an employer or insurer can access one of dozens of addiction telemedicine startups that allow them to see a doctor and have a medicine like buprenorphine sent directly to their home. Some of the virtual rehabs offer digital cognitive behavior therapy, with connected devices and even mail-in urine tests to monitor sobriety compliance.

Many apps offer peer support and coaching, and entrepreneurs are developing software for treatment centers that manage patient records, personalize client time in rehab, and connect them to a network of peers.

But while the founders of for-profit companies may want to end the suffering, said Fred Muench, a clinical psychologist and president of the nonprofit Partnership to End Addiction, it all comes down to revenue.

Startup experts and clinicians working on the front lines of the drug and overdose epidemic doubt flashy Silicon Valley tech will ever reach the addiction-ridden people who are unstablely housed, financially challenged and on the wrong side of the digital divide.

“People who are really struggling, who really need to access addiction treatment, don’t have 5G and a smartphone,” said Dr. Aimee Moulin, professor and director of behavioral health for the Department of Emergency Medicine at UC Davis Health. “I’m just concerned that as we start to build on these tech-heavy treatment options, we’re just creating a structure where we’re really leaving behind the people who really need the most help.”

Investors willing to pump millions into startups typically don’t invest in efforts to extend treatment to the less privileged, Moulin said.

Also, it’s hard to make money in the addiction tech business because addiction is a stubborn beast.

Conducting clinical trials to validate digital treatments is difficult due to frequent user lapses in medication adherence and tracking, said Richard Hanbury, founder and CEO of Sana Health, a startup that uses audio-visual stimulation to relax the mind. mind as an alternative to opioids.

There are thousands of private, non-profit, and government-run drug treatment programs and centers across the country. With so many small players and disparate programs, startups face an uphill battle to attract enough customers to generate significant revenue, he added.

After conducting a small study to ease the anxiety of people detoxifying from opioids, Hanbury postponed the next step, a larger study. To sell his product to the vast array of drug treatment providers nationwide, Hanbury decided, he would need to hire a much larger sales team than his fledgling company could afford.

Yet the overwhelming need fuels enthusiasm for addiction technology.

In San Francisco alone, more than twice as many people have died from drug overdoses than coviD over the past two years. Employers, insurers, providers, families and people with addiction themselves are all demanding better and affordable access to treatment, said Unity Stoakes, president and managing partner of StartUp Health.

The investment firm has launched a portfolio of early-stage startups that aim to use technology to ending opioid addiction and the opioid epidemic. Stoakes hopes the wave of new treatment options will reduce the stigma of addiction and increase awareness and education. The emerging tools aren’t trying to take away human care for addiction, but rather “overburden the doctor or the clinician,” he said.

While acknowledging that underserved populations are hard to reach, Stoakes said technology can expand access and improve targeted efforts to help them. With enough startups experimenting with different kinds of fulfillment and delivery methods, hopefully one or more will succeed, he said.

Addiction telehealth startups have gained the most traction. Quit Genius, a virtual alcohol, opioid and nicotine addiction treatment provider, raised $64 million from investors last summer, and in October, $118 million went to Workit Health, a virtual drug treatment prescriber. Several other startups — Boulder Care, Groups Recover Together, Ophelia, Bicycle Health and Wayspring, most of which have nearly identical telehealth and prescription models — have secured significant funding since the pandemic began.

Some of the startups are already selling to self-insured employers, providers and payers. Some market directly to consumers, while others conduct clinical trials to gain FDA approval that they hope will turn into more stable reimbursement. But going this route involves a lot of competition, regulatory hurdles, and the need to convince payers that adding another treatment will reduce costs.

Sarabia’s inRecovery plans to use its software to help treatment centers operate more efficiently and improve outcomes for their patients. The startup is piloting a follow-up program, aimed at keeping patients connected to prevent relapse after treatment, with Caron Treatment Centers, a Pennsylvania-based nonprofit premium treatment provider.

Its long-term goal is to cut costs enough to offer its services to county-run treatment centers in hopes of expanding care to those most in need. But for now, implementing the technology isn’t cheap, with processors paying between $50,000 and $100,000 a year to license the software.

“Bottom line, for the treatment centers that don’t have consistent revenue, the ones on the bottom end, they probably won’t be able to afford something like this,” he said. .

This story was produced by KHNwho publishes California Healthlinean editorially independent service California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.

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