Launch HN: Ophelia (YC W20) – At-home recovery for opioid addiction
My name is Zack, and I'm the cofounder of Ophelia (https://meetophelia.com). We help people quit opioids without going to rehab. We offer online doctor's visits, medication for withdrawal and cravings, and long-term support for recovery.
There’s a treatment for opioid addiction that works, and it’s low-cost, discreet, and convenient. It’s called medication-assisted treatment (or MAT), it reduces mortality by more than 5x [1], and it resembles treatment for anxiety or depression: medication and therapy. Yet 80% of the 3 million Americans addicted to opioids are not getting it. You can read more about MAT at [2] [3] [4].
I decided to work on this problem after my girlfriend died of an overdose last year. She wanted to quit, but she was afraid of losing her job and her privacy, and she found it easier to get this medication from a drug dealer than a doctor or rehab. The rest of the story is too sad to articulate, and I don’t want this post to be about her. It’s about all of the people just like her, struggling to get help today. This is why we started Ophelia: to lower the barriers to proven, lifesaving treatment.
Most Americans struggling with opioids have jobs, families, and privacy concerns that make rehab an impossible option. They want to quit, but they’re afraid of withdrawal, and the medication that helps is too hard to get: doctors need a special waiver to prescribe it, which only 5% of them have [5], so most people are buying it on the black market. Yet, drug dealers aren’t doctors, and the statistics support it: every 11 minutes, another American dies of an opioid overdose – now the #1 cause of death for Americans under 50.
As it turns out, rehab is not just unnecessary: the data shows it rarely works anyway [6] [7]. Without medication, 90% of people relapse in the first 3 months: yet, 2/3rds of rehabs don’t offer medication, and most don’t even employ doctors! Thus: 80% of people avoid getting help, and the rest succumb to pseudoscience that does nothing to address their problem.
Ophelia’s mission is to replace drug dealers with doctors, without any loss of privacy or convenience. We make MAT discreet, convenient, and affordable for anyone who needs help but can’t or won’t go to rehab.
Our medical directors are two of the best addiction specialists in the world (Dr. Adam Bisaga and Dr. Arthur Robin Williams, both Columbia Professors and NIH-funded research scientists), and we’re now treating patients in Philadelphia and New York, through a combined in-person and telemedicine approach.
There's a problem, though: we're restricted by regulations from letting people know that this treatment is available. Both Facebook and Google require a third-party certification before allowing us to use their platforms, and many sites like Reddit don't allow any advertising for addiction treatment at all.
We would love your help figuring out how to get past this bottleneck.
The other big problem is the stigma around addiction, which stops most people from sharing success stories about MAT, so its efficacy is underappreciated. If you know anyone who is personally struggling with this issue, please make sure they know about MAT. It can literally save their life.
If you have thoughts about how we can solve these problems, I would be grateful for your help: any ideas to increase awareness of MAT, or any stories you can share that may help us better understand the needs of our patients. Thank you!
[1] Effects of medication-assisted treatment among opioid users https://www.ncbi.nlm.nih.gov/pubmed/29934549
[2] Medication-Assisted Treatment (MAT) https://www.samhsa.gov/medication-assisted-treatment
[3] Information about Medication-Assisted Treatment (...
74 comments
[ 2.5 ms ] story [ 148 ms ] threadKratom is certainly one of the solutions that people trying to overcome opioid addiction are resorting to, but it's unclear whether it's effective — not enough studies have been performed, and it's not an FDA-approved treatment for opioid use disorder. There's also some evidence to suggest that kratom actually leads to more health problems than it solves [1].
[1] https://www.mayoclinic.org/diseases-conditions/prescription-...
Re: safety of kratom itself: AKA (https://www.americankratom.org/) has had independent physicians look into each reported death involving kratom in the US, and all have involved various other substances of abuse, none have been exclusively cause by kratom.
When taking powdered leaf itself, OD is pretty much impossible since you end up vomiting. There are many extracts and such on the market, but most people I know partake of (including myself) are wary about strength and clarity of said extracts.
I'd love to see more of a push for some legitimate research, I think it's something that could be very effective in this space. Good luck with licensing and I'll be sure to share the service with ones I know are currently trying to kick opiods.
The only real problem to Kratom is that there is no standardization to potency or means of labeling.
The percentage content of the active alkaloids in Kratom (Mitragynine and 7-Hydroxy-Mitragynine) can vary widely, with the stuff sold in gas stations and smoke shops being particularly low-potency or volatile.
The worst that will happen in the event of a Kratom overdose though, is horrendous nausea and vomiting that will make you wretch at the sight of the stuff for a good while.
Another personal anecdote, I have been a daily user for several years and had periods of weeks/months without use due to inconvenient life circumstances (traveling, too busy to buy more, etc) and never felt any ill effects from sudden cessation. Some people online report the opposite, though I suspect this might be largely psychological.
I don't know if you guys are aware of it, but two other overlooked medications for opiate withdrawal/recovery are Baclofen and Loperamide (yes, Immodium, the drugstore constipation medicine).
Immodium is active at the mu-opiod receptor but does not cross the blood-brain barrier, and so is not psychoactive. This can help to ease some of the withdrawals without risk of relapse.
Baclofen is mildly psychoactive but helps with opiate and benzodiazepine or other GABA-ergic drug withdrawals, with much less of the risk factors associated with traditional medications like methadone or buprenorphine.
The industry is beginning to mature, with online vendors actively getting their batches tested before sales. Seeing % alkaline contents is a very nice thing to see from them.
It's fairly expected for a serious operation to provide analytical data on alkaloid content and/or employ dedicated quality control personnel these days.
Possible G and FB have gotten faster and better with their detection of health specific ads, but up until about a year ago, one temporary workaround (while waiting for legitscripts) was to create an Instapage or Leadpages landing page with a subdomain (eg. lp.meetophelia.com) and direct ads there.
Unfortunately, it's going to be quite a while before any psychedelics are FDA-approved. Right now, MDMA and Psilocybin are both in FDA trials (Phase 3 and Phase 2, respectively) but I think Ibogaine is still quite a ways out.
Interestingly, in terms of your comment about Ibogaine's use outside of the US: other countries besides the US (and Canada) have not really seen quite the same problem in terms of opioid addiction as we have here in the US. This is mostly due to American pharmaceutical companies historically having been really successful at convincing US doctors to prescribe opioid-based pain medication [2], and due to the fact that pain was added as a 5th vital sign in 2001 by the Joint Commission [3]. That isn't to say that other countries haven't had problems with opioid addiction, but it hasn't generally been at nearly the scale of the problem in the US, and other countries have had varying rates of success with solutions that haven't been possible in the US thus far.
[1] https://maps.org/research/ibogaine-therapy
[2] There's a really great John Oliver segment about this https://www.youtube.com/watch?v=-qCKR6wy94U
[3] https://www.medpagetoday.com/publichealthpolicy/publichealth...
Those limitations were added as a response to real abusive and harmful practices [0]. Just changing the advertising rules hasn't solved the problem, now almost any drug related search has had the results SEOed into complete uselessness by rehab companies. The answers they give to basic questions (what doses are harmful, is it safe to mix these substances) are usually misleading and sometimes explicitly false in order to maximize their conversion rates.
[0] https://www.theverge.com/2017/9/7/16257412/rehabs-near-me-go...
"It is the law, the first visit be in person."
Good luck to you guys. I’m certain that your endeavors would make her proud.
Is this a for-profit company?
Do you think for-profit companies should be able to advertise medical products? Because in my view they shouldn’t, full stop.
So you’re up here telling us that one of your challenges is that you can’t advertise anywhere, and to that I say “good.”
Perhaps you and your 81% white male team/advisors (with zero female/minority people with executive level decision making ability) could answer to some of that.
My condolences to your girlfriend, but this isn’t an issue that a web CRUD platform is going to solve and seeing it laid out in typical Silicon Valley marketing copy is kind of sickening. It reminds me of some of those less than stellar web therapy platforms that seem like another way to Uber-ize the professional therapy workforce into poverty.
Can you restructure the strategy so that the business can operate with a low (initial) growth rate ? You might find success by partnering with regional public health officials, who would sponsor or subsidize real world advertisement.
I live in Europe and last time I was in NY the subway was full of public health billboards encouraging people to carry naxalone.
Maybe you can convince one official or non profit somewhere to subsidize those billboards for you. You're not only solving a personal problem for the addicted, your solving a societal problem. I imagine that if you can show efficacy in one or two pilot regions, you'll have an easy time partnering with other ones / raising money (maybe non vc) / funding acquisition yourself.
My $0.02, hope it helps and good luck, nice to see startups doing important things.
Do you have enough patients to do that ?
If you do, why do you seek growth? Isn't it better, in the long term, to prove yourself, build a stable foundation and a good reputation among clinicians and than scale ?
It's also not clear what the relationship is, if any, between those regulations and third-party certification. Likewise, is third-party certification something you're unable to comply with? Why?
In terms of regulations restricting what we can say publicly, besides FDA regulations around medical claims we're allowed to make, our biggest obstacle is that many of the common channels available to startups for building awareness are restricted or blocked entirely. Facebook and Google, for example, both require LegitScript (https://legitscript.com/) certification. We're in the process of going through that and it may take several months. That's also a requirement for us to be able to do payment processing through services like Stripe, since we qualify as a "high-risk business" since we do both telemedicine and addiction-recovery services.
But even when we do have those certifications, Google, Facebook, Reddit, and many other sites have a blanket ban against targeting users who are part of addiction and addiction-recovery groups.
It's not that we can't comply with any of these regulations (and in fact, we're working on many of them as we speak), but many of them are really onerous and time consuming for a startup given the stage that we're at.
On this, do you have yourself published research on how effective your particular application of this treatment is, how many patients stick with it, or anything else along those lines?
More generally: MAT is very well researched, vetted, and accepted by the medical community. Our innovation is in the delivery of this treatment, through ways that make it easier to opt into and stick with. MAT has historical adherence rates of 60-70% (same as diabetes and depression), but often people drop out because they grow tired of visiting a clinic regularly for group therapy, just to get their medication refilled. We think we can increase adherence rates by making MAT less of a burden to people, particularly as they enter into the later stages of treatment.
I really like the site design and snappy fast pages too.
Last Minutes With ODEN
https://vimeo.com/8191217
Best of Luck ;)
When you say "regulations" here, do you mean government law, or just the rules of online services as in your examples?
To advertise to addicts, go where the addicts are; bulletin boards in halfway houses, homeless shelters, probation/parole offices, and clinics that offer court-mandated treatment programs. Granted, these are the places where the most down-on-their-luck addicts will be, but perhaps they will be more open to change than the "successful" ones. That said, you might have some luck targeting those types on web forums for drug addicts and experimenters - some of these use their own in-house ad systems rather than something like AdSense for obvious reasons.
(If it sounds like I might know some things about where you can find drug addicts… well…)
I wish you nothing but the best of luck with your project.
I agree with you about getting the word out in a grassroots way, and we've definitely been to some of the hardest-hit areas out there. The problem is that 80% of opioid users aren't currently seeking treatment and are just like you and me, but living with a secret problem. Those are the people we want to reach and let them know there are options for them.
I think the current opioid problem in the US is a prescription opioid problem.
I'm really keen on what you're working on. It's fantastic. I am a big believer in what you're doing.
I have some marketing ideas for you. I work in cannabis so I face all these same challenges of closed tech platforms.
Email is in profile, let's talk
https://onezero.medium.com/900-000-americans-tell-google-the...
What you're doing is incredibly inspiring. I have a friend who ha to kick their morphine addiction alone when the medical system wouldn't support anything other than continued medication.
I can only assume your girlfriends name was Ophelia. What an incredible tribute to her memory.
You're correct that this is a tough space. I've been in and out of the "recovery community" for a couple of decades, and I think you may have only scratched the surface of how complex this market is. I would love to chat. I think I may have some good ideas for breaking through those barriers you're facing. I've created this burner to respond (re:stigma)and I've also created a burner email. Hit me up at the mail service of proton with the name "30days1000nights"