Once a peripheral drug problem, opioid addiction has become an epidemic in the United States. To address the crisis, many innovators and government agencies are turning to digital health technologies.
While words like “crisis” and “epidemic” may seem overblown, prescription opioids, heroin and fentanyl now claim a shocking number of American lives. According to the CDC, “Opioids — prescription and illicit — are the main driver of drug overdose deaths. Opioids were involved in 42,249 deaths in 2016, and opioid overdose deaths were five times higher in 2016 than 1999.”
Traditional state and federal responses to a drug addiction include ramping up data collection and sharing, enhanced surveillance activities and sharing support resources. For example, CDC is working with 45 states and Washington D.C. to enhance prescription drug monitoring programs. They’ve also ramped up the Rx Awareness communication campaign to increase consumer knowledge about the risks of prescription opioids.
As with many sectors, digital health isn’t changing the traditional response to drug addiction as much as it is giving it a boost. Government agencies are turning to digital health innovators to expand methods for preventing and treating opioid addiction and overdose.
In December, the Department of Health and Human Services (HHS) hosted a code-a-thon to address the opioid crisis. Over 150 computer programmers, public health advocates and innovators descended on Washington D.C. to create data-driven solutions that have an immediate and practical impact. At the end of the 24-hour event, winners were awarded in three categories: prevention, treatment and usage.
In the prevention track coders were asked, “How can you help federal, state, and local stakeholders predict and analyze the supply and movement of legal and illicit opioids?” The Visionist Inc. team came up with a program called Take Back America that assesses the unmet need for takeback programs at pharmacies where unused or unneeded opioids can be returned.
The app targets an important leverage point by working to take unused prescription opioids out of circulation. As Visionist Inc. says, “More than 70 percent of those who abuse prescription pain killers get them from friends and family. In what areas should Take-Back centers be more accessible?” The app includes a map comparing the prevalence of opioid abuse to the prevalence of prescription take back centers by zip code. The beta version of the Take Back America app is now live.
Startups are also offering digital health solutions to the opioid epidemic. For example, the Edification Project is a social venture startup working to bring virtual reality into schools to teach children and teens about the dangers of addiction. While still in its infancy, the first phase of the project will pilot and test theory-driven, evidence-based prevention programs teaching students how to handle situations where they may have to say no to drugs.
Prescription opioids account for 40 percent of all opioid overdose deaths, according to the CDC. Digital health initiatives are leveraging data to help providers avoid unnecessary prescriptions.
In the HHS code-a-thon, teams in the usage track worked on tools to help stakeholders identify at-risk populations and their underlying characteristics of opioid misuse and abuse. The winning team created The Opioid Prescriber Awareness Tool (OPAT), which provides physicians with a visual representation of their opioid prescribing patterns compared with their peers. The tool also allows physicians to visualize the prescribing patterns of other physicians in their area that they might refer their patients to.
The code-a-thon team isn’t the first group to focus on prescribing patterns. Dr. Marty Makary, a Johns Hopkins surgeon, has taken a similar approach. Marty’s initiative Practicing Wisely also addresses the wide variation in physician prescribing patterns by synthesizing data to give physicians visibility into standard prescribing practices.
As Dr. Makary sums it up, “When it comes to combating our nation’s opioid epidemic, we should focus on taking away matches, not just extinguishing fires. And that means addressing the issue of overprescribing.”
Epidemic Solutions is a new startup working on the opioid crisis from a different angle – how to improve outcomes when someone has already overdosed. The company is developing a wearable that detects when someone is overdosing and alerts family members via an app. The person receiving the alert can either administer Narcan – a drug that reverses the dangerous effects of an overdose – or call for help. Epidemic Solutions hopes to eventually develop a wearable product that could administer the narcan automatically.
Another way to improve addiction treatment is by improving adherence via remote patient monitoring. A company called emocha is using video and mobile technology to help physicians remotely monitor adherence to opioid substitutes. Patients using the system login with a smartphone app that communicates with the provider. They can use the app to enter any side effects that they encounter and record a video of themselves taking the pill on camera.
As emocha CEO Sebastian Seiguer emphasizes, “The therapies that exist for opioid addiction, for example methadone, only work when they are taken. By securing medication adherence, in this particular population, we can see patients retaining care and help make sure they are successful.”
Finally, telemedicine is gaining momentum as a way to treat patients suffering from opioid addictions. As MobiHealthNews summarized in a recent article, “It is commonly agreed upon that replacement medications such as Buprenorphine and methadone are key to treating opioid addiction. However, most patients are required by law to at least meet face to face with their doctor before being prescribed the medication. Telemedicine policies such as these vary state to state.”
Unfortunately, meeting with a provider can be challenging for many patients, especially those living in rural areas or in poverty. Yet rates of drug overdose deaths in rural areas have surpassed rates in urban areas. As a result, many see telemedicine as a vital part of opioid addiction treatment solutions.
While telemedicine laws remain varied and complex, one app may soon gain FDA clearance as a prescription digital therapeutic specific to opioid addiction. Pear Therapeutics’ reSET app recently became the first software-only digital therapeutic cleared by the FDA to treat substance use disorder (SUD). In October, the FDA gave an Expedited Access Pathway to reSET-O, a new version designed to treat individuals recovering from opioid addiction.
reSet-O combines cognitive therapy with a prescription for Buprenorphine, a drug used to help people addicted to opioids recover. Patients receiving Buprenorphine are required to attend cognitive therapy while taking the drug. While many will be skeptical of an app-only digital therapeutic, the reality is that many patients recovering from opioid addictions aren’t getting therapy.
As Dr. Yuri Maricich, chief medical officer at Pear, told MobiHealthNews, “While there are multiple reasons why a patient might not be getting their behavioral therapy the fact of the matter is many don’t. reSETt-O allows patients to not only get access to that therapy but it provides it in a way that is on demand. So rather than only getting behavioral therapy when they are able to get to a medical provider, they are able to get their therapy at any time, particularly when they are experiencing a craving.”
With states struggling to provide adequate treatment resources, innovators like Maricich believe that prescription digital therapeutics will change the way we address opioid dependence.