Launch HN: Ophelia (YC W20) – At-home recovery for opioid addiction

Hi HN,

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 (MAT) https://www.fda.gov/drugs/information-drug-class/information...

[4] We have a solution for the opioid epidemic. It’s dramatically underused. https://www.vox.com/policy-and-politics/2019/12/17/18292021/...

[5] America’s Healthcare System is Making the Opioid Crisis Worse https://www.theatlantic.com/health/archive/2018/11/why-heroi...

[6] Lapse and relapse following inpatient treatment of opiate dependence. https://www.ncbi.nlm.nih.gov/pubmed/20669601

[7] Does Rehab Work as a Treatment for Alcoholism and Other Addictions? https://www.scientificamerican.com/article/does-rehab-work/

Mattan here (co-founder of Ophelia). We're certainly considering any options that are scientifically backed and evidence-based. Medication-Assisted Treatment (MAT) is the standard in the medical community among addiction specialists and it's proven to be the most effective solution.

Kratom 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-...

Yeah, I see the issue with relying solely on anecdote.

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.

>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.

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...