Burner account here. I've been on MAT for years, during which I've gone to grad school, worked, and otherwise lived a normal and productive life. A couple of points/observations.

1) I think an online advertising growth strategy will be hard, or really any strategy that strictly involves spending X in advertising for the recruitment of Y in revenue spend. However, people that use drugs talk to each other about where to get drugs and treatment (surprising, I know), and I would build your marketing strategy around word of mouth and patient to patient referrals. Initially reaching these communities are hard, but I would really think about how well the product can be optimized for patient -> uninitiated patient referrals, similar to "growth loops"

That said, I've worked in a start up with a similar premise, hire domain experts to give advice to customers during a life transition, and watched it fall down as the operations shook apart and the acquisition cost was very high. It's hard to get both the operations to stay great during the scale out, and keep the the marketing channels diverse enough so when you tap one out, another 5 are in different stages of life.

2) When assessing this product for my own use, the thoughts I had where: 2.1 Is this available in my area? How far would I have to travel initially? 2.2 Do they drug test me like my current place? 2.3 How frequently do I met the doc/what's the script duration? 2.4 What is expected of me to stay in MAT?

Basically, I have a provider, but with more up front information, might be willing to switch. However, the website and FAQ are pretty sparse, and I really don't feel like picking up the phone to talk to someone (flatmates, ya know?), so I feel like that's kind of a blocker.

Good luck!

This is incredible feedback, thank you. I’m happy to hear that MAT has helped. Here’s some color:

1. We need to be licensed in each state in which we operate, which limits our reach.

2. Our lawyers tell us that a “referral program” is illegal. Sounds stupid to me.

3. I think you’re right about the phone call. What would you recommend instead? We have the text prompt up top, but it’s not the main call to action.

You seem like a great person to get to know. Email me if you’re interested in chatting more. I appreciate it.

Try to uncover more angles to the "referral". Is it illegal because they receive compensation/cut? If yes, build it around "being the hero" for people not directly affected but have huge stake or motivation to help addicts (like some in this thread) - try and reach people on the edge of communities most affected by it - for example, distribute a "qualifier questionnaire" physical leaflet which gives people free consultation and 30% off list price on treatment. Your "Withdrawal Heroes" would get a pack and they could drop some off in relevant places in their communities or give to people directly - they probably know what places to hit better than you could identify effectively. The value for them is helping others; this might be your better bet anyways compared to referral $$ incentive anyways. Next step is to use people in recovery who used your system for similar little bets and more - giving talks, spreading the word in communities as part-time employees for example (some sort of "ambassadorship" for the lack of a better word). ps. I'm in Europe and only following opioid news from the distance, just want to add keep it up and good luck with the project, more stuff like this is needed happy to brainstorm or invest some more time in coming up with ideas pro bono just let me know

Sorry to hear about the loss of your girlfriend. This is an amazing way to honor her life, and important work you're doing to help solve a painful problem for millions of people. I've lost a family member to this disease, and have friends who have as well. I'm going to share this with someone I know who is also battling opioid addiction today. Thank you for building this.

I'm so sorry to hear that, but I really appreciate your words of support, and I hope whoever you know who is struggling is doing OK. The biggest barrier to accessing treatment is just the lack of awareness that it exists. Please reach out if you want to chat or want more information as they consider options.

Hello Zack! Thank you so much for working in this space. I am a recovered opiate addict, who benefited from medication-assisted treatment a few years ago. I have come a long way from being homeless and living on the street in Austin, Texas for 2 years. I am now a good father and husband, and I have a pretty damn good job too. It was truly a life and death struggle, against HUGE odds, and I'm definitely one of the lucky ones.

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"

I’ve got nothing useful to add except saying that I find it inspiring that you were able to turn a personal loss into entrepreneurial energy for positive change.

Good luck to you guys. I’m certain that your endeavors would make her proud.

I really appreciate that - and it's useful to me! Thank you.

> 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.

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.

While there are some regulations (both state and federal) around what we can and can't say publicly, most of our obstacles so far have been the policies of sites like Facebook, Google, Reddit and the like. Many of them have gotten into trouble before with scammy rehab programs preying on vulnerable populations, so they've made it incredibly difficult for startups like us who have something new to offer to even get the word out. We're working on it, but it's still hard.

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.

Maybe see if you can partner with a national pharmacy to put flyers in opioid prescription bags. Not sure of the pros and cons but it would really get the message out.

If you can get a pharmacy on board with the idea of encouraging their customers to stop buying their products, sure, but most of the worst ope addicts aren't getting their pills from pharmacies…

Don’t be so cynical. I sell drugs in my practice. I don’t want any addicts buying them.

I think the current opioid problem in the US is a prescription opioid problem.

Reach out to Scott Adams. He is passionate about this topic and signal boosts startups he believes in.

With that in mind, also look in to podcast ads, or doing interviews wherever interviews are done, as there is enough human interest to make that possible.

podcasts are a great idea, I'm sure there are a several big ones dealing with addiction.

Hi, Tony here, Flower Co W19

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

Thanks Tony, your support means a lot. I will email you to continue this conversation. Looking forward to hearing more.

>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...

>> We would love your help figuring out how to get past this bottleneck.

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.

Appreciate these thoughts talolard. I like the idea of partnering with local governments and non-profits, and would welcome any introductions or suggestions there. As you mentioned, most would want to see efficacy in a few pilot regions first, which is what we're currently working on.

You're working on proving your process.

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 ?

I am really excited for this startup. Opioid crisis needs to be addressed and I think this is one of the many steps that can help the people/families who are suffering.

As a pain specialist, I ask you to strongly incorporate one more element:

Make it ridiculously easy for the patient to put your docs in touch with (other docs). At some point they will land in the hospital, and ONLY having your doc talk to the attending on the other hand will save them from under treatment and withdrawal.

This is great feedback. I would love to talk more about this. If you’re open to it, send me an email at zack@meetophelia.com.

Have you seen this? Not sure if it's helpful for your regulatory problem, perhaps you could reach out this guy:

https://onezero.medium.com/900-000-americans-tell-google-the...

Wow this is great. No I hadn't seen this but I'll definitely be reaching out to him. Thanks!

Congrats on the launch Zack!

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.

Thanks! That's definitely a good suggestion, but there's always the risk they disapprove of something like this and then reject our certification - which would make it not worth it.

Thank you for building this. I lost my best friend, someone I'd known since I was 2 years old. It is painful to learn that MAT could have saved him, but also uplifting to think of the people who will be saved by this.

With that said, I work in healthcare and want to warn you about the HIPAA implications of using Google Analytics (which is not HIPAA compliant nor covered under a Google BAA) on your scheduling form for consultations. This can connect PII to a health condition in Google's system by means of a Google universal identifier.

I am the CTO at a healthcare startup and sincerely wish you the best in this venture, and will gladly/freely offer any knowledge I have to you - let me know if you'd like me to elaborate by email.

Thanks for the tip, would love to chat further if you want to shoot me an email at mattan@meetophelia.com

I think this TED Talk did a great job of describing why this is such a huge issue, and how people get into the state of addiction https://www.ted.com/talks/travis_rieder_the_agony_of_opioid_...

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.

Please do not feel offended by my words but I would never ever use a service like this.

The question in most cases in my opinion is not "will there be a data breach?" but when it will occur. Leaving this kind of data on some servers of some company just opens the door for patients to be extorted etc. in the future.

I like the idea of apps and computers helping us with problems like that but in our world services and devices are just not trustworthy enough for my taste.

Maybe a desktop app on a device that has no internet connection would be a reasonable alternative.

I wish you good luck with your business though and keep my fingers crossed that somehow your data remains secure.

When I was trying to kick a Doctor-originated benzo habit, I spent a lot of time on a community forum called BenzoBuddies, and it was a life-line for me and many other users. There's got to be a glut of opiate-focused boards? I think if you can establish legitimacy with them, building a direct advertising relationship with them might help?

I'm glad you're working on this. I was given opiates as a child and not getting shot at, beaten, living outside in a northern winter, doing things that make me horribly ashamed today, could make me quit but Suboxone got me living a regular-ass life in about a year.

It's been 6 years since I last had any dope, I've achieved so many of the goals I thought I had abandoned. I still use the subs though, I've tried kicking and I just can't seem to function even coming off a near homeopathic dose.

For anyone still in it though it's amazing how fast stopping drugs can improve your life. Someone out there would be happy if you could even put a few days together, tried treatment again, or just called.

We're in a similar place in terms of restrictions on promotion -- we can't advertise on any of the major platforms, at all, ever.

One thing that has worked for us is directly reaching out to community groups or (and I hate that I'm about to use this word) influencers. I'm sure there are plenty of sober / in-recovery people out there with large followings and/or community connections who believe in your cause.

It can be tough, because people who dive bomb into a community for the sake of self-promotion are gross and deserve to be shunned, but there's a balance there where you're actively participating, and helping, and also telling people about the thing you're doing to help.

Hi Zack and the Ophelia, congrats on the launch! It's great to see others tackling important problems in the healthcare space. I'd love to see if there is a way for my team at CareDash to help out. We are a data-driven health tech startup (the fastest growing doctor review site in the US), and we are very fortunate to have a scale to impact lives positively. Feel free to get in touch with me at rcarlton(at)caredash.com.

Which medication(s) are you using? My personal experience with both Suboxone and methadone were absolutely horrible and made my getting clean 10x worse.

We're primarily focused on medication-assisted treatment with Suboxone. Sorry to hear about your experience irscott, it's certainly not the right solution for everyone.

In the Netherlands anyone can get drugs tested for free and anonymously. I believe this is a very important point of contact for health officials.

It's not clear from your post what you're implying when you say you're restricted by regulations. Are you saying they are regulations you're unable to comply with? Why?

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?

Oof, where to begin. There are regulations around what states we're allowed to operate in, what kinds of clinicians are able to see patients, how we have to treat patient data, and what the clinical protocols have to look like.

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.

>There's a problem, though: we're restricted by regulations from letting people know that this treatment is available.

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?

This is a great question. Our medical directors have published a lot of research on this protocol (MAT). If you're interested, I recommend this book by Dr. Bisaga: https://www.amazon.com/Overcoming-Opioid-Addiction-Authorita...

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.

Have you considered using kratom to assist with weaning or helping with withdrawl symptoms?

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.

Thanks for your thoughts. I'm interested to see how kratom fits into the longer-term solution. An issue right now is that its formulation is not standard, so there are different brands with different concentrations, which makes it difficult to "prescribe" as medicne. Another problem is that it's sold at smoke shops along with vape pens and paraphernalia, so people who aren't already using opioids are trying it out of curiosity and becoming accidentally dependent.

Are you implying that you think kratom should not be available otc? If so you’re completely going against your mission of helping people get off opiates. I can add to the pile of anecdotes that I personally know 10-15 people who’ve used kratom to kick serious years-long addictions to oxycontin.

This is entirely anecdotal, but I know six people who've quit either heroin or prescription/illicit oxycodone usage via Kratom.

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.

I second your anecdotes, it's been great within my friend group, especially with a few that were returning from deployment with injury and oxy prescriptions. The withdrawal-type symptoms are something I've also nothing I've experienced, I'm sure it's entirely psychological.

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.

Like most things on the internet, Reddit has a great community for this haha. But yeah, it's been really cool to see how professional and business-like the industry has come in the past few years.

It's fairly expected for a serious operation to provide analytical data on alkaloid content and/or employ dedicated quality control personnel these days.

It's not purely psychological, especially when you get into extracts or higher potency items, but it is very minimal comparatively.

Hi, I have over a decade of experience working with addiction treatment centers and getting around these type of issues. The problem is the certification, I'd be happy to provide some guidance.

That would be great! Mind shooting me an email at mattan@meetophelia.com?

Could you explain more by what you mean by Facebook requires a third party certification? What type of third-party certification and why are you having trouble getting this certification?

Facebook and Google both require LegitScript (https://legitscript.com/) certification. We're in the process of going through that and we're told it may take several months.

This is great work!

I really like the site design and snappy fast pages too.

Thanks so much. The brand design is really important to me, so I am glad that it resonates with you.

I think about this short doc from a decade ago all the time

Last Minutes With ODEN

https://vimeo.com/8191217

Best of Luck ;)

Wow. That's beautiful, thanks for sharing.

I just wanted to chime in and say that this is incredibly inspiring and I hope it takes off.

ibogaine ? theres strong anecdotal evidence for this and while it isn't possible in the US, there are many countries in the world besides the US. Have you looked into this?

Yes! MAPS has conducted and collected some really great research around psychedelics and their use in the treatment of things like PTSD and addiction. Specifically, Ibogaine Therapy has shown some real promise around drug addiction [1].

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...

Former IV opiate addict here. Medication is great and important for breaking the physical addiction. But it does nothing to resolve the mental health issues that led to the dependence in the first place.

Buprenorphine helped me get into a state where I could deal with my mental health issues with a professional. But until I began to deal with the mental stuff, I was still very unwell. Addiction is transitive, it pops up in new and unexpected ways.

Discontinuation of use is only a small aspect of recovery. Don't get me wrong, I think what you are doing is great. Access to medication is definitely an issue in the USA. But in Canada, we have easy access to addiction doctors in urban areas, and we haven't ended addiction yet.

A big part of the problem is general ignorance. Most people still think addiction is a moral issue. Shame and guilt are fuel for addiction. So hiding away and getting help in secret compounds the problem both for the individual and society at large. When people start to see that it affects many people close to them, that is when the stigma is destroyed.

You wouldn't say you are too busy to get treatment for any other life-threatening condition.

All treatment centers are not alike. Some are downright harmful. There is a heady mix of science, mysticism, greed and benevolence. There can be benefits: removal from environmental stressors, reduces shame by showing you are not alone, learning about the neuroscience of addiction, bonding with people over a common struggle, a chance to feel good about yourself.

The human mind loves to simplify things. Oversimplify and your model does not reflect reality.

Recovery from addiction and underlying mental health issues is not a simple process. It requires a multifaceted approach, strong personal support and constant honest self-evaluation. It requires letting go of shame and guilt. It also requires, of course, discontinuation of use and withdrawal management.

I could go on and on about my experiences and what they have taught me. One day I might write it down. I want nothing more than to make the road a bit easier for others. I have spent thousands of hours trying to distill what I have learned into some sort of essential truths. I haven't got there yet.

I'm going to have to stop myself there. To anyone out there interested, my email is in my profile. To anybody struggling out there right now: Be kind to yourself. Find your own path and make your own honest definition of success. I found keeping track of days of abstinence to be actively harmful. It resulted in more severe and longer relapses. So I stopped counting. Some said this was bad, but they were wrong because it worked for me. I identified that the shame and guilt of "losing" all those days was more harmful than motivating. It's been a long journey, I couldn't have done it without the support of family. I wouldn't change a thing though because I finally like myself.

Addiction is a symptom. Treat the symptom while working to address the underlying causes.

Thank you for your work.

Might want to reword this sentence in the FAQ under "Who do I see on the first visit?":

"It is the law, the first visit be in person."

Fixed! Thanks for catching that Brian.

You are welcome!

Link: meetophelia.com

Added above now. Thanks!