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As bad as the opioid crisis was before COVID, the pandemic made it even worse: data from the CDC shows that fatal drug overdoses grew by 28.5% for the 12-month period ending in April 2021, while the number of predicted deaths reached over 100,000, compared to 78,000 the year prior.
And, yet, despite all of those people dying, there are still numerous barriers standing in the way of people getting treatment, something that Zack Gray found out about when someone he loved died due to opioid addiction.
"There is a CDC-endorsed gold-standard treatment, a medication-assisted treatment (MAT), that works, reduces overdoses by 75%, and is covered by insurance. Yet fewer than 10% of those who need it get it, and most rehab programs don’t offer it. Most people with opioid use disorder find it easier to get MAT medication from drug dealers than doctors, even if it means spending a thousand dollars per month," he said.
The medication, called buprenorphine, but which is often branded Suboxone, is used to stem withdrawal and cravings, and without it, 90% of people relapse in the first 3 months, he said.
However, a separate license from the federal government, called an “x waiver,” is required for clinicians to prescribe buprenorphine, and only 5% of clinicians have this license. For those who do have this license, they are often capped to treating a specific number of patients, and for most, this number is 30.
"For people with opioid use disorder, this means that they can search for a private psychiatrist with an x-waiver and wait a week for an appointment that could be an hour away from them, they could make use of a traditional MAT clinic covered by insurance that may have a wait time of several weeks and include mandatory group therapy, or they could turn to the black market for immediate medication. Unfortunately, many choose the latter," he explained.
It was finding out about all of these barriers that led Gray to found Ophelia, a digital provider of MAT for opioid use disorder; on Tuesday, the announced a $50 million Series B round of funding led by Tiger Global, and includes funding from Menlo Ventures, General Catalyst, Refactor Capital, 640 Oxford Ventures, Interplay Ventures, PillPack founder Elliot Cohen, and Good Friends, which is the fund launched by the founders of Warby Parker, Harry’s, and Allbirds.
This follows its $15 million Series A round earlier this year, bringing its total raised to $68 million.
The company's mission is to take the MAT treatment and make it universally accessible, which it does with it's Ophelia Care Model.
"We bridge geographic barriers by offering a telehealth solution that also helps bridge privacy and stigma concerns by allowing patients to get discreet treatment where and when works best for them," said Gray.
After an initial call with a member of the Ophelia support team to discuss the program and answer any lingering questions, patients are then connected over video to their care team, which is made up of a prescribing clinician, a nurse, and a care coordinator; together, they go over the patient's medical history and identify a treatment plan.
Patients can pick up their first Suboxone prescription the same day as their initial visit. After that, patients connect remotely with their clinicians on a regular basis, whether weekly, bi-weekly, or monthly.
Ophelia, which is currently licensed to operate in 27 states and has insurance contracts covering 75 million people, operates seven days a week. The company began providing care to its first patient in 2020, and since then it has grown 6x year-over-year and doubled the number of patients in the last few months.
While Gray emphasizes that "the population with opioid use disorder looks just like America," meaning there's no typical type of person who becomes addicted, the company is focusing on a specific subset of the population: the 80% of Americans with opioid use disorder who are unengaged with the healthcare system, with a particular focus on the Medicaid population.
"We are working to solve the shortage of prescribers by creating new work opportunities for existing x-waivered clinicians and training new ones. Ophelia is focused on reaching the Medicaid population, and does not rely on referrals, which only reach people engaged with the health care system," h said.
"By recruiting patients directly online, we can meet people where they are, before they’ve had an episode that brings them to the emergency room."
The name Ophelia isn't based a real person, and the reason the founders chose it was threefold: first, it’s derived from the Greek opheleia meaning "help." Second, it’s associated with mental health by way of Shakespeare’s character Ophelia in Hamlet. And, finally, it starts with "Op," as does "Opioid."
The company plans to use the new funding to expand its treatment program to more patients and clinicians across the country, to integrate with additional payors and partners, and develop its clinician recruitment, training, and support platform.
"We have a particular focus on the Medicaid population, but we partner with Medicaid, Medicare, and commercial health plans. We are also working to partner with more nursing schools and other organizations to help recruit and train more clinicians to be able to offer MAT," said Gray.
"Our belief is that a digital-first platform is superior to brick-and-mortar in addiction treatment across every relevant dimension: more effective, more accessible, lower cost, and preferred by patients. Ultimately, our goal is to rebuild the rehab industry from first principles and expand it to include the 80% of people struggling who cannot access it today."
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