A remote tracking system to maximize methadone take-homes may hold promise for the future of the field. At least that’s what Michael Giles, M.D., the founder of Sonara, hopes. As a resident in psychiatry working in an opioid treatment program (OTP), Giles found that patients had a hard time staying in treatment – or couldn’t due to scheduling difficulty – because of the requirement that they be there in-person each day to get their medication. “They had to wait in line for hours every day,” Giles told AT Forum, where he was exhibiting Sonara at the American Association for the Treatment of Opioid Dependence (AATOD) conference.
“The vast majority of patients aren’t maximized for the number of take-homes they could have,” said Giles. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) allows stable patients to receive up to 28 days of take-home doses, but many states do not, he said. The reality is that the majority of patients are still on daily dosing.
The “lack of trust between the patient and the provider” is one of the impediments to successful treatment.
BayMark is one of the OTP groups using Sonara in a pilot across several of its treatment centers.
The Sonara label was designed to be used on standard issue liquid take-home methadone bottles. The label includes a QR code that is digitally voided upon scanning and opening the liquid medication. The patients video record themselves on their phones swallowing the methadone and the video is automatically uploaded to the OTP care teams for review.
“We meet with clinic leadership” to encourage buy-in by the nurses and staff, noted Giles.
One problem, not specific to remote observation of dosing, is how OTPs can get reimbursed for take-homes. In some states, they only get reimbursed when the patient comes in for a visit. New York worked out a reimbursement scheme for take-homes when, under COVID-19, patients were allowed more take-homes even if they were “less than stable” to reduce transmission of the virus. Now, however, the take-homes have become so popular among patients – and among OTPs who see their patients staying in treatment longer as a result – that innovative ways to implement them are taking hold. Sonara is an example.
Giles admits that the reimbursement structure is a “huge problem,” but a different one from what Sonara is solving. By reducing diversion in a simpler way than clunky lockboxes or bottles with special lids, this kind of system once approved by regulatory authorities could be a game-changer.
That is what Sonara’s investors – venture capital at this point – are counting on. “We’re optimistic,” Giles told AT Forum.
With the researcher Dennis McCarty, Ph.D., Giles submitted an article on Sonara to the Journal of Substance Abuse Treatment last week.
A note about Giles: if you have met him, you know that he’s young (33), earnest, and charming. He’s also a medical doctor, which gives him a lot of credibility when communicating with opioid treatment program medical directors, many of whom are used to talking to salesmen without his level of training. “It definitely helps with the business side of things,” he said.
And he knows his business. Every message from Sonara resonates with the themes heard throughout the AATOD conference: some kind of reform is needed urgently because of the crisis of overdose deaths.