App Contest Provides Guide to Medication-Assisted Treatment

In her post What the Opioid Epidemic Means in Virginia, Handshake Media’s Executive Director Laurel Sindewald writes, “Latest science informs us that the best approach to treating opioid substance use disorders is medication-assisted therapy. Suboxone and methadone keep people stable enough in recovery to live more normal lives. People with substance use disorders are more than twice as likely to stay in treatment and not relapse if they are receiving medication than if they are not.”Smartphone apps help with recoveryAs we do research to prepare to develop an updated release of our free addictions recovery smartphone app, New2Recovery, I was fascinated to read the clear definitions and terms used in this opioid addictions recovery mobile app development contest from the Substance Abuse and Mental Health Services Administration (SAMHSA).

Addiction is a chronic brain disease. Those who suffer from a substance use disorder need help to change their behavior and learn new strategies to maintain health. They can get this help with treatment – with the care of doctors and substance use disorders treatment providers. Treatment can help people stop using substances. It helps them get through withdrawal and cope with cravings. Treatment also helps address other harmful behaviors that are not conducive to recovery.

Just as important, treatment helps people address life issues they might have that can trigger relapse, such as feelings of low self-worth, a bad situation at work or home, a co-occurring mental disorder, or spending time with people who use drugs. In short, treatment helps people move into healthy lifestyles – into a new way of living which is referred to as recovery.

Treatment may include medication. Medication-assisted treatment (MAT) is treatment that includes the use of medication along with counseling and other types of support. Treatment that includes medication-assisted treatment is an important option for opioid use disorder. Medication-assisted treatment can reduce problems of withdrawal and craving. Research also shows maintenance treatment typically leads to reduction or cessation of illicit opioid use and its adverse consequences, including cellulitis, hepatitis, and HIV infection from use of nonsterile injection equipment, as well as criminal behavior associated with obtaining drugs. These changes can give the person the chance to focus on the lifestyle changes that lead back to healthy living. People in outpatient MAT could benefit from a mobile app for smartphones that provides features and information that supports their maintenance in recovery.


Insight 1. Patients receiving Medication-assisted treatment (MAT) need information about possible side effects and drug interactions in a format that is easy to understand and access.

Required Features:

The app must provide information on common side effects that patients receiving Methadone, Buprenorphine, or Naltrexone treatment experience, how to deal with side effects, and when they are expected to subside.

The app must include information on drug interactions with Buprenorphine, Methadone, and Naltrexone.

The app must provide information on the potential adverse effects of combining Methadone, Buprenorphine, or Naltrexone with Benzodiazepines , Benzodiazepine Analogs or Barbiturates. These side effects include, but are not limited to, decrease in breathing ability and blood pressure as well as death.

Insight 2. Patients receiving MAT need education and psychoeducational materials for opioid recovery support, e.g., time management, parenting skills, effects of drug use on family, etc.

Required Features:

The app must provide educational tools and materials including broad and general resources, especially resources that encourage users to discuss content with a recovery coach or clinician, including the resources in the Asset File.

Insight 3. Individuals in MAT need support to reduce risk for relapse, e.g., increase participation in healthy activities, and avoid people, places and things that might trigger drug use.

Required Features:

Meeting Location Finder: The app must provide opportunities for users to find mutual aid meetings and peer support groups.

Insight 4. Individuals in MAT need support in relapse prevention such as warning signs, trigger alerts, and motivations for recovery.

Insight 5. Individuals in MAT maintenance are often juggling their work, personal, and treatment schedules.

– Excerpted from SAMHSA’s Opioid Recovery App Challenge, submission deadline 5/28/16

I share this because the writers of the app contest have inadvertently created a lovely, concise, simply-worded description of what addiction is, what medication-assisted therapy is, what challenges people need help with, and straightforward guidelines for recovery.

Anne Giles is President of Handshake Media, Incorporated, publishers of the free addictions recovery smartphone app, New2Recovery.

What the Opioid Epidemic Means in Virginia

In a nation where addiction is slow to be recognized as a disease, “opioid epidemic” sounds almost unbelievable. Surely we have more important diseases to worry about such as cancer, AIDS, and diabetes, right? Yet this year the Obama administration has proposed $1 billion in new funding for treatment and research on treatment to address the opioid epidemic in our country. An estimated 44 people die every day from prescription painkiller overdose in the United States. Since 2008, 115,000 Americans have died of overdose from opioid painkillers.

Named for the receptors on which they act in the brain, opioids are drugs that relieve physical and emotional pain. Opioids include opiates, which is an older term for drugs derived from opium, such as morphine. Common opioids include prescription painkillers such as OxyContin, hydrocodone, Percocet, methadone and Vicodin, as well as drugs like morphine and heroin. Opioids cause a rush of dopamine in the brain, conditioning the brain over time and altering pathways dealing with pleasure, memory, learning, and decision-making.

“The brain is not designed to handle it,” said Dr. Ruben Baler, a scientist with the National Institute on Drug Abuse. “It’s an engineering problem.”
Jason Cherkis, “Dying To Be Free,” The Huffington Post

The rise in opioid use in the United States is largely due to unregulated overprescription of painkillers beginning in 1999. Sales of painkillers quadrupled between 1999 and 2010. OxyContin, in particular, hit rural Appalachia hardSouthwest Virginia included. Recent evidence indicates that OxyContin’s effects wear off much faster than pharmaceutical companies claimed. This means that people will need to take the drug more frequently, which is more likely to cause addiction due to repeated behavior.

People in rural Virginia were also at higher risk for addiction in general, in part due to poverty, a known precursor for addiction. Poverty causes people extreme stress and hopelessness, which often results in mental illness. A new study has found that when unemployment rates rise 1%, fatal opioid overdose rates and emergency room visits rise by 3.6% and 7%, respectively.

As state and federal law enforcement began to crack down on prescription and distribution of painkillers, people who were now addicted to painkillers turned to heroin, which is cheaper and in some areas more readily available.
Video by Leah DickScreenshot from the YouTube video by Leah Dick, featured in her post This is what an addict looks like, 2/22/16.

The opioid epidemic is strongly affecting the Commonwealth of Virginia. In 2013 there were more drug-related deaths in Virginia per capita than motor vehicle deaths. Two people in Virginia die from prescription opioid and heroin overdose every day according to the 2016 policy brief for the Virginia Senate. Untreated substance challenges cost the state of Virginia more than $600 million annually in health care and public safety expenses. The policy brief also specified that, “Virginia’s Medicaid program spent $26 million on opioid use and misuse in 2013, with $10 million of this spending occurring in Southwest Virginia.” Eighty percent of the 986 drug overdose deaths in Virginia in 2014 were due to prescription opioids and heroin. The Virginia Department of Health syndromic surveillance October 2016 report shows that the rising trend of emergency room visits for opioid overdoses has continued, especially in Southwest Virginia where emergency room visits have risen 71% since September.

Statistics this dire may feel remote, but the opioid epidemic is far from being a distant problem or one isolated to pockets of the population. Opioids penetrate both low and high-income areas, affecting young people, older people (especially ages 55-64), and infants. The opioid epidemic has taken such a hold of Virginia and of America that we will need to address the issue at a community level in order to see much progress.

Latest science informs us that the best approach to treating opioid substance use disorders is medication-assisted therapy (MAT). Suboxone and methadone keep people stable enough in recovery to live more normal lives. Pregnant women who are addicted to opioids are advised to take buprenorphine (Subutex) to stabilize themselves and their babies until delivery. People with substance use disorders are more than twice as likely to stay in treatment and not relapse if they are receiving medication than if they are not. Furthermore, total healthcare costs for people with substance use disorders on methadone are 50 to 62% lower than people not on an MAT program. Unfortunately, access to MAT is currently very limited. Even if every slot available for MAT treatment in the US were filled, over 914,000 would be left without treatment.

Abstinence-based approaches to treating opioid addiction have failed, often resulting in fatal overdose due to lower tolerance following abstinence. Incarceration of people with opioid substance use disorders is also ineffective, and may even impair that person’s ability to recover by putting additional stress on the person. Addiction is known to be a chronic disease of the brain requiring long-term treatment. And to quote NIDA Director, Dr. Nora Volkow, “If we embrace the concept of addiction as a chronic disease…perhaps we will be able to feel empathy for a patient suffering from a disease we call addiction.”

Laurel Sindewald is Executive Director of Handshake Media, Incorporated, publishers of the free addictions recovery smartphone app, New2Recovery.

This post was updated on 5/4/17.

A New Vision for Handshake Media

On December 5, 2012, my intention as a presenter at the mHealth Summit in Washington, D.C. was to outline best practices in mobile health entrepreneurship.

I thought I knew of what I spoke. I’ve been working online since 1996. My father’s only requirement for my undergraduate education was that I take FORTRAN in 1978, setting me up for decades of skillful if-then thinking. I can’t remember Jay’s last name but when he taught me HTML in 1996, he ignited passion in me for lines of code and what they can display on screens.

Awareness gives me a chance to change

The mHealth Summit presentation was based on extensive trial-and-error learning about mobile application development. With Alex Edelman, then with Jim Schweitzer, and with the help of other developers, we had released our own portfolio of mobile applications and our behavioral health software platform Cognichoice. (Here’s our press release about the mHealth presentation on PRWeb.)

We explored the mobile app development business model (how do we pay for software development costs when users want their apps for free?!) , disclosed transparently how much a mobile app really costs to develop, including sharing the numbers for one of our own apps, and revealed the extensively detailed work that goes into creating a mobile app before the first line of code is written. We did our market research on health apps and found enormous competition.

We believed powerfully in our software and plowed determinedly ahead.

But here’s the rub for health apps. Health apps aren’t asked to just be useful or helpful.

“Does it work?”

“Does it do no harm?”

The medical profession and the health care industry demand definitive answers to those questions before they’ll recommend a product or service to patients or customers. The gold standard for a definitive answer in health care is a randomized control trial, or RCT.

We were able to collaborate with a health care entity to attempt a lesser standard – a pilot study – with our software. The entire process is confidential so I wrote with circumspection about the steps required to do health app research here.

Whether you think your health app is a treatment or not, the health care industry thinks an app is a treatment and it will require you to conduct research to prove that your app works and does no harm. An mHealth developer needs to know that research takes time and costs time which is antithetical to the lean startup model and burns most startups’ thin capital like tissue paper.
– Anne Giles, mHealth Zone Live interview, May 2, 2013

. . . . .

The night before my presentation at the mHealth Summit, the most important thing for me to do was not review my notes, not arrange my business suit on a chair for the next day, not start to unwind to prepare for a good night’s sleep. What was most important for me to do was get glasses of wine. Not a glass. Glasses. No mind that at the convention center bar cabernet sauvignon cost $15 per glass.

Twenty-three days later, on December 28, 2012, I got sober.

. . . . .

Terrified by the stigma surrounding addiction, I didn’t tell anyone, including my business partners. Sick from going without alcohol, I still attempted to lead a crowdfunding campaign to further develop Cognichoice, agreed to between the end of the mHealth Summit and my sobriety date. I wrote of my growing  unease about the process two weeks in.

Missing from the rah-rah about contributions-based crowdfunding is the news that a percentage of the funding received will pay taxes. In my mind, my for-profit startup is a cause, but cause or not, people buy products and services from for-profit companies. If it’s not from investors, what is the term for money given to a for-profit company? A contribution? A donation? I have attorney Ken Maready’s permission to quote his answer: “Whether you call it a contribution or a donation, the IRS is going to call it revenue.”
– Anne Giles, Lessons Learned from Two Weeks of Crowdfunding, January 30, 2013

I was so grateful to the sweet people who contributed! However, I wrote about bitter lessons learned a month after the campaign ended. (My adamant advice to startups about crowdfunding? Don’t.)

. . . . .

By the time I presented at the Virginia Counselors Association Convention on November 8, 2013, our mHealth entrepreneurship could be summarized in one word: failure. The audio recording at the mHealth Summit didn’t work so no one other than the hundred or so in attendance heard it. Our crowdfunding campaign failed (we netted about $3K, $97K short of the standard $100K needed to fund serious app development). Our pilot study failed. (I can’t say more than an insufficient number of participants were enrolled to even test if the app “worked,” i.e. resulted in measurable, positive outcomes.)

For the Virginia Counselors Association Convention, I prepared so thoroughly to lead a round table discussion on mobile health technology for mental illnesses.

One person attended.

Quit, right?! Just quit! Too much uphill battling, too much failure!

. . . . .

I cried most of my first year of sobriety. I finally told my business partners and received their kind and full support. Resigning myself to the shame of alcoholism, I had banned myself from writing about my struggles so, when my mind could work, I pondered mobile health app research and by early December of 2013, I had worked out the beginnings of a way to use the fundamentals of our software platform, Cognichoice, in a simple mobile application to help people like I am, people who struggle with addiction, and need 24-7 help to not drink or use.

Thanks to the heroic efforts of Alex and Jim, in an unprecedented one-month-from-idea-to-product, we were able to release our free addictions recovery mobile application,  New2Recovery, on January 6, 2014. (Here’s the New2Recovery press release on PRWeb.)

I was 1 year and 8 days sober.

Drinking and using is one kind of hell. Abstinence is another. I sobbed most of the way through the development of New2Recovery and remain in awe of Alex’s and Jim’s patience with me and belief in the project. Years 2 and 3 were intermittently anguish-filled and I pretty much withdrew from society and from business, although I did share publicly on April 28, 2014, that I was in recovery from alcohol abuse disorder. I’ve only started recently to feel better for longer periods of time.

For 23 years, I lived in Tampa, Florida, home of an average of 246 days of sunshine per year. That bounty of bright days was like my creativity prior to beginning to drink in 2006. After 6 years of drinking and 3 years of abstinence, for me, feeling better in recovery from alcohol use disorder is like lightning bugs on a summer night. I feel tiny bursts of inspiration.

One of those bursts is to relaunch Handshake Media, Incorporated, founded in 2008, but with very little activity from 2013-2015. For the rebirth of Handshake Media in 2016, I hired Laurel Sindewald as Executive Director on January 1 and we’re exploring possibilities with delightful synergy.

Another of those bright bursts gives me longing to issue an updated release of New2Recovery. We have generous, specific feedback from users about what they’d like. We still haven’t figured out how to make money from mobile apps, but there’s just enough in the business account to cover a few enhancements.

I’m moved to new tears that our original New2Recovery team members – Alex Edelman and Jim Schweitzer – are willing to consider the project again more than 2 years after the original release, and that they will be joined by Laurel Sindewald.

So, no, I’m not quitting – not at sobriety, not at life, not at business. I also have no inspirational, meme-worthy adages to offer. This has been quite a thing.

Awareness gives us a chance to change. We’re becoming aware of opportunities for Handshake Media, Incorporated and its new vision is evolving. Here’s what we’ve got going so far:

For their support and patience, we thank our past and current clients, and friends and fans of Handshake Media’s 8-year effort to become a useful and profitable company, and welcome suggestions and guidance as we begin anew in 2016.

With gratitude,

Anne Giles, M.A., M.S.
Handshake Media, Incorporated
Since 2008

. . . . .

If you’re interested, my presentation for the mHealth Summit 2012 was entitled “The Entrepreneurial Clinician: What Clinicians with Great Ideas for Health Care Mobile Apps Need to Know” and I was one of about half a dozen panelists in a session entitled “What Goes into Making an Extraordinary mHealth App?” Since the audio recording setup didn’t work during my presentation, I came home and recorded my slide presentation in this YouTube video.