The camera on your smartphone normally used to capture selfies might help fight the opioid crisis.
Baltimore startup emocha Mobile Health has found success using a video app for patients taking drugs for tuberculosis and hepatitis C. With a $1.7 million research grant from the National Institute on Drug Abuse, the company has now set its sights on the opioid epidemic across the country.
Watching patients take drugs remotely
Emocha launched in January 2014 with four employees as a pilot program with the Baltimore City Health Department to help tuberculosis patients increase their rates of taking medication.
Directly observed therapy has been used as the standard for tuberculosis patients. Medical professionals watch patients take every dose of medicine.
For in-person, directly observed therapy, adherence rates tend to be in the 90 percent range; emocha’s app has reached similar adherence rates.
In the app, users take a short video of themselves taking the prescribed dosage of their medicine, normally around 45 seconds, and tap submit. The video gets sent to their provider for review.
On their end, emocha provides support for users on both the patient and provider sides of the app. For patients, the app records side effects, captures video and encrypts it to conform with HIPAA. On the provider side, emocha assigns patients a risk group so providers can review the videos and identify who needs more support and calculate their adherence rates.
But beyond the technical benefits the app provides, it has some secondary benefits.
“The relationship that’s built is very special,” said Sebastian Seiguer, emocha’s CEO and co-founder. “A lot of patients actually find this pretty funny that they have to record themselves taking their medication, and they submit some really funny stuff. If the provider actually sees that, then they’re going to call them up or at their next visit they’ll say, ‘that was pretty funny’ or ‘next time you might want to put your shirt on’ or whatever it would be.”
When Seiguer has talked to health departments and hospitals about using the technology, he has run into questions about whether patients would actually film themselves taking medicine.
“People love video-recording themselves,” he said. “I’m sure that people video-record themselves almost as much as they text at this point with apps like Snapchat.”
Expanding to opioid treatment
Now, the app could be used to help with the opioid epidemic as well. Emocha received a grant from the National Institute on Drug Abuse to study the feasibility of video directly observed therapy for patients in the initiation phase of buprenorphine treatment.
Buprenorphine is one of two types of medically assisted treatment for opioid addicts. The other is methadone, which must be taken in a clinic, limiting the scale at which it can be used.
But patients treated with buprenorphine can take several doses of the drug home to use.
“Just like any other drug, people don’t take their medicine properly, and in this case if you don’t take it, you still crave drugs,” Seiguer said. “We think we can have a big impact by helping patients when they start (treatment) to stabilize. Or the patients that are struggling to stabilize on (treatment), to help them get stable.”
After about three to 12 months, patients could stabilize and move to injectable long-acting drugs in their treatment that would not require the use of directly observed therapy.
For the pilot program, Seiguer said he looked for the best experts in the field of addiction to help tailor the app. He found them at the University of Washington School of Medicine and Boston Medical Center, where the app will begin some trials.
Emocha will also test the app in Tennessee, with possible expansion to Baltimore soon.
Building the company
Before Seiguer attended Hopkins to earn his MBA, he had founded a coffee chain in Europe called San Francisco Coffee Company. He sold that company in 2011 and returned home to Baltimore to attend Hopkins.
Seiguer came from a family of doctors — his wife is an infectious disease doctor, and his sister and parents are pathologists — and was curious about public health.
“They’re very motivated by what they do every day and I wanted to do something that had an impact on communities and on society in general,” he said.
At the Baltimore City Health Department in 2013, he found that staffers were trying to use Skype as a pilot in a drug adherence program, but it wasn’t working because they had to schedule appointments. But he remembered seeing the emocha technology in the tech transfer office and started the company in January the next year.
The company now has 11 employees, all in emocha’s small office space in Johns Hopkins Technology Ventures’ FastForward 1812, and it has clients in California, Delaware, Maryland, Michigan, Rhode Island and Texas as well as globally in Australia, India and Puerto Rico.
After a $1 million seed funding round concluded last month, Seiguer plans to expand the company to 14 by adding more employees to the sales staff. The company wants to only raise what it needs as it expands, he said.
“Raise as little as possible, that’s my thought process,” he said. “We would raise money in order to take what we have and expand it. I don’t believe in having a runway where we’re burning cash.”
With the $1 million raised, Seiguer thinks emocha can triple its sales, proving the scalability of the company for the next round of fundraising. Tackling the opioid crisis could also help the company grow.
“Opioid addiction would be the first chronic condition. It’s also a really big problem,” he said. “I think it’s certainly one way to scale that particularly vertical. But we decided we’re just going for the hardest possible scenarios. When we prove it with what everybody considers the hardest, we have a nice proxy for a disease that isn’t as hard but is very costly.”