Sonara Health: Transforming methadone treatment access for opioid use disorder patients

With his background in psychiatry, Michael observed the daily struggles of patients in Opioid Treatment Programs and developed Sonara to offer a more flexible and supportive approach. This groundbreaking solution allows patients to demonstrate responsible methadone use, earn take-home doses faster, and achieve their recovery goals with greater ease.

Liza Laws (LL):​ If you could start by telling us a bit about yourself and how you came to start Sonara?

Michael Giles (MG):​ Sure. I'm a psychiatrist and the CEO of Sonara Health. I started Sonara during my residency training when I got to work in an Opioid Treatment Program (OTP).

MG:​ As you know, in the United States, methadone is primarily dispensed through Opioid Treatment Programs (OTPs), and the standard of care requires patients to visit the clinic daily for their dose. During my rotation, I observed patients lining up for hours to receive one dose of methadone, and many were leaving treatment due to various life responsibilities like childcare, work, or education. I advocated for these patients to receive take-home doses, and when I successfully convinced the attending physician, the idea for Sonara was born. Sonara is a platform designed for OTPs and their patients, enabling patients to demonstrate responsible methadone use so they can receive take-home doses earlier in their treatment, ultimately reaching their recovery goals faster.

LL:​ Makes sense. How does the app and QR code system enhance the accessibility of take-home methadone treatments?

MG:​ Without Sonara, patients must slowly earn their provider's trust, as providers can't be sure if patients are taking their medication correctly. Concerns include medication diversion, missed doses, or incorrect dosages. Sonara addresses these issues by allowing patients to demonstrate adherence through a web application that records their medication intake via video. This helps providers trust that the patient is taking the medication properly.

LL:​ How exactly does the system ensure security and adherence?

MG:​ Sonara's web application works on low-cost phones, making it highly accessible. We provide phones to patients who don't have them. Patients log in, scan a unique QR code on their methadone vial, and the system ensures the QR code is not reused. The label is designed to show tampering, and the process is recorded and stored for asynchronous review by the provider. This method includes checks like asking the patient to say a phrase to ensure they're not storing and injecting the medication later.

LL:​ That sounds ingenious. What kind of feedback have you received from patients and healthcare providers?

MG:​ The feedback has been overwhelmingly positive. We've recorded close to 150,000 doses without serious safety events. Patients using Sonara typically have twice as many take-home doses compared to those not using the platform. The process is quick, averaging 72 seconds, and it significantly reduces the time spent traveling to and waiting at the clinic, which is life-changing for many patients.

LL:​ Impressive. Could you tell me more about the patient experience and outcomes in areas heavily impacted by the opioid crisis?

MG:​ Initially, we launched a minimal viable product in San Francisco's Tenderloin district, a challenging area with many unstable patients. Despite initial concerns, the patients did very well, benefiting from the regular engagement Sonara provided. Many had favourable toxicology screenings for the first time, demonstrating that stability and trust can significantly improve outcomes even in high-risk areas.

LL:​ It seems trust is a significant factor. How does Sonara help in building this trust?

MG:​ Trust is crucial in treating opioid use disorder, as the condition often leads to a loss of trust from the community and loved ones. By giving patients, a reliable way to demonstrate their adherence, Sonara helps them rebuild trust, which is therapeutic and addresses a core pathology of substance use disorders.

LL:​ How did the idea for Sonara come about? Was it a eureka moment or more of a gradual realization?

MG:​ It was both. I had the idea during my residency and shared it with colleagues, who initially thought it was eccentric but eventually saw its potential. After pitching it to one of the largest OTPs in the U.S., we received positive feedback and agreed to pilot the project. This support validated the concept and helped us move forward.

LL:​ Have you faced any challenges in scaling Sonara across the U.S.?

MG:​ The main challenge has been cost. Some clinics are very focused on their bottom line and may not have the operational flexibility to adopt Sonara. However, we've had success with many clinics and have been creative in finding funding solutions, such as utilizing settlement funds from opioid-related lawsuits.

LL:​ Are there any new features or improvements you're planning for Sonara?

MG:​ Absolutely. We're working on integrating high-end features supported by new regulations, such as remote intakes specific to OTPs, virtual counselling, and messaging. We're also exploring AI to stratify patient risk levels and automate video reviews, although we want to ensure this doesn't compromise the trust-building aspect.

LL:​ Do you have plans to expand internationally, or are you focusing on the U.S. for now?

MG:​ We're currently focused on the U.S. due to the high need here, but we're open to international expansion if the opportunity arises. There's definitely interest, especially in places like the UK.

LL:​ What about partnerships? Are you looking to collaborate with other organizations?

MG:​ We're open to partnerships that help us serve patients better, whether through collaborations, sales contracts, or other mechanisms. Our goal is to expand our impact and improve patient outcomes.

LL:​ When did you start Sonara?

MG:​ We founded Sonara in November 2020 and had a real product by the end of that year. We've been operating as a fully virtual company since then.