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ou’re in recovery from opioid addiction, and your walk to work takes you down the same streets where you used to buy heroin. The drug’s calling to you, still. Just then, your phone buzzes, with a message that reads like a text from an old friend:

“Hey, I know you’re near a risky area. You can do this.”

It’s from Hey,Charlie, an app — conceived at a 2016 Massachusetts Institute of Technology health hackathon — that aims to help people avoid environmental triggers that might threaten their recovery from an opioid addiction. The app, now being piloted by several treatment centers in Boston and Framingham, Mass., monitors a user’s contacts and location, and sends pop-up notifications to caution them about risky acquaintances or neighborhoods.

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“People and places can remind you of using drugs and stress you out,” leading people to relapse, said Emily Lindemer, co-founder of Hey,Charlie.

The app chimes in with a different reminder: recovery. “It helps them keep their sobriety at the front of their mind,” she said.

There are a sea of addiction apps, many connecting people to treatment or augmenting their outpatient therapy, by counting the number of days in recovery, for example, or recording fluctuations in mood or cravings. Some simply encourage users with inspirational quotes or hypnosis guides. Social apps are increasingly a focus, as well.

“Social outlets are critically important,” said Wilson Washington Jr., a senior public health adviser at the federal Substance Abuse and Mental Health Services Administration (SAMHSA). “You need family support, you need community support, you need system support.”

One such app, SoberTool, offers an anonymous forum for discussion. Sober Grid is a social network — purported to be the largest for people with a chemical dependency — with a news feed reminiscent of Instagram.

But when Lindemer attended the MIT hackathon, she saw a gaping hole among the existing apps — not only could an app foster positive social connections, but it could also help people sever the negative ones.

Michael Kidorf, a psychiatrist and associate director of addiction treatment services at Johns Hopkins School of Medicine, told STAT that the social networks of urban drug users tend to include a mix of people who use substances and people who are drug-free.

“As you would expect, people who have more network members who use illicit drugs use more drugs [themselves] and engage in more risky behaviors,” he said by email.

Opioid users also rely heavily on their contacts to secure heroin and other drugs, Kidorf added. Studies consistently show that regular interaction with other users predicts poorer treatment outcomes.

The hard part, he said, is getting people to dismantle and rebuild their social network. “It is relatively easy to tell substance users to ‘change people, places, and things.’ It is much harder to provide a strategy to help them achieve this important goal.”

Hey,Charlie is piloting one such strategy.

Having watched someone close to her — the namesake for Hey,Charlie — struggle with opioid addiction, Lindemer noticed the obstacles people in recovery face. Even for those who receive medication-assisted treatment, “you go live your life and in the day-to-day 24/7 doing normal things, you still are in recovery and you still have to battle these constant environmental triggers,” she said.

As a then-Ph.D. student in the joint Harvard-MIT Health Sciences and Technology program, Lindemer thought an app could help mediate those urges.

Following the hackathon, Lindemer with her co-founder, Vincent Valant, and head developer, Benjamin Pyser, created a company that initially was funded through MIT grants. Now that she has graduated — she has a day job as a scientist at Watson Health in Cambridge, Mass. – the startup is running mostly on funding from the Robert Wood Johnson Foundation and the National Institute on Drug Abuse.

Hey,Charlie’s business model is their “Achilles’ heel,” Lindemer said.

She wants to ensure that Hey,Charlie is accessible to everybody. “Our goal is that, if we are charging for it, we are not charging the patient. We want it to fit into a treatment program,” which is why the company hopes to eventually demonstrate the app’s clinical efficacy in controlled trials.

The app is still being refined, but the basics are in place. When sending a text to a “risky” contact, or receiving one, a message from Hey,Charlie will pop up: “Wait a minute, are you sure you want to speak to John Smith right now?” If the user decides against communicating, Hey,Charlie can send an automatic response. The app also shares a handful of affirmative messages with the user throughout the day.

For now, Hey,Charlie’s location services simply create a pause (you’re near a risky area). “The idea is that if you are aware of a potentially triggering situation before it arises, you are more mentally primed to handle it effectively,” said Lindemer.

But in the future, Lindemer hopes the app can go one step further. She envisions it not only warning people that they’re approaching a risky location, but suggesting an entirely different path as well. Lindemer wants to partner with local businesses so that Hey,Charlie can say, “Hey, there’s a coffee shop with a discount a couple of blocks away if you’re willing to switch up your route!”

The app relies on a combination of data actively input by users — a one-time occurrence — and data passively collected as they continue to use their cellphones. The onboarding process asks users a series of questions about their contacts, ranked by frequency of communication, and then calculates the risk each contact poses.

Lindemer said that she and her team don’t expect users to be completely upfront and that, especially at the beginning of recovery, relationships can be confusing as they rapidly evolve. Hey,Charlie continues to check in periodically, asking, “Is there anything you want to tell me about this person?”

While the initial version of the app focused on sheltering users from risky contacts, Lindemer and her team are now working to incorporate positive support features as well — letting supportive contacts know when their friend or family member is in a risky place.

“One of the things we know really well is that many people in recovery do have somebody — like a really close family member or friend — who wants to help them, and they often just don’t have the tools, and they don’t know when is the right time to reach out, so we’re trying to address that,” Lindemer said.

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Kidorf stressed the importance of supportive, drug-free contacts. His research focuses on how treatment providers can mobilize drug-free individuals to be active participants in their loved one’s recovery.

Hey,Charlie is being piloted at local clinics in and around Boston. Dr. Christopher Shanahan, an internist and professor at Boston University School of Medicine, is leading the effort.

Shanahan, who has been studying substance use for nearly 20 years, loved the idea that Hey,Charlie could be there for his patients when he can’t. He said Lindemer pitched it to him and his colleagues during their journal club hour — when researchers typically discuss new papers published in their field.

“We have, what, 15 to 20 minutes with a patient in a clinic?” Shanahan said. “We give them some advice, a little bit of coaching, and send them out with some buprenorphine — and then it’s a crapshoot.”

The app, he said, is “a very innovative way of addressing the other 23 hours and 15 minutes of the day where doctors aren’t seeing patients.”

But he won’t hang his hat on it. An app can help patients cope with triggers and temptations, but it’s far from the perfect solution, he said.

Kidorf expressed a similar level-headed optimism, noting that apps can bring users closer to people and organizations that can support their recovery. “Overall, I think it is fair to say that these apps can be helpful for people motivated to use them.”

But still, he added, “We have to do better at thinking of opioid use disorder as a severe and often chronic disorder. The best apps in the world will have a hard time competing with it.”

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  • “Drug Addicts,” like all addicts of any substance ( and the majority are multiple substance abusers) will do what they choose to do. Addiction treatment centers are revolving doors. Studies show failure rates as high as 85% after initial treatment for addiction. Relapse. Back to addiction treatment centers. Repeat…Addicts must want to be helped and be committed to seeking help on their own. Illicits are everywhere so everywhere will be ” high risk” areas for addicts.

    I seriously doubt any app is going to be of benefit to addicts by offering a warning/alert for “drug infested” areas or warnings re addicted “friends” who may be nearby.

    The people whose lives are most tormented, ripped apart are the family members and “significant others” of addicts. Addicts only care about escaping realities of daily life. They really don’t care who they hurt, whether their parents, sibs, spouses, friends, or their very own children. I’ve seen enough parents whose addicted minor and adult kids do nothing but suffer for the behaviors of their addicted kids. I’ve seen parents who have nearly lost or lost their homes thinking they could “help” their kids. I’ve met with parents who have buried their kids because of their kid’s drug addictions, typically the illicit drugs along with other substances, multiple addictions. Ppl in “drug addiction treatment” programs often receiving meth. just become addicted to a new substance, meth. Then, addiction to Suboxone. Whatever treatments out there for drug addicts only leads to another addiction. Addicts losing jobs, shelter, their spouses, their minor children. Grandparents, other family members, foster care placement raising the children of addicts.

    All the focus is on “the addicts, the addicts, the opiates, the opiates, the 115 people dying daily…from drug addiction.” The “opiate crisis” hype and hysteria needs to cease. There is no ” opiate crisis. We have an illicit drug crisis AND a pain crisis.

    The one way to stop the illicit opiates (ILLICIT Fentanyl from China #1 offender as of 6/18) followed by heroin, cocaine and meth is to stop the importation of these illicits into the US, bust meth labs wide open. It CAN be done! Mexico- exported 85% of all heroin into the US, 95% is vesseled via waterways. China- packages of illicit fentanyl delivered to US onto UPS, other Couriers and into the home. What’s the problem manning Customs? Mail distribution centers? Courier hub distribution centers?There should be law enforcement all over the place… including
    at Customs with plain clothed and uniformed officers, K9 trained dogs to detect narcotics. Columbia, China, Mexico…cocaine, illicit Fentanyl and heroin respectively. The confiscation of any amount of drugs imported to the US should come with a known, hefty “price” for any individual or drug cartel responsible, imprisonment, possibly the death penalty.

    Lastly, the one group who is being ignored, treated as “addicts” are the people truly suffering: This group is NOT to be confused and labeled “drug addicts.” Indeed, they are not! The chronic, intractable pain population, the group suffering from physically traumatic events, the pts. in accidents where serious pain is a life long sentence, such as pt.s with CRPS, MS, SLE, RA, EM, countless other diseases and disorders where no treatments or inadequate treatments exist, yet chronic, intractable pain is the foremost chief complaint and pt’s greatest need or one of their top needs.

    While I regret most addicts and substance abusers have their own plight and recognize “addiction” is indeed a disease, perhaps even with a genetic basis, it is well past the time to realize if the sources of their addiction to the illicits they choose is brought to a screeching halt, then and only then, can the illicit drug crisis be curbed.
    No app required.

    • The problem here is that this “Crisis” is a marketing opportunity for these ghouls. There was a problem back in 2000, but our Regulatory Agencies, were bought off. I have been noticing that the “News” or various publication and the Tech Companies have been promoting Apps for nearly everything. When it became abundantly clear that kids were being damaged by Screen time, they even peddled an App for that.
      A lot of people have been cashing in on Americas’ Epidemic of Despair. They just want a quick, easy and cheap fix. There is not much fact based reporting on any of this.
      It is irresponsible for a publication like this to run articles like this. They tend to use the data from a minuscule study, often with qualitative data, and reframe the issue. Using the Data from 2014 the peak of the so called “epidemic” is only meant to mislead misinform and terrify people. If we look at different news-outlets, instead of portraying factual information, there are lot of meaningless articles like this. They give the appearance ‘helping’ when in fact, they are merely marketing another product. The marketers can use the fact that this was published here to help sell it, and give it credibility.

      Most of these articles don’t mention chronic pain. Many are in the Opinion Section, so they don’t have to be factual. The media and publication like this deliberately conflate chronic pain with addiction, this is by design. They have written people with chronic pain out of the equation. At the same time they run silly articles about “breakthroughs’ for pain, usually based on rat or mouse studies , which mostly do not translate to humans. As long as the headline is click bait or attention getting it will run.
      We should all be very afraid for our country, that idea that something like this could go on for 20 years with no meaningful response, as people died should be a wake up call. Instead of using an Evidence Based Scientific response, they are peddling Apps!

    • VERY well put! Un unfortunately, the people who CAN help won t…… NOT HELPING won’t line their pockets!!!
      Thanks for ur efforts.

  • Americans want a quick, easy, magical solution for everything. These Apps don’t have to work they just have to have an attention getting marketing scheme. Someone should have paid attention back when the mass media started peddling “Wellness Apps.” When it became apparent that kids were spending too much time on screens, increasing rates of suicide, depression and social isolation, clever marketing hucksters, created an App for that.
    The Tech Industry has unlimited funds for misleading “research” they can use to peddle this too. It does not have to work, it just has to be profitable. Drug Addicted people are disposable anyway. Apps appear less expensive than real social interventions, jobs or a future anyway.

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