The MAT and MOUD Induction Story

Daniel Powell [00:00:04]:
When we started Spark, we thought there were two main paths in addiction treatment. One is for people who want to get off opioids entirely—where our product plays a critical role by helping with detox and managing withdrawal. The other is medication-assisted therapy (MAT), or what’s now often called medicines for opioid use disorder (MOUD). In that path, patients take a medication that includes an opioid component to manage withdrawal—under medical supervision.

Navid Khodaparast [00:00:49]:
In our first study, back in 2020–2021, over 80% of our patient population was using heroin, which matched national trends at the time. But with the influx of fentanyl, heroin is becoming a thing of the past. Overdoses are rising rapidly.

Alejandro Covalin [00:01:23]:
And that’s a big problem because fentanyl is super cheap to produce. It's being laced into everything, and people don’t even know.

Navid Khodaparast [00:01:35]:
Exactly. Overdose deaths keep rising not just from opioids but also from stimulants like meth and cocaine—because street fentanyl is being laced into those drugs too.

Alejandro Covalin [00:02:02]:
There were even marijuana cases where people overdosed because of fentanyl-lacing. It’s terrible.

Navid Khodaparast [00:02:14]:
With Suboxone—used for MOUD—the package insert used to be clear: the patient tests positive for opioids, then waits to go into withdrawal before being administered Suboxone. But with fentanyl, this approach causes problems.

Navid Khodaparast [00:02:47]:
Suboxone combines an agonist (which activates opioid receptors) and an antagonist (which blocks them). If given too soon after fentanyl use, it can trigger a dangerous physiological event.

Alejandro Covalin [00:03:10]:
It blocks the receptor too fast, kicking fentanyl off, and causes precipitated withdrawal—intense anxiety, panic, and fear.

Daniel Powell [00:03:36]:
Previously, people could wait 12 hours after heroin use and start Suboxone. With fentanyl, 12 hours isn’t enough. People now have to wait 24–48 hours in extreme discomfort while going deeper into withdrawal. It’s making treatment much harder.

Navid Khodaparast [00:04:11]:
With heroin, they’d wait until the Clinical Opioid Withdrawal Scale (COWS) hit 8+, then start with 8 mg of Suboxone. That was manageable. But with fentanyl, starting at 8 mg can cause precipitated withdrawal.

Navid Khodaparast [00:05:00]:
Now, protocols use microdosing. They start with 2 mg, observe the patient, then increase to 4 mg, and so on—working their way up to 8 mg slowly.

Alejandro Covalin [00:05:30]:
That’s more costly and time-consuming for facilities. Plus, if anything goes wrong, patients who were ready to quit might leave.

Daniel Powell [00:05:52]:
And only doctors or nurse practitioners can administer these meds—not nurses or counselors. So the most expensive staff must supervise multiple touchpoints throughout the day.

Navid Khodaparast [00:06:21]:
That’s where we saw opportunity.

Navid Khodaparast [00:06:26]:
Auricular neurostimulation could streamline this process. Our device may reduce or eliminate precipitated withdrawal by helping the body release its own endogenous opioids to fill those receptors.

Daniel Powell [00:06:56]:
What’s exciting is our device keeps patients comfortable. It can be applied before withdrawal hits—so they don’t have to reach a high COWS score. Then they wait 24–36 hours and ideally skip microdosing altogether, starting straight with 8 mg.

Navid Khodaparast [00:07:27]:
That would be ideal—using the device to manage withdrawal until the patient is ready for full-dose Suboxone.

Alejandro Covalin [00:07:44]:
You wouldn’t need to microdose at all anymore.

Daniel Powell [00:07:47]:
That’s our goal.

Alejandro Covalin [00:07:48]:
Right.

Daniel Powell [00:07:48]:
This approach would help MAT facilities—especially outpatient or inpatient clinics. Hospitals are usually reserved for alcohol or benzo detox, not opioids.

Alejandro Covalin [00:08:19]:
One of the most important things is how hard it is for someone to make that decision to get clean. They probably say it to themselves 20 times before they walk into a clinic. If something derails that moment—like precipitated withdrawal—they may leave and never return.

Alejandro Covalin [00:09:27]:
And that’s tragic. That moment was probably the hardest decision they’ve made in years.

Navid Khodaparast [00:09:37]:
And if they go through precipitated withdrawal, the odds of them leaving go way up.

Alejandro Covalin [00:09:47]:
And they might not come back. It could take years to make that decision again.

Navid Khodaparast [00:09:54]:
Exactly.

Alejandro Covalin [00:09:55]:
It’s horrible.

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